Citation Nr: 20030146 Decision Date: 04/29/20 Archive Date: 04/29/20 DOCKET NO. 16-44 023 DATE: April 29, 2020 ORDER Service connection for obstructive sleep apnea as secondary to service-connected right shoulder strain, left shoulder strain, cervical spine strain and thoracic spine strain is granted. FINDING OF FACT With resolution of the doubt in his favor, the Veteran’s obstructive sleep apnea was caused by the prescription pain medication required to treat his service-connected right shoulder strain, left shoulder strain, cervical spine strain and thoracic spine strain. CONCLUSION OF LAW The criteria to establish entitlement to service connection for obstructive sleep apnea have been met. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from May 1982 to November 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision of the Seattle, Washington Regional Office (RO). In June 2019, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge (VLJ). During the hearing, the VLJ engaged in a colloquy with the Veteran toward substantiation of the claim. Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A hearing transcript is in the record. Obstructive sleep apnea Service connection shall be granted on a secondary basis under 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder caused or aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran contends that his obstructive sleep apnea was caused by the prescription pain medication required to treat his service-connected right shoulder strain, left shoulder strain, cervical spine strain and thoracic spine strain. A March 2014 VA treatment record reflects that the Veteran underwent a sleep study. The Veteran was diagnosed with obstructive sleep apnea, obesity and was advised to lose weight. VA treatment records reflect the Veteran having been prescribed several pain medications, to include methadone and oxycodone to treat his service-connected bilateral shoulder strain and back strain. In a January 2017 letter, the Veteran’s private provider, having reviewed the Veteran’s VA treatment records, opined that the Veteran’s obstructive sleep apnea was caused by the prescription pain medication, to include morphine and oxycodone that was required to treat the Veteran’s service-connected bilateral shoulder strain and back strain because the applicable literature revealed an association between opioid analgesics and obstructive sleep apnea. The medical opinion is of high probative value because the examiner had an accurate and complete understanding of the Veteran’s medical history and provided a medical conclusion with sufficient rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In January 2017, the Veteran submitted an undated article titled “The Association of Obstructive Sleep Apnea and Chronic Pain” reflecting that opioids used to treat pain affected respiratory physiology by increasing airway resistance and decreasing the patency of the upper airways which led to ineffective ventilation and upper airway obstruction, therefore, resulting in abnormal breathing patterns and gasping. This article is of high probative value because it considers the specific facts and circumstances presented in the Veteran’s appeal. In the June 2019 Board hearing, the Veteran testified to having used pain medication to treat the above-noted service-connected disorders for approximately thirteen years and that he first experienced trouble sleeping eight years ago. The Veteran’s wife testified to having observed the Veteran experience trouble breathing and gasping for air during sleep for approximately thirteen years. The Veteran and his wife are competent to report the Veteran’s observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). The Veteran and his wife are also credible in their reports. (Continued on the next page)   The Board will grant the claim based on the benefit-of-the-doubt doctrine. The Veteran’s private provider opined that the Veteran’s obstructive sleep apnea was caused by the prescription pain medication required to treat the Veteran’s service-connected bilateral shoulder strain and back strain. The Veteran submitted an article that considered the specific facts and circumstances presented in the Veteran’s appeal and the Veteran’s wife testified to having observed the Veteran experience trouble breathing and gasping for air during sleep for approximately thirteen years. The Board will resolve all reasonable doubt in favor of the Veteran. Therefore, service connection is warranted and the claim is granted. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Cohen, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.