Citation Nr: 21000843 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 16-39 434 DATE: January 6, 2021 ORDER Service connection for sleep apnea is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran’s sleep apnea was caused or aggravated by his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from May 1982 to August 1982, January 2003 to March 2004, and January 2, 2010 to January 7, 2011. He also served in the Army National Guard between 1982 and 2011. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection can also be established on a secondary basis for a disability which is proximately due to, or the result of a service-connected disability. 38 C.F.R. § 3.310. The Veteran is seeking service connection for sleep apnea, which he believes was either caused or aggravated by his service-connected PTSD. His wife provided a statement in July 2014 that the Veteran had symptoms of sleep apnea, which became much worse after he returned from his last overseas deployment. These symptoms included long periods of persistent snoring, choking or grasping for air at night, feeling tired and sleepy during the day, etc. The Veteran was afforded a VA examination in May 2014, at which the examiner confirmed the diagnosis of obstructive sleep apnea, but opined that this condition was not caused by or related to the Veteran’s service or to his service connected PTSD, explaining that it was caused by developmental narrow nasal pharyngeal airway with superimposed natural aging and obesity. The Veteran provided a medical study conducted in October 2010 showing high percentage of sleep apnea found in combat veterans diagnosed with PTSD. The Veteran also provided a medical opinion from his VA treating physician Dr. H. dated July 2014 who stated that the Veteran’s depression/PTSD likely exacerbated his sleep apnea. However, Dr. H. did not provide a rationale for his opinion, and he did not establish any baseline for the sleep apnea prior to the aggravation occurring as required by VA regulations. The Veteran also provided a private medical opinion from Dr. D. dated July 2016 in which he stated that there was compelling medical evidence that the Veteran developed “upper airway resistance syndrome” as a consequence of his service connected PTSD and that such resistance led to the development of obstructive sleep apnea. However, there is no explanation of how this condition was diagnosed or why it led to sleep apnea. To resolve the difference among these medical professionals, a February 2019 Board decision remanded the matter to obtain a VA medical opinion to further investigate the etiology of the Veteran’s sleep apnea. In July 2019, a VA examiner reviewed the claims file, and opined that (1) it is less likely as not (less than 50 percent probability) that the Veteran’s sleep Apnea occurred during or caused by his service, because he was diagnosed more than one year after separation from his active service; and (2) it is less likely as not (less than 50 percent probability) that the Veteran’s sleep apnea occurred during or caused by his service connected PTSD, because review of medical literature did not show a clear association between PTSD and sleep apnea, and the opinions provided by Dr. H and in July 2014 and Dr. D in July 2016 did not provide proper rational to support their conclusions. In February 2020, the Veteran provided two additional medical opinions to support his claim. One of them is from his VA treating psychologist dated August 2019, who opined that the Veteran’s sleep apnea was certainly aggravated (if not caused) by his PTSD. The psychologist conducted medical research which indicated a prevalence rate of sleep apnea with veterans diagnosed with PTSD of 75 percent. The Board finds that the evidence of record is in relative equipoise as to whether the Veteran’s sleep apnea was caused by his service-connected PTSD. Accordingly, service connection for a sleep apnea is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Wang, 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.