Citation Nr: 21002485 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 15-24 678 DATE: January 13, 2021 ORDER Entitlement to service connection for sleep apnea, as secondary to service-connected posttraumatic stress disorder (PTSD) including depressive disorder, is granted. FINDING OF FACT The evidence weighs in favor of finding that the Veteran’s service-connected psychiatric disorder has at least as likely as not aggravated his sleep apnea. CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.102, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from June 1965 to December 1968, including in the Republic of Vietnam. In February 2018, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. In an August 2018 Decision, the Board, in pertinent part, remanded the issue herein. In a September 2020 Decision, the Board again remanded the issue herein. 1. Entitlement to service connection for sleep apnea Secondary service connection may be granted for disabilities which were proximately due to, the result of, or aggravated beyond natural progression by a service-connected disability. 38 C.F.R. § 3.310(a). On June 14, 2019, the Court issued the precedential decision in Ward v. Wilkie, 17-1204, holding that a “permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). The Veteran generally contends that his sleep apnea is secondary to his service-connected mental health condition. See October 2013 Statement; April 2014 Codesheet; June 2017 VA Form 646. The Veteran was afforded pertinent, etiological opinions in April 2014, June 2019, and September 2020. However, these opinions are not adequate because: (a) the April 2014 opinion only analyzed causation, but did not analyze aggravation; (b) the June 2019 opinion did not consider the Veteran’s lay statements or articles he submitted; and (c) the September 2020 opinion also only analyzed causation, but did not analyze aggravation. Ward, supra; Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Nevertheless, the Veteran has presented sufficient and consistent evidence showing: (a) sleeping issues and disruptions concurrent with his psychiatric symptoms; and (b) medical articles and literature in support of his contentions. See September 2004 Correspondence (has a problem sleeping and only sleeps three or four hours per night); October 2004 Statement (does not sleep well for any length of time because of nightmares); July 2010 Correspondence (has to sleep sitting up and has difficulty falling and staying asleep because of his psychiatric symptoms); April 2011 VA psychiatric examination (diagnosed insomnia); June 2011 Statement (has to sleep in a separate room than his partner because of activity during nightmares); August 2012 Statement (psychiatric symptoms cause nightmares with combative behavior, night sweats, and sleeplessness); February 2013 VA psychiatric examination (psychiatric symptoms included recurrent distressing dreams of the trauma, difficulty falling or staying asleep, and chronic sleep impairment); articles received in June 2013 and October 2013 (suggested a correlation between PTSD and sleep apnea); January 2015 Correspondence and July 2015 VA Form 9 (the Veteran described how his psychiatric condition causes sleep deprivation and severe and continuous sleep impairment, aggravating his sleep apnea). Based on this, the Board finds that the evidence weighs in favor of finding that the Veteran’s service-connected psychiatric disorder has at least as likely as not aggravated his sleep apnea; specifically, the Veteran’s chronic difficulty falling and staying asleep due to PTSD would more likely than not hinder his sleep apnea treatment efforts, ultimately aggravating the condition). As such, secondary service connection is granted. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Daus, 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.