Citation Nr: 21002507 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-09 136A DATE: January 13, 2021 ORDER Entitlement to service connection for obstructive sleep apnea (OSA), to include as due to service-connected anxiety disorder is granted. FINDING OF FACT The Veteran’s OSA is aggravated beyond its natural progression by his service-connected anxiety disorder. CONCLUSION OF LAW The criteria for service connection for OSA as secondary to service-connected anxiety disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from July 1983 to May 1986 and from July 1989 to April 1992. This appeal comes before the Board of Veterans’ Appeals (Board) from November 2009 and November 2012 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In a May 2018 decision, the Board denied the claims for service connection for an acquired psychiatric disability, a lumbar spine disability, bilateral hip disabilities, hypertension, and obstructive sleep apnea. The Veteran appealed the decision, with the exception of the denial of entitlement to service connection for hypertension, to the Court of Appeals for Veterans Claims (Court). After receipt of a May 2019 Joint Motion for Partial Remand (JMPR), the Court vacated the Board’s May 2018 decision and remanded the matter back to the Board. In November 2019, the Board remanded the issue below on appeal for further development, and the case has since been returned to the Board. The Board finds that the AOJ has substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for OSA, to include as due to service-connected anxiety disorder The Veteran contends that his OSA is due to his now service-connected anxiety disorder. In the November 2019 Board remand, the AOJ was directed to obtain an opinion as to whether the Veteran’s OSA was due to his now service-connected anxiety disorder. To that end, the Veteran attended a VA OSA examination in June 2020. The examiner diagnosed OSA and opined it was at least as likely as not aggravated beyond its natural progression by his acquired psychiatric disorder. The rationale provided was: In my opinion, the Veteran's sleep apnea is at least as likely as not worsened beyond natural progression (aggravated) by his acquired psychiatric disability. Veteran has multiple medical co-morbidities that are associated with OSA such as Depression, Alcohol Dependence, Anxiety, HTN, COPD, Obesity. All these are factors and has high prevalence on individuals with OSA. However, STRs and medical records did not sufficiently demonstrate that the veteran's OSA was caused by his acquired psychiatric disability. Medical studies and literatures are lacking to show that direct causality that veteran's psychiatric disability directly caused his OSA. Numerous medical literatures show high prevalence of OSA among individuals with Depression, Anxiety or PTSD. These individuals tend to have poorer compliance to use CPAP. Anti-depressants and anti-anxiolytics also cause worsening of OSA and depresses respiration. Veteran has anxiety disorder and takes medication for it. Some encounter visits below documented that he, indeed, has occasions of sleep disturbances and restless sleep and fatigue - worsening his sleep apnea and symptoms of sleep apnea. Based on the foregoing positive opinion and the remaining evidence of record that is silent for a medical opinion stating otherwise, the Board finds that service connection is warranted. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. A. Elliott II, 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.