Citation Nr: 21004481 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 16-59 509 DATE: January 27, 2021 ORDER Entitlement to service connection for sleep apnea remains denied. FINDING OF FACT 1. It is less likely than not that the Veteran’s sleep apnea was caused by a service-connected event. CONCLUSION OF LAW The criteria for service connection for sleep apnea have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had a period of active duty service from September 1981 to September 1989. In September 2017, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In December 2018, the Board remanded the Veteran’s appeal for evidentiary development. It has since been returned to the Board for further consideration. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a veteran must show: (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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The Veteran asserts that an adverse reaction to a typhoid inoculation in-service proximately lead to his bruxism which resulted in his current diagnosis of obstructive sleep apnea. Sleep Apnea Analysis November 1981 STRs reveal that the Veteran was diagnosed and treated for an adverse reaction to a typhoid inoculation. VA obtained records from Chanute Air Force Base (AFB) for 1981-1982 showing treatment in 1981 for headaches, nausea and fever, diagnosed as a viral syndrome secondary to Veteran’s typhoid shot. There are no records showing bruxism or sleep apnea in service. Complaints of body muscle twitching are not recorded and it is now shown that the Veteran was sedated and hospitalized. Dental records do not show findings of abnormal wearing of the teeth or any other recorded symptoms indicating a bruxism was present in service. Evidence in the claims file suggests that the Veteran was first diagnosed for sleep apnea in July 2009. On recent examination, examiners noted that bruxism is the abnormal clenching or grinding of the teeth, and may play a role in temporomandibular disorders (TMD). Bruxism can occur during sleep and when awake. Awake bruxism is thought to be related to psychological factors like stress, anxiety and depression, while sleep bruxism is thought to be related to micro-arousals during the sleep cycle. The examiners went on to cite a specific literature that suggest that bruxism while sleeping might cause sleep disorders, contemplating a possible link between the Veteran’s bruxism and sleep apnea. Most episodes of bruxism occur in supine and are more common in those with sleep apnea, sleep disorders and in sleepwalkers. During a November 2019 VA examination, the examiner opined that the typhoid injection/reaction is less likely than not to have caused the claimant’s sleep apnea, detailing the lack of objective information on record to corroborate sleep apnea in service. During two separate December 2019 VA examinations, the examiners provide thorough opinions that it is least likely as not that the Veteran’s bruxism is related to his sleep apnea. Although one examiner stated that the twitching reaction from the shot could be related to bruxism because bruxism while sleeping might cause sleep disorders, the overall conclusion was that it is less likely than not that the entire body muscle twitch that the Veteran experienced in 1981 could impact the muscles that cause bruxism. One examiner attributed the bruxism to anxiety. Consequently, the Board gives more probative weight to the competent medical evidence, which is consistently negative for a diagnosis of sleep apnea. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Finally, despite the positive association between bruxism and sleep apnea brought to light by new research, there is still a missing link between the Veteran’s bruxism and an in-service event. There is no evidence that shows or suggests a bruxism was present in service or for years thereafter. There has not been any additional evidence submitted in support of the Veteran’s claim which would warrant a change in the prior decision. Therefore, service connection for sleep apnea continues to be denied since this condition neither occurred in nor was caused by service. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Omosegbon, Babalakin O. 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.