Citation Nr: 21064240 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 15-14 176A DATE: October 19, 2021 ORDER Entitlement to service connection for sleep apnea as secondary to service-connected sinusitis is granted. FINDINGS OF FACT 1. The Veteran is currently service connected for sinusitis. 2. Resolving all reasonable doubt in favor of the Veteran, it is at least as likely as not that his sleep apnea is aggravated beyond its natural progression by his service-connected sinusitis. CONCLUSION OF LAW The criteria for service connection for sleep apnea as secondary to service-connected sinusitis have been met. 38 U.S.C. §1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from October 1974 to October 1978. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a December 2011 rating decision issued by the Agency of Original Jurisdiction (AOJ). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in February 2019. A transcript of the proceeding has been associated with the file. The claim was previously before the Board in February 2020, August 2020, January 2021, and May 2021. In February 2020, the Board denied service connection for bilateral hearing loss. Most recently, the claim for service connection for sleep apnea was remanded to the AOJ for further development to include obtaining an adequate medical opinion as to the etiology of the Veteran's sleep apnea. The claim has been returned to the Board for appellate review. Entitlement to service connection for sleep apnea as secondary to service-connected sinusitis Service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service-connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 48 (1995) (en banc). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). There is no dispute that the Veteran is service connected for sinusitis. There is also no dispute that the Veteran is diagnosed with obstructive sleep apnea, most recently in a March 2016 sleep study. The remaining issue is a nexus. In July 2021, a VA examiner opined that the Veteran's sleep apnea was at least as likely as not aggravated by the Veteran's service-connected sinusitis. The examiner cited medical literature that found nasal obstruction, caused by sinusitis, leads to mouth breathing which is thought to destabilize the upper airway. The article, Nasal Pathologies in Patients with Obstructive Sleep Apnea, noted evidence showing that nasal obstruction can contribute to the pathogenesis of OSA, decrease the quality of life in OSA claimants, contribute to snoring and represent an obstacle for effective treatment with CPAP. The examiner was asked to explain how he determined the Veteran's sinusitis aggravated his sleep apnea when the examiner could not determine the baseline severity of the Veteran's sleep apnea. The examiner explained that the Veteran's sinusitis predated his sleep apnea and placed him at increased risk of developing obstructive sleep apnea. Though the examiner opined that the Veteran's sinusitis was not 50 percent or greater the etiology of the Veteran's sleep apnea, his sinusitis did contribute to the development of the sleep disorder. Specifically, the examiner explained the while the Veteran's body mass index (BMI) was the primary cause of his sleep apnea (more than 50 percent), the Veteran's specific BMI did not place him at overwhelming risk for development of sleep apnea. Consequently, while the examiner could not opine that the Veteran's sinusitis more likely than not caused his sleep apnea, the examiner did find that it aggravated the Veteran's sleep apnea beyond its natural progression because but for the combination of his BMI and sinusitis, the Veteran's sleep apnea may not have developed. The Board notes that the July 2021 opinion was provided by a medical professional competent to render an opinion. The opinion reflects reasoned consideration of the evidence of record and includes sufficient explanation. Moreover, there is no competent medical evidence of record to contradict the opinion. Given the probative evidence, the Board finds that the preponderance of the evidence supports the Veteran's claim. As such, service connection for sleep apnea as secondary to service-connected sinusitis is granted. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Sherman 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.