Citation Nr: 21064903 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-35 938 DATE: October 21, 2021 ORDER Entitlement to secondary service connection for obstructive sleep apnea (OSA) is granted. FINDING OF FACT The Veteran's OSA is proximately due to his posttraumatic stress disorder (PTSD). CONCLUSION OF LAW The criteria for entitlement to secondary service connection for OSA are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1987 to January 2012, including service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the appeal for further development in March 2019. As secondary service connection under 38 C.F.R. § 3.310 is warranted, the Board need not address the Veteran's contentions on direct service connection. Service connection may be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310. To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998). Here, the Veteran is currently diagnosed with OSA (see January 2020 VA examination report) and is service-connected for PTSD. Thus, the first two elements of secondary service connection are established. Regarding the last element, nexus, the record contains both unfavorable and favorable evidence. Against the claim is the opinion of the January 2020 VA examiner, who noted an "association between PTSD and OSA ha[d] been recognized for several years" but denied the claim based on the lack of a "pathophysiological relationship between the two conditions." The examiner also noted that he was unable to find any medical studies in support of the claim and failed to review the medical articles submitted by the Veteran. Thus, this unfavorable opinion is inadequate and is afforded no probative value. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (a medical opinion that relies on the absence of general medical literature supporting nexus without discussing the specific facts of the case is inadequate). In favor of the claim are the medical articles regarding PTSD and OSA submitted by the Veteran in May 2015. A 2005 study of a cohort of 4 million veterans found that sleep apnea was associated with a higher prevalence of psychiatric comorbid conditions and a 2010 study analyzed the prevalence of sleep disorders among soldiers with combat-related PTSD, such as the Veteran here, and found that sleep complaints were almost universal amongst such soldiers, with the majority diagnosed with insomnia and/or OSA. See Amir Sharafkhaneh et al., Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort 38 (No. 11) SLEEP 1405 (2005); see also Vincent Mysliwiec et al., Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel, 36 (No. 2) SLEEP 167 (2013); Nick Orr et al., Prevalence of Sleep Disorders Among Soldiers with Combat-Related Posttraumatic Stress Disorder, 13B (No. 4) CHEST Journal (2010)(sleep complaints almost universal among soldiers with PTSD; the majority were diagnosed with insomnia or obstructive sleep apnea). Medical article and treatise evidence may suffice to establish a nexus if this evidence "standing alone, discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion." Sacks v. West, 11 Vet. App. 314, 317 (1998). While the Board could remand for another opinion, such a request would merely be obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); see also Andrews v. McDonough, 34 Vet. App. 151 (2021). In sum, the above-cited medical articles are sufficient to decide the claim and are demonstrative of an etiological relationship between the Veteran's PTSD and OSA, and the Board will afford the Veteran the benefit of the doubt in this regard and find a proximate cause relationship between them. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.S. Mahoney 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.