Citation Nr: 21066576 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 17-31 731 DATE: November 1, 2021 ORDER Entitlement to service connection for obstructive sleep apnea (OSA), secondary to service-connected posttraumatic stress disorder (PTSD), is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran's OSA was caused by his service-connected PTSD. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for OSA, secondary to his service-connected PTSD, on a causation basis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in active duty from August 1966 through July 1968, which includes service in the Republic of Vietnam. His awards include the Purple Heart Medal and the Combat Infantry Badge. This matter originally came before the Board of Veterans' Appeals (Board) from a July 2014 rating decision of the Department of Veterans' Affairs (VA), which denied the Veteran's claim for service connection for OSA. In August 2014, the Veteran filed a Notice of Disagreement and a Statement of the Case was issued in April 2017, continuing the denial of service connection for OSA. The Veteran perfected his appeal in June 2017. This matter was remanded in January 2019 and in July 2021 for additional development including obtaining adequate medical opinions. Pursuant to the July 2021 remand, a new VA medical opinion was issued in August 2021. As the Board is granting the benefits sought in full, discussion of remand compliance is unnecessary. See Stegall v. West, 11 Vet. App. 268 (1998). A Supplemental Statement of the Case was issued in September 2021, continuing the denial of service connection for OSA. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F. 3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Secondary service connection may be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Entitlement to service connection for OSA. In an April 2013 rating decision, the Veteran was granted service connection for PTSD, effective September 25, 2012. The Veteran contends that his current OSA is caused by his service-connected PTSD. In an April 2014 VA sleep study, the Veteran was diagnosed with OSA, thus establishing the current disability requirement. As noted above, the Veteran was granted service connection for PTSD in an April 2013 rating decision, thereby establishing the service-connected disease element of secondary service connection. The dispositive issue is whether there is a relationship between the Veteran's current OSA and his service-connected PTSD. To that end, in June 2017, a private psychologist provided an opinion finding that it was reasonable to assume that the Veteran's current OSA is caused by his service-connected PTSD. He explained that the Veteran does not have other typical somatic and physical characteristics associated with OSA and that the relationship between PTSD and OSA has been well documented. While the examiner did not provide an extensive rationale to accompany his opinion, an examiner need not explicitly lay out their journey from the facts to a conclusion in order for an opinion to be considered probative. Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate). Reading the June 2017 psychologist's opinion as a whole and in context of the evidence of record, the conclusion that the Veteran's OSA is caused by his service-connected PTSD is entitled to substantial probative weight. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). Pursuant to a July 2021 remand, which found that prior VA examinations conducted in May 2014 and October 2019 were inadequate, the Veteran underwent another VA examination in August 2021. In an August 2021 medical opinion, a VA examiner found that the Veteran's OSA was less likely than not related to his service-connected PTSD. While the examiner acknowledged that medical studies indicate that the prevalence of OSA is increased in patients with a variety of conditions, including PTSD, he noted that there are no clinical trials or studies directly citing PTSD as a cause of OSA. The August 2021opinion is flawed as the examiner cited other contributing factors of OSA without specifically ruling out the Veteran's service-connected PTSD. He also failed to address the Veteran's lay statements and the June 2017 medical opinion as directed by the July 2021 Board remand. The examiner's opinion is therefore inadequate and warrants little, if any, probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (to be afforded probative weight, a medical opinion must contain clear conclusions with supporting data and a reasoned medical explanation connecting the two). While the Board could remand the case for yet another medical, doing so could be construed as 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"); Andrews v. McDonough, 34 Vet. App. 216 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim"); Gardner-Dickson v. Wilkie, 33 Vet. App. 50, 62 (2020) (Order) (denying petition for a writ of mandamus challenging a remand, but agreeing "with the petitioner that it 'would not be permissible for VA to undertake... additional development if a purpose was to obtain evidence against an appellant's case.'") (citing Mariano v. Principi, 17 Vet. App. 305, 312 (2003) and Hart v. Mansfield, 21 Vet. App. 505, 508 (2007)). The above evidence reflects that there is a competent, probative medical opinion that weighs in favor of service connection for the Veteran's OSA secondary to his service-connected PTSD, and no probative evidence against. The evidence is thus at least evenly balanced as to whether the Veteran's service-connected PTSD caused his current OSA. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for OSA on a secondary, causation basis is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.K. Donaldson, 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.