Citation Nr: 21070832 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 16-56 592 DATE: November 26, 2021 ORDER Service connection for a sleep disorder is denied. FINDINGS OF FACT 1. The Veteran had active duty from October 1986 to September 1993; he has been 100 percent disabled based on unemployability since October 2013. 2. A sleep disorder was not shown in service; a current sleep disorder is not shown; Rather, a sleep disorder, diagnosed as insomnia and fatigue, is part and parcel of the already service connected depression and/or is not caused or aggravated by a service connected disability CONCLUSION OF LAW A sleep disorder was not incurred in service and is not secondary to a service connected disability. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board remanded the claim in 2018 and 2021. The case has now been returned to the Board for adjudication. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As an initial matter, the Veteran contends that a sleep disorder was incurred in service and/or was caused or aggravated by a service connected disability. Therefore, both direct and secondary service connection will be addressed. Turning first to direct service connection, the Veteran has been diagnosed with insomnia and fatigue. Therefore, the first element of service connection is met. As to an in-service incurrence, in an April 1993 service treatment record (STR), the Veteran reported increased sleepiness due to headache medication; however, he did not report difficulty sleeping on any occasion in service. Therefore, a chronic sleep disorder was not shown in service and the medical evidence does not support direct service connection. To the extent that the Veteran asserts that a sleep disorder began in service, in an August 2014 VA examination, he reported experiencing insomnia for the last 10 years. Upon examination, the examiner marked that the Veteran had "insomnia or hypersomnia" but did not provide an opinion as to whether it was incurred in service. In addition, by the Veteran's own statements, he dated the onset of insomnia to approximately 2004, more than a decade after discharge. This evidence does not support the appeal. Further, in a September 2020 VA examination, the Veteran complained of difficulty sleeping since 2004. Upon examination, the examiner opined that a sleep disorder was not incurred in service. She reasoned that given that the Veteran voiced the belief that his sleep difficulties were part of depression, that no evidence could be found in the claims file suggesting a separate condition, and that the sleep complaints may be alcohol induced, a diagnosis of a separate sleep disorder could not be made. This evidence weighs against the claim. In 2021, the Board remanded the claim for an updated opinion as to whether the Veteran had a sleep disorder that was separate from his depressive disorder. In a September 2021 VA opinion, the clinician opined that a sleep disorder was less likely than not incurred in service. She reasoned that the Veteran's sleep disorder was part of his long standing depressive disorder and was not a separate condition. This evidence weighs against the claim. In addition, in a January 2015 Social Security determination, the adjudicator wrote that while the Veteran's polycythemia could cause some fatigue, it was not known to be disabling. As the Veteran is not service connected for polycythemia, an analysis as to whether fatigue was either part and parcel of and/or was caused or aggravated by a nonservice-connected disorder is not warranted. Based on the above, the medical evidence does not support that a separate and distinct chronic sleep disorder was directly incurred in service. In this regard, the medical evidence showed that a sleep disorder was part and parcel of the already service connected depressive disorder and was not a separate condition. Further, while polycythemia was noted to cause fatigue, this is a nonservice-connected disorder so secondary service connection is not applicable. In addition, while clinical records showed treatment for insomnia, they did not contradict these findings. Therefore, the medical evidence does not support that a separate sleep disorder was directly incurred in service. As to secondary service connection between a sleep disorder and headaches, the Veteran has been diagnosed with insomnia, hypersomnia, and fatigue and is service connected for headaches. Therefore, the first two elements of secondary service connection, a current disorder, and a service connected disability, are met. As to nexus, in a September 2021 VA opinion, the clinician opined that a sleep disorder was not caused or aggravated by a service connected disability, as Veteran's sleep disorder was part of his long standing depressive disorder and was not a separate condition. There is no contradictory opinion. Further, clinical records do not show that a sleep disorder was caused or aggravated by headaches. Therefore, the medical evidence does not support the claim of secondary service connection. In sum, the medical evidence does not show that a sleep disorder was incurred in service and/or was caused or aggravated by a service connected disability. The Board has considered the Veteran's assertions that a sleep disorder was incurred in service and/or is related to a service connected disability. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an etiology of this disorder. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ragofsky, 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.