Citation Nr: 21073328 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-13 929A DATE: December 8, 2021 ORDER Service connection for obstructive sleep apnea, to include as secondary to service-connected status post rhinoseptoplasty or service-connected status post uvulopalatopharyngoplasty is denied. FINDING OF FACT The Veteran's obstructive sleep apnea is not secondary to service-connected status post rhinoseptoplasty or service-connected status post uvulopalatopharyngoplasty, and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea as due to service or to service-connected status post rhinoseptoplasty or service-connected status post uvulopalatopharyngoplasty are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the United States Air Force from May 1981 to May 2001. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In her March 2017 Substantive Appeal, the Veteran requested a Board hearing. In August 2019, a Board hearing was scheduled. Prior to the scheduled hearing, the Veteran's representative withdrew the Veteran's Board hearing request in a July 2019 statement. In November 2019, the Board remanded this matter for further development. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for a disability, 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. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be granted for a disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. The Veteran contends that her obstructive sleep apnea is due to an in-service broken nose, or in the alternative due to her service-connected status post rhinoseptoplasty or service-connected status post uvulopalatopharyngoplasty. For the following reasons, the Board disagrees and finds that service connection is not warranted. The Veteran has a diagnosis of obstructive sleep apnea. Service treatment records indicate that the Veteran suffered a broken nose, has had nasal surgery, and was diagnosed with snoring before her in-service uvulopalatopharyngoplasty. She is also service connected for a status post rhinoseptoplasty and a status post uvulopalatopharyngoplasty. Accordingly, the Board finds this to satisfy the first two elements for direct and secondary service-connection. Turning to the third element, medical nexus, the evidence consists of a March 2014 and December 2019 VA examination. The March 2014 VA examiner opined that it was less likely than not that the Veteran's obstructive sleep apnea was related to service. The examiner's rationale was that the Veteran only exhibited snoring during her time in service. The examiner noted that a diagnosis or observation of snoring does not automatically result in the development of sleep apnea. However, as noted in the November 2019 Board remand, the examiner's opinion did not discuss whether the Veteran's sleep apnea is related to her in-service surgeries. In December 2019, the Veteran underwent another VA examination. Regarding direct service connection, the examiner opined that it was less likely than not that the Veteran's obstructive sleep apnea is related to her in-service nasal bone fracture or septorhinoplasties. The examiner's rationale was that the Veteran's in-service injury was resolved as evidenced by a December 1999 visit with Dr. T that noted the Veteran no longer had any form of nasal obstruction status-post her in-service septorhinoplasty demonstrating that the Veteran's in-service deviated septum from her nasal fracture had resolved before her diagnosis of obstructive sleep apnea in 2013. The examiner concluded that, as the nasal bone fracture was corrected by the in-service septorhinoplasty, it could not be the cause of obstructive sleep apnea as it was no longer present by the time the Veteran developed sleep apnea symptoms and was diagnosed with obstructive sleep apnea. The examiner is competent to provide this opinion, the Board finds the examiner to be credible, and the Board affords the opinion great probative weight. Turning to the question of secondary service-connection, the December 2019 examiner also opined that it was less likely than not that the Veteran's obstructive sleep apnea was caused by or aggravated beyond its natural progression by her service-connected status post rhinoseptoplasty or service-connected status post uvulopalatopharyngoplasty. Regarding causation, the examiner's rationale was that the Veteran's rhinoseptoplasty had resolved her nasal bone fracture and as such could not be the caused of obstructive sleep apnea. The examiner also explained that the Veteran's uvulopalatopharyngoplasty was not the cause of the Veteran's obstructive sleep apnea as the surgery was, at the time, regarded as a preventative measure for obstructive sleep apnea, but later was regarded as not effective in treating obstructive sleep apnea. The examiner concluded that, although the surgery did not prevent obstructive sleep apnea, it was not the cause. Regarding the question of whether the Veteran's service-connected disabilities aggravated her obstructive sleep apnea beyond its natural progression, the examiner again found it was less likely than not. The rationale was that both surgeries are considered corrective procedures for obstructive sleep apnea, and although they did not prevent the development of obstructive sleep apnea they did not aggravate it beyond its progression. The uvulopalatopharyngoplasty was later found to not be effective in treating obstructive sleep apnea, but it has not been found to aggravate the condition. The rhinoseptoplasty could not have aggravated the Veteran's obstructive sleep apnea beyond its natural progression as it corrected the nasal airway blockage from the in-service nasal bone fracture. The examiner is competent to make this opinion, the Board finds the examiner to be credible, and the Board affords the opinion great probative weight. (Continued on the next page) The Board recognizes the argument raised by the Veteran's representative that the Veteran states she has had symptoms of obstructive sleep apnea since service. Though the Veteran is competent to report observable symptoms such as snoring, she has not shown that she has the medical expertise to diagnose her snoring as indicative of sleep apnea. As such, the Board affords less probative weight to the Veteran's statements that she has had obstructive sleep apnea since service, and affords more probative weight to the findings of the VA examiner. Accordingly, the preponderance of the evidence is against a finding that the Veteran's obstructive sleep apnea is secondary to service-connected status post rhinoseptoplasty or service-connected status post uvulopalatopharyngoplasty, or related to an in-service injury or disease. Because the preponderance of the evidence weighs against this claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As such, service connection for obstructive sleep apnea is denied. L.M. YASUI Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Chandeck, 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.