Citation Nr: 21073953 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 17-03 447 DATE: December 13, 2021 ORDER Service connection for sleep apnea is granted. Service connection for headaches is granted. FINDINGS OF FACT 1. The Veteran's sleep apnea is proximately due to or the result of his service-connected psychiatric disorder. 2. The Veteran's headaches are proximately due to or the result of his sleep apnea. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea, as secondary to service-connected PTSD, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for headaches, as secondary to service-connected sleep apnea, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1969 to April 1972. The case is on appeal from a February 2016 rating decision. The matter was last before the Board in August 2021. At that time, the Board remanded the claims for further development. 1. Service connection for sleep apnea. The Veteran seeks service connection for sleep apnea. He maintains that his sleep apnea is related to service or secondary to a service-connected disability. The Veteran was afforded a VA examination in October 2019. The examination reported reflected that sleep apnea was diagnosed in October 2004 based on a sleep study, and use of a continuous airway pressure (CPAP) machine was recommended. The examiner opined the Veteran's sleep apnea less likely than not had its onset in service or was otherwise related to his service. The examiner further opined the Veteran's service-connected disabilities, to include DMII, did not cause or aggravate the Veteran's sleep apnea. Additionally, the VA examiner indicated the Veteran's sleep apnea was more likely related to his obesity. Pursuant to the Board remand in August 2021, the Veteran was provided an addendum medical opinion in October 2021. The VA examiner opined the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected conditions. As rationale, the examiner provided that neither diabetes mellitus type II (DMII) nor posttraumatic stress disorder (PTSD) cause or aggravate sleep apnea directly and they do not directly cause obesity. Obesity is the majority cause of sleep apnea. While an associative relationship exists between psychiatric disorders, such as PTSD, and sleep apnea, per current medical literature, a causative relationship does not exist. The examiner further mentioned there is a strong associative relationship, according to medical literature, between sleep apnea and PTSD. Additionally, at the time of the sleep study, the Veteran had a BMI above 25 in either the overweight or obese category, which is a majority cause of sleep apnea. Unfortunately, therefore any other causes less likely than not the cause of OSA including DMII and PTSD. Even though the August 2021 examiner concluded the Veteran's sleep apnea is not caused or aggravated by PTSD or DMII, the rationale provided actually supports the Veteran's claim. In this regard, the examiner stated that medical literature shows psychiatric symptoms, including those stemming from depression and PTSD, are associatively related to weight gain. The examiner then went on to state that obesity is the likely cause of the Veteran's sleep apnea. Here, the evidence shows that the Veteran suffers from serious psychiatric symptoms, to include near-continuous panic or depression affecting the ability to function independently, appropriately and effectively. See VA examination (January 2019). In light of the Veteran's serious psychiatric symptoms, the August 2021 examiner's opinion that psychiatric disorders can cause obesity, supports the notion that it is atleast as likely as not that the Veteran's obesity could be an intermediate step between hiss psychiatric disorder and his sleep apnea. It is well-established that obesity may be an "intermediate step" between a service-connected disability and a current disability that may be connected on a secondary basis. 38 C.F.R. § 3.310; see also Walsh v. Wilkie, 32 Vet. App. 300 (2020). Thus, after resolving any doubt in the Veteran's favor, the Board finds that the Veteran's sleep apnea is proximately due to or the result of his service-connected psychiatric disorder. Thus, service connection for sleep apnea is warranted. 2. Service connection for headaches. The Veteran seeks service connection for headaches. He maintains that his headaches are related to service or secondary to a service-connected disability. In October 2019, a VA examiner opined, in pertinent part, that the Veteran's headaches are most likely secondary to hypoxic episodes associated with his sleep apnea. When coupled with the fact that the Board has, by this decision, granted service connection for sleep apnea, the October 2019 VA examiner's uncontroverted opinion establishes that the Veteran's current headaches are proximately due to or the result of his service-connected sleep apnea. Accordingly, service connection for headaches warranted. Joshua Castillo Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becton, 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.