Citation Nr: 21075838 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 18-15 478 DATE: December 21, 2021 ORDER Service connection for obstructive sleep apnea (OSA) is denied. FINDING OF FACT The Veteran's OSA did not have it onset in service, and is not otherwise causally related to any disease or injury in service, to include the claimed use of corticosteroids for the Veteran's service-connected eczema. CONCLUSION OF LAW The criteria for entitlement to service connection for OSA, to include secondary to the service-connected eczema have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from August 1993 to December 1996. This matter is before the Board of Veterans' Appeals (the Board) on appeal from the August 2015 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The rating decision denied service connection for OSA. The Veteran's Notice of Disagreement (NOD) was received in September 2015. The Statement of the Case was issued in January 2018 and the Veteran's VA Form 9, substantive appeal to the Board was received in March 2018. In February 2021, the Veteran and his representative appeared before the undersigned Veterans Law Judge (VLJ) for a Board virtual haring. The transcript is of record. The claim was remanded in a June 2021 Board decision. Entitlement to service connection for OSA. The Veteran seeks service connection for OSA and alleges that it is related to the medication that he takes for his service-connected eczema. At the February 2021 Board hearing, the Veteran testified that he has been using corticosteroid creams since he separated from service, including clobetasol, triamcinolone, and hydrocortisone. The Veteran testified that the side effects of these include weight gain around the face and neck area. The Veteran also testified that he gained approximately 170 lbs. since separation, attributing this to use of corticosteroid creams. The Veteran testified that he was diagnosed with OSA in 2015 following his weight gain. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). "To establish a right to compensation for a present 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"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Establishing a service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). It is the Board's responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. The Veteran's service treatment records (STRs) do not contain complaints or treatments for OSA. The Veteran's VA treatment records indicate that the Veteran was diagnosed with OSA pursuant to a May 2015 sleep study. In September 2021, the Veteran underwent a VA examination for his claim. OSA diagnosis was confirmed, and the Veteran's current symptoms were listed as snoring and gasping for air while not using CPAP. The Veteran reported using steroid ointments since 1990's for his service-connected eczema, and contended that this caused obesity, which caused the development of his OSA. It was noted that the Veteran was taking Lorazepam and required continuous use of a CPAP machine. The VA examiner provided a negative nexus opinion, indicating that while the profile for the steroids that the Veteran is taking indicates that they can cause weight gain, this is for oral steroids and not for topical creams. The VA examiner noted that eczema does not cause sleep apnea and cited appropriate medical literature in support of the opinion. There is no competent medical evidence to the contrary. Based on the review of the entire record, the preponderance of the evidence supports the finding that the Veteran's OSA did not have its onset in service, and is not otherwise causally related to the Veteran's service, to include secondary to his use of steroid creams for his eczema. As such, service connection is not warranted. The Veteran's OSA did not have its onset in service. The Veteran's STRs and VA treatment records indicate that the Veteran's OSA was not diagnosed until the May 2015 sleep study. Moreover, the Veteran does not claim that his OSA had its onset in service. As such, the remaining question is whether OSA is otherwise causally related to the Veteran's service. With respect to a nexus, the Veteran contends that he has been using topical steroid creams to treat his service-connected eczema, which caused him to become obese and develop OSA. While the Veteran is competent to report observable symptoms, such as daytime fatigue and trouble sleeping, he does not possess the medical expertise to provide a nexus opinion in this case. In other words, he is not competent to state that his OSA is due to use of steroids to treat his eczema. The issue of causation in this case is medically complex, and requires knowledge and interpretation of complicated diagnostic medical testing, records, and studies. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, the Veteran's contentions with respect to a nexus in this case are not competent or probative, and are outweighed by the September 2021 medical opnion. The September 2021 VA medical opinion indicates that the Veteran's OSA was not caused by the topical steroids used to treat his service-connected eczema. The VA examiner cited extensive medical literature and indicated that the Veteran's obesity was not caused the topical steroids. The VA examiner specifically indicated that oral steroids, and not topical steroids cause weight gain. Given that the VA examiner addressed the Veteran's contentions, provided sound medical rationale, and provided a plethora of supporting medical literature, the opinion is highly probative. There is no other competent medical opinion to contradict the VA opinion. Thus, the preponderance of the medical evidence does not support a finding that the Veteran's OSA is causally related to the use of topical steroids for his service-connected eczema. The Veteran was diagnosed with OSA almost 20 years after service and the most probative evidence of record weighs against a finding that the OSA had its onset during service or is otherwise related to disease or injury in service, including the Veteran's long-term use of topical steroid creams to treat his eczema. 1. Accordingly, the preponderance of the evidence is against the claim for service connection for OSA, to include secondary to service-connected eczema, and it is therefore, denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kuksova, Kseniya 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.