Citation Nr: 21076703 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-02 586 DATE: December 27, 2021 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. Entitlement to service connection for obstructive sleep apnea is granted. FINDINGS OF FACT 1. The Veteran's GERD had its onset during or is otherwise related to his active service. 2. The Veteran's sleep apnea had its onset during or is otherwise related to his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for GERD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from July 1996 to July 2000; and in the Air National Guard from November 2001 to October 2002 and from March 2003 to February 2004. For his meritorious service, the Veteran was awarded (among other decorations) the Air Force Achievement Medal with one oak leaf cluster. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing before the undersigned Veterans Law Judge in August 2021. A transcript of the hearing is of record. SERVICE CONNECTION Generally, to establish service connection there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for gastroesophageal reflux disease (GERD) The Veteran asserts he is entitled to service connection for GERD. The Veteran testified during his August 2021 hearing that he began experiencing symptoms of GERD in service. He described his symptoms as a pain in his chest that made him uncomfortable and woke him up at night. He described his post-service symptoms as difficulty swallowing, pain in the chest, heartburn, discomfort after eating, and regurgitation. Service treatment records (STRs) corroborate the Veteran's testimony with notations of complaints of chest pains in January 1999. In September 2017, the Veteran underwent a VA examination to determine the nature and etiology of his GERD. The examiner confirmed the Veteran's diagnosis of GERD. The examiner opined that the Veteran's GERD was less likely than not related to service. The examiner explained that while the Veteran reported chest pains in service, the chest pains were inconsistent with GERD. For the following reasons the Board finds the September 2017 VA examination to be inadequate. First, the examiner ruled out the Veterans chest pains being related to GERD (as well as heart and lung conditions) but did not provide a medical reason as to why his in-service chest pains were not consistent with a GERD diagnosis. Second, the examiner did not address the Veteran's lay statements of his symptomatology during service as well as its continuation post-service. As such, the Board affords the September 2017 VA medical opinion little probative value. Following his hearing, the Veteran submitted a medical opinion from his private treating physician in August 2021. Upon review of the Veteran's medical records, the physician opined that the symptoms the Veteran experienced in service were the first episodes of his chronic GERD. The Board finds that the August 2021 private medical opinion is entitled to great probative weight as such considered all of the pertinent evidence of record, to include the statements of the Veteran, relying on and citing to the records reviewed. Moreover, the physician offered clear conclusions with supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Accordingly, the Board finds that the preponderance of the evidence weighs in favor of the Veteran's claim for entitlement to service connection for GERD, thus, entitlement to service connection for GERD is granted. 2. Entitlement to service connection for obstructive sleep apnea The Veteran asserts he is entitled to service connection for sleep apnea. The Veteran contends that his sleep apnea began in service and, in the alternative, is secondary to his now service connected GERD. During his August 2021 Board hearing, the Veteran reported snoring while in service. More specifically, he reported occasional snoring that progressed into loud nightly snoring once returning from a deployment in Qatar in 2003. Lay statements submitted by colleagues and the Veteran's wife corroborate his testimony. The Veteran underwent a VA examination for his sleep apnea in September 2017. The examiner noted the Veteran's diagnosis of sleep apnea provided in 2010 through a sleep study. The examiner opined that the Veteran's sleep apnea was less likely than not related to his military service. The examiner explained that the Veteran's symptom of in-service snoring is not specific to obstructive sleep apnea. Instead, the examiner noted that the Veteran's sleep apnea was more likely than not caused by obesity. In contrast, the Veteran's private treating physician opined that the Veteran's sleep apnea began in service. Though she acknowledged that there is less direct evidence of the Veteran's suffering from sleep apnea during his active service, the Veteran's private physician noted the "bidirectional relationship" between GERD and sleep apnea, and cogently explained why the presence of one would indicate the presence of the other. In comparing the conflicting medical opinions of record, the Board affords more probative value to the August 2021 private medical opinion. In this regard, the August 2021 private medical opinion considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). On the other hand, while the September 2017 VA medical opinion provided medical reasons and bases for the conclusion, the opinion did not address the possible relationship between GERD and obstructive sleep apnea. As such, more probative weight is given to the August 2021 private medical opinion and any reasonable doubt will be resolved in favor of the Veteran. Though the Veteran's private physician also explained why the Veteran's sleep apnea may be secondary to his GERD, such a determination is ultimately unwarranted. In the end, reading her opinion alongside the Veteran's testimony regarding his symptoms, the Board finds that the Veteran had symptoms of sleep apnea during service, and that his current disability is related to those in-service symptoms. That is, the Board is able to grant his claim for service connection on a direct basis. Thus, for the preceding reasons, the Board finds that the Veteran's sleep apnea had its onset during or is otherwise related to his active service. Service connection for sleep apnea is warranted. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. K. Hall, 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.