Citation Nr: 21076826 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 20-19 799 DATE: December 27, 2021 ORDER Service connection for sleep apnea, to include as secondary to service-connected paroxysmal atrial fibrillation, with shortness of breath, chest pain and fatigue associated with arterial hypertension disability (atrial fibrillation) is denied. FINDING OF FACT The preponderance of the competent medical evidence is against a finding that the Veteran's currently diagnosed sleep apnea was caused or aggravated as secondary to his service-connected atrial fibrillation. CONCLUSION OF LAW The criteria for service connection for sleep apnea, to include as secondary to service-connected atrial fibrillation have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1983 to July 1986 and from April 1987 to April 1990. The Board remanded this issue for additional development, to include a VA examination in September 2021. Entitlement to service connection for sleep apnea. The Veteran seeks service connection for obstructive sleep apnea. In support, the Veteran asserts that service connection is warranted because the disability was caused or aggravated by his service-connected disabilities, and in particular his heart disease. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). As previously noted, the Board remanded this issue for additional development, to include a VA examination and opinion that would address secondary service connection. See September 2021 Board Decision. Specifically, the Board determined that the Veteran's July 2019 private medical opinion was insufficient to grant the Veteran's claim and remanded for an adequate nexus opinion based on current medical studies and principles. Id. The October 2021 VA examiner opined that the Veteran's diagnosed obstructive sleep apnea is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner reasoned that there was no evidence showing that obstructive sleep apnea is caused by paroxysmal atrial fibrillation, with shortness of breath, chest pain and fatigue associated with arterial hypertension. There examiner explained that there was no evidence that atrial fibrillation increases frequency, duration or severity of obstructive sleep apnea even temporarily. The VA examiner reasoned that there is no evidence in the literature to support the Veteran's service-connected atrial fibrillation causing or aggravating the Veteran's diagnosed sleep apnea. The examiner reasoned that there is no medical evidence in the literature to support the Veteran's service-connected atrial fibrillation causing or aggravating his diagnosed sleep apnea, as there is no evidence that arterial fibrillation causes obstructive sleep apnea and there is no evidence that arterial fibrillation increases frequency, duration or severity of obstructive apnea even temporarily. To the extent that the Veteran has asserted that his obstructive sleep apnea has a nexus to a service-connected disability, he is not competent to diagnose or directly link any disability to service, to include as secondary to service-connected conditions or medications used to treat them, as medical expertise is required. I n this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. As such, at this time, there is no competent evidence of a nexus between the Veteran's diagnosed obstructive sleep apnea, to include as secondary to arterial fibrillation. Therefore, the preponderance of the evidence is against the claim. The Veteran has submitted no competent evidence to contradict the October 2021 VA medical opinion. For all the reasons set forth above, the Board finds that the preponderance of the evidence is against the claim for service connection for obstructive sleep apnea, to include as secondary to as secondary to paroxysmal atrial fibrillation, with shortness of breath, chest pain, and fatigue associated with arterial hypertension. As such, because the preponderance of the evidence is against the claim, service connection must be denied. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jordan, Jacquelynn 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.