Citation Nr: 21077580 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 19-36 072A DATE: December 30, 2021 ORDER Entitlement to obstructive sleep apnea (OSA) secondary to the Veteran's service-connected posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The probative and competent evidence of record shows that the Veteran's OSA was caused, or is aggravated, by his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for OSA secondary to PTSD have been met. See 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the Army from September 1968 to April 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). SERVICE CONNECTION Service connection may be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (a). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. See 38 C.F.R. § 3.310 (b). The United States Court of Appeals for Veterans Claims (Court) held in the case of Ward v. Wilkie, 31 Vet. App. 233 (2019) that aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the condition. Rather, the Court explained that "aggravation" is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence. Id. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. The Veteran was diagnosed with OSA in a September 2017 sleep study. See December 2017 VA examination (VAX). He is also service connected for PTSD. The first and second element of secondary service connection are met. Regarding the third element of secondary service connection, a December 2019 opinion authored by D.A., MD, was provided by the Veteran. Dr. A. determined that the Veteran's OSA was more likely than not due to his service-connected PTSD. The opinion was based on an interview of the Veteran, a review of his claims file, and medical publications. Rationale was included with the opinion. For these reasons the private medical opinion has significant probative value. The record also includes a negative November 2019 VA medical opinion. The opinion includes flaws that tend to reduce its overall probative value. Thus, based on the forgoing, the probative evidence weighs in favor of finding that the Veteran's OSA was caused, or aggravated by, his PTSD. The three elements of secondary service connection are met. Service connection for OSA is granted. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Smith, 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.