Citation Nr: 21011407 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 14-14 567 DATE: March 1, 2021 ORDER Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s OSA began during active service, is otherwise related to an in-service injury or disease, or is secondary to service-connected disability. CONCLUSION OF LAW The criteria for service connection OSA, to include as secondary to service-connected PTSD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1967 to February 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing at the RO before a member of the Board in his April 2014 substantive appeal. In October 2015, he withdrew his request for a Board hearing. Accordingly, his hearing request was withdrawn. See 38 C.F.R. § 20.704(e). In January 2018 and August 2019, the Board remanded the case for additional development, to include obtaining a VA opinion. As an adequate VA opinion was obtained in February 2020, the Board finds that there has been substantial compliance with prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, the Board may proceed with adjudication. Entitlement to service connection OSA, to include as secondary to service-connected PTSD. The Veteran contends that his OSA is secondary to his service-connected PTSD. See April 2012 VA 21-4138, Statement in Support of Claim. He asserts that his PTSD symptomatology includes nightmares and sleep disturbances that affects his sleep apnea. See April 2013 NOD. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progression by service-connected disability. The Board concludes that, while the Veteran has a current disability of OSA as demonstrated by December 2008 private treatment records, the preponderance of the evidence is against finding that the Veteran’s OSA is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Board notes that service treatment records show no report or finding of OSA, and the Veteran has not alleged otherwise. Rather, he has contended that his OSA is related to his service-connected PTSD. To this regard, in a March 2012 rating decision, the RO granted service connection for PTSD. The first mention of OSA is contained in December 2008 private treatment records when clinically significant sleep apnea was identified by overnight polysomnographic study. The Veteran was prescribed a continuous positive airway pressure (CPAP) machine in March 2009. The Veteran was afforded a February 2013 VA examination, in which an examiner opined that the Veteran’s OSA was less likely as not caused by PTSD. As the examiner did not provide any rationale for the conclusion reached, and failed to provide an opinion on aggravation, in January 2018, the Board remanded the claim for a new medical opinion. In an August 2018 VA addendum, the same examiner stated that his prior opinion remains unchanged. The examiner reiterated that the Veteran’s OSA is less likely as not caused by or a result of PTSD. He stated that the weight of medical literature is against the claims that PTSD causes sleep apnea. However, because the examiner did not specifically address aggravation, in August 2019, the Board remanded the claim again for a new medical opinion. In support of his claim, in a July 2019 appellate brief, the Veteran by and through his representative referenced studies linking PTSD and sleep apnea. See also December 2020 Appellate Brief. In a February 2020 VA medical opinion, an examiner opined that the Veteran’s OSA is less likely than not proximately due to or the result of service-connected condition. As rationale, the examiner acknowledged that there is a high incidence of sleep apnea in those that suffer from PTSD, however, PTSD does not cause upper airway obstruction that causes snoring and sleep apnea. The examiner referenced a June 2018 VA pulmonary diagnostic study report showing that sleep apnea is well controlled and documenting the Veteran’s denial of any abnormal sleep behavior. In fact, the Veteran reported that his CPAP mask is in place when he wakes up. As for aggravation, the examiner also provided a negative opinion reiterating that the Veteran’s sleep apnea is well controlled as evidenced by medical records. Further, the examiner noted the Veteran’s denial of having any difficulties using his CPAP machine and denial that PTSD interfered with his ability to use the CPAP machine that treats sleep apnea. The Board finds the VA examiner’s opinions to be probative and persuasive, because they are based on an accurate medical history and provide an explanation for the opinions. Nieves-Rodriguez v. Peake, supra. Additionally, the Veteran has not submitted competent evidence to the contrary. While the Veteran believes his OSA is caused or aggravated beyond its natural progression by his service-connected PTSD, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the February 2020 VA examiner’s opinions. Jenna Brant Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Baker, 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.