Citation Nr: 21014360 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-35 179A DATE: March 12, 2021 ORDER Service connection for obstructive sleep apnea (OSA) is denied. FINDINGS OF FACT 1. The Veteran had active service from June 1976 to August 1992. 2. OSA was not shown in service, is not causally or etiologically related to service, and has not been medically associated with a service connected disability. CONCLUSION OF LAW OSA was not incurred in service and is not related to a service connected disability. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran testified before the undersigned Veterans’ Law Judge in July 2018. A copy of the transcript has been associated with the claims file. In April 2020, the issue was remanded for additional development. It is again before the Board for adjudication. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As an initial matter, the Veteran contends that OSA was incurred in service and/or was caused or aggravated by service connected posttraumatic stress disorder (PTSD). Therefore, both direct and secondary service connection will be addressed. Turning first to direct service connection, in an April 2013 clinical record, the clinician wrote that the Veteran most likely had moderate OSA. Further, in an April 2014 VA examination, he was diagnosed with OSA. Therefore, a current disorder is shown, and the first element of direct service connection is met. As to an in-service incurrence, at the July 2018 hearing, the Veteran testified that symptoms of OSA began in service. Specifically, he stated that he would wake up and feel like he needed to go back to sleep. However, service treatment records (STRs) are absent of complaints, diagnoses, or treatment for OSA or symptoms of OSA. Specifically, he sought treatment for a sinus infection, rectal pain, and a right leg muscle spasm. Moreover, he did not report trouble sleeping at separation. Therefore, the medical evidence does not support an in-service incurrence. To the extent that the Veteran asserts that OSA began in service, in an October 2019 VA examination, he reported that he began having trouble sleeping after an incident in basic training. However, upon examination, the examiner opined that OSA was less likely than not incurred in service. She reasoned that the STRs were absent of complaints, diagnoses, or treatment for OSA. There is no contradictory opinion. In the February 2021 brief, the Veteran contended that the October 2019 VA examination was inadequate, as the opinion had been rendered by a Nurse Practitioner. However, as she is a medical professional, she is competent to render an etiology as to this disorder. Moreover, despite the findings made in the October 2019 VA examination, the Veteran did not report OSA or symptoms of OSA in service. Therefore, the evidence upon which the examiner rendered the opinion was accurate. As such, the medical evidence does not support the claim of direct service connection. As to secondary service connection, the Veteran has been diagnosed with OSA and is service connected for PTSD. Therefore, the first two elements of secondary service connection, a current disorder and a service connected disability, are met. As to medical nexus, in a July 2020 VA opinion, the clinician opined that OSA was not caused or aggravated by service connected PTSD. He reasoned that OSA was an obstructive phenomenon involving the upper airways and that there was no physiologic or anatomic mechanism by which psychological conditions could impact OSA. Further, he noted that it was accepted in medical practice that PTSD did not cause OSA. There is no contradictory opinion. In the February 2021 brief, the Veteran contended that the July 2020 VA opinion was inadequate, as the opinion had been rendered by a gynecologist and should be remanded for another opinion so that it was “a bit more valid.” However, the clinician is a medical professional and the opinion was based on a review of file, an understanding of basic anatomy, and accepted medical literature. There is no indication that the clinician was not aware of the Veteran’s complaints or misstated any relevant fact. Therefore, the Board finds that the opinion is adequate for evaluation purposes. The Board has considered the Veteran’s lay statements and testimony that OSA began in service and/or is related to a service connected disability. While he is competent to report symptoms because this requires only personal knowledge as it came to him through his senses, he is not competent to offer an etiology of this disorder. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28. Vet. App. 366, 369-370 (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.