Citation Nr: 21014500 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 07-25 317 DATE: March 12, 2021 ORDER Service connection for obstructive sleep apnea is granted. FINDING OF FACT The Veteran’s obstructive sleep apnea is proximately due to service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Army from April 1983 to February 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2006 rating decision. The Veteran testified before the undersigned Veterans Law Judge at Board hearings in September 2012 and December 2020. It was remanded for additional development in April 2013, November 2013, September 2018 and December 2019. As noted in the December 2019 remand, the Veteran’s underlying service connection claim was for residuals of a rhinoplasty, septoplasty and cartilage graft procedure performed during service. The evidence reflects obstructive sleep apnea as a diagnosed condition which is alleged to have resulted from this procedure. Additional residuals alleged to be associated with the in-service procedure have been addressed. Therefore, the Board’s current decision is limited to sleep apnea specifically. Service connection for obstructive sleep apnea Private treatment records from March 2019 show the Veteran was diagnosed with severe obstructive sleep apnea based on a sleep study. A January 2020 VA examiner stated that sleep apnea was less likely than not proximately due to or aggravated by the Veteran’s service-connected disabilities. He listed multiple risk factors for sleep apnea but concluded that even though the prevalence of obstructive sleep apnea was increased with those risk factors, a causative nexus was not established. Among the listed risk factors were craniofacial/upper airway abnormalities and nasal congestion. The Veteran is service-connected for allergic rhinitis and sinusitis, and blockage of the nasal passages is inherent in those ratings. The examiner also noted that the medication gabapentin could also exacerbate obstructive sleep apnea, and the Veteran uses it to treat his service-connected low back disability. While the Board acknowledges the examiner’s statement that a specific causative relationship between the stated risk factors and sleep apnea was not shown, it nonetheless finds that, upon review of the record, the evidence is at least in equipoise as to whether the Veteran’s current obstructive sleep apnea is proximately due to his service-connected disabilities. Accordingly, after resolving   all doubt in favor of the Veteran, the Board finds that service connection for obstructive sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shamil Patel, 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.