Citation Nr: 21020996 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 17-54 175 DATE: April 9, 2021 ORDER Entitlement to service connection for obstructive sleep apnea is granted. Entitlement to service connection for hypertension and left ventricular hypertrophy (claimed as heart palpitations) is granted. FINDINGS OF FACT 1. Resolving all doubt in his favor, the Veteran’s obstructive sleep apnea is etiologically related to active service. 2. Resolving all doubt in his favor, the Veteran’s hypertension and left ventricular hypertrophy is etiologically related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension and left ventricular hypertrophy are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2003 to April 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding will be associated with the record. The Board notes that the Veteran submitted a claim of entitlement for heart palpitations in 2014. However, as treatment records reflect a diagnosis of hypertension and the Veteran has claimed his hypertension is related to service, the Board construes the Veteran’s original claim as encompassing service connection for all hearted-related disorders, including hypertension. See Clemmons v. West, 206 F.3d 1401, 1403 (Fed. Cir. 2000). Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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 or aggravated during service, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for obstructive sleep apnea is granted. The Veteran is seeking to establish service connection for obstructive sleep apnea. Specifically, he contends his obstructive sleep apnea manifested in service. After a review of the evidentiary record and in light of the applicable legal criteria, the Board finds that service connection for obstructive sleep apnea is warranted. With regard to a present disability, treatment records show that the Veteran has a diagnosis of obstructive sleep apnea. In a March 2021 correspondence, the Veteran’s physician, Dr. R. M. F., stated that the Veteran had been under her care for the treatment of obstructive sleep apnea since 2017. As such, the first element of service connection is met. With regard to an in-service event, on a Report of Medical History upon separation from service, the Veteran endorsed frequent trouble sleeping and noted that it was impossible for him to sleep on his back due to snoring and suspected sleep apnea. An undated Report of Medical Assessment reflected that the Veteran intended to seek disability due to sleep problems. Additionally, September 2017 statements from Messrs. J. L. and S. H., the Veteran’s former military colleagues, noted that the Veteran constantly snored in service, would often choke himself awake, and fell asleep standing up on numerous occasions. Therefore, the second element of service connection is met. As for the third element of service connection, evidence of a nexus between the Veteran’s obstructive sleep apnea and service, the Board finds this final element has been met. In a September 2017 private Disability Benefits Questionnaire (DBQ) for sleep apnea, Dr. S. B., the Veteran’s physician, noted that an August 2013 sleep study performed in service indicated the presence of sleep apnea. Therefore, Dr. S. B. opined that the Veteran’s obstructive sleep apnea was more likely than not related to service. In the March 2021 Board hearing, the Veteran testified that he first developed issues sleeping during his service aboard a submarine in 2005. He was a Navy diver and began snoring, falling asleep while driving, and was irritable during the day. The Board notes that the Veteran is competent to report that he has experienced sleep issues since service. See 38 U.S.C. § 1154; 38 C.F.R. § 3.303; see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Further, the Veteran’s reports of sleep issues while in service are corroborated by his endorsement of frequent trouble sleeping on his Report of Medical History upon separation from service and statements from his former military colleagues noting snoring, choking, and daytime sleepiness. As such, the Board finds the Veteran’s statements both competent and credible. The Board acknowledges the negative VA nexus opinion of record. However, in light of documented in-service complaints of sleep issues, a diagnosis of sleep apnea, the competent and credible lay statements of record, and the positive nexus opinion from Dr. S. B., the Board resolves reasonable doubt in favor of the Veteran and finds that his obstructive sleep apnea manifested in service. Accordingly, the Board finds that service connection for obstructive sleep apnea is warranted. 38 C.F.R. § 3.303(d); 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for hypertension and left ventricular hypertrophy (claimed as heart palpitations) is granted. The Veteran is seeking to establish service connection for hypertension and heart palpitations. Specifically, the Veteran contends these heart disorders are etiologically related to service. After a review of the evidentiary record and in light of the applicable legal criteria, the Board finds that service connection for hypertension and left ventricular hypertrophy is warranted. With regard to a present disability, treatment records show that the Veteran has a diagnosis of hypertension and left ventricular hypertrophy, mild with palpitations. As such, the first element of service connection is met. With regard to an in-service event, on a Report of Medical History upon separation from service, the Veteran endorsed heart trouble or murmur and palpitations, pounding heart or abnormal heartbeat. Additional information indicated that a heart murmur and heart palpitations were discovered in 2005 while the Veteran was stationed in Japan. Therefore, the second element of service connection is met. As for the third element of service connection, evidence of a nexus between the Veteran’s heart disorder and service, the Board finds this final element has been met. In a September 2017 private Disability Benefits Questionnaire (DBQ) for heart conditions, Dr. S. B. indicated he had reviewed the Veteran’s service treatment records and had noted diastolic hypertension on multiple occasions. Records reflected that the Veteran had been advised on lifestyle approaches to control blood pressure; however, after no improvement, the Veteran was started on anti-hypertensive therapy. Dr. S. B. explained that cardiometabolic syndrome was common among submarine crew and the Veteran had served five years on a Navy submarine. Therefore, Dr. S. B. opined that the Veteran’s hypertension was more likely than not directly related to service. (Continued on the next page)   The Board acknowledges the negative VA nexus opinion of record. However, the Board resolves reasonable doubt in favor of the Veteran and finds that his heart disorders manifested in service. Accordingly, the Board finds that service connection for hypertension and left ventricular hypertrophy is warranted. 38 C.F.R. § 3.303(d); 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Silverblatt, 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.