Citation Nr: 21021691 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-57 355 DATE: April 13, 2021 ORDER Service connection for obstructive sleep apnea is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, obstructive sleep apnea had its onset during active duty service. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1982 to August 1988. This matter comes before the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersign in a February 2021 Board hearing. A transcript is of record. 1. Service connection for sleep apnea The Veteran contends that his sleep apnea is etiologically related to his service. Specifically, that the sleep apnea began in service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1166-1167 (Fed. Cir. 2004). The Veteran was diagnosed with sleep apnea based on a sleep study in July 2014. Therefore, the issue before the Board is whether the Veteran’s sleep apnea is etiologically related to service. Service treatment records indicate that the Veteran was taken to the emergency room due to hyperventilating and a panic attack in the middle of the night in August 1982.The Veteran’s service treatment records indicate that the Veteran was diagnosed with insomnia in December 1982. Throughout service, the Veteran reportedly had anxiety issues related to the Veteran’s sleep and difficulty breathing. Parenthetically, the Board notes that service connection for generalized anxiety disorder with panic disorder has been established. In April 2016, the Veteran underwent a private sleep apnea examination. The examiner diagnosed the Veteran with obstructive sleep apnea. The private examiner opined that the it is much more likely than not that the Veteran developed sleep apnea during the years of his active service. The examiner reasoned that the development of sleep apnea takes place over the course of an individual’s adulthood, usually beginning with snoring and gradually worsening, with more disruptive snoring, more frequent breathing pauses, more oxygen desaturation episodes, more significant decreases in oxygen saturation nadir, cardiac involvement, and more sleep impairment. The examiner noted that sleep apnea always worsens over the years and takes many years to develop. The examiner noted the Veteran first developed sleep apnea 30 years prior. The examiner stated that during active duty years, the Veteran reported he was told by others that he snored disruptively during sleep and was observed to stop breathing during sleep. The Veteran reported that he had poor sleep quality and believed his fatigue was due to his duty schedule. The examiner noted that disruptive snoring, observed breathing difficulties, poor sleep quality, and daytime sleepiness are all symptoms of obstructive sleep apnea. The examiner also noted that the Veteran developed hypertension and hyperlipidemia, which untreated sleep apnea will cause. The examiner noted that these medical problems are evidence of underlying sleep apnea and provides the link between the Veteran’s sleep apnea and his service. The examiner further noted that the Veteran had panic attacks and difficulty sleeping while sleeping. The Veteran woke up from sleep choking with night sweats. The examiner stated that research demonstrated that untreated sleep apnea contributes to anxiety and is associated with high frequency of panic attacks during awakenings from sleep. The examiner concluded that based on her expert opinion the Veteran’s sleep study evaluation, his medical history and his sleep history, the Veteran’s sleep apnea more likely than not developed during service. The Veteran testified at a February 2021 Board hearing. The Veteran testified that during service he stopped breathing during his sleep. The Veteran stated his long hour days during service disrupted his sleep pattern and he believed that was how the sleep apnea started. The Veteran stated he had sleep issues. The Veteran stated he would wake up in the middle of the night and could not breath. The Veteran stated he was taken to the emergency room and he was diagnosed with hyperventilation, but the Veteran asserted that it was probably sleep apnea and not the diagnosed hyperventilation disorder. The Veteran stated that he would wake up in the morning with headaches, difficulty breathing, and tightness in his chest. The Veteran stated he always felt tired and never really slept well. The Veteran stated he was diagnosed with insomnia in service and he also felt that was a part of his sleep apnea. The Veteran noted that ever since service he had anxiety and sleep issues. The Board finds that the service connection for sleep apnea is warranted. In this regard, the Board has considered the relevant lay and medical evidence of record. The Board has considered the lay statements of the Veteran that sleep apnea is related to active service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not competent to offer an opinion as to the etiology of sleep apnea due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Such competent evidence has been provided by the April 2016 sleep medicine expert who examined the Veteran, reviewed the Veteran’s service treatment records, the Veteran’s post-service medical records, and his sleep history. Here, the Board attaches the greatest probative weight to that examination report. There is no indication that the private examiner was not fully aware of the Veteran's past medical history or that any relevant fact was misstated. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Therefore, the April 2016 private examiner's opinion is of great probative value. The Board notes further, that there is no contrary opinion of record of equal or greater weight. Based on the foregoing and resolving all reasonable doubt in the Veteran’s favor, the Board finds that service connection is warranted for sleep apnea and the appeal is granted. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.