Citation Nr: 21022939 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-56 102 DATE: April 19, 2021 ORDER Entitlement to service connection for sleep apnea with chest pain and breathing difficulties, secondary to the Veteran’s service-connected posttraumatic stress disorder (PTSD), on a causation basis, is granted. FINDING OF FACT The Veteran’s PTSD caused his sleep apnea with chest pain and breathing difficulties. CONCLUSION OF LAW The criteria for service connection for sleep apnea with chest pain and breathing difficulties, secondary to the Veteran’s service-connected PTSD, on a causation basis, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 2002 to January 2006. The Veteran received the Combat Action Ribbon for his service in Iraq, among other awards. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the RO denied service connection for obstructive sleep apnea, breathing condition, and chest pains. The Veteran testified before the undersigned Veterans Law Judge at an April 2021 hearing. A transcript of the hearing has not yet been associated with the claims file, but as the benefit sought is being granted in full, a transcript is unnecessary. As the Veteran and his attorney indicated during the April 2021 Board hearing, the Veteran seeks entitlement to service connection for a sleep disorder diagnosed as sleep apnea and with manifestations that include respiratory symptoms and events of chest pain. A claim should not be limited to a disorder as characterized by the Veteran but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim. Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). The issue granted herein encompasses all of the Veteran’s symptoms he has sought compensation for on appeal. Service Connection Entitlement to service connection for sleep apnea with chest pain and breathing difficulties, secondary to PTSD is granted on a causation basis. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The Veteran filed his application for service connection in April 2013. He wrote that his sleep apnea began in January 2002, and his chest pains and breathing condition began in April 2003. In his September 2014 Notice of Disagreement, the Veteran wrote that records reflect an acute respiratory condition during service but it worsened over time and that he still has chest pains. At the April 2021 Board hearing, the Veteran testified to the undersigned Veterans Law Judge that his breathing symptoms and chest pains were part of his sleeping difficulties. The Veteran’s service treatment records contain a post-deployment record which indicated the Veteran was constantly on guard, startled easily, experienced sleep problems, and was under treatment for anger management. In April 2004 the Veteran reported trouble sleeping. In October 2005, the Veteran wrote he had frequent trouble sleeping and would awake at any noise he heard and also noted he attended anger class as a type of counseling. Post-service medical records during the appeal period show the Veteran has repeatedly reported problems sleeping, difficulty falling or staying asleep, and has been prescribed Trazodone for mood and sleep, as well as another medication for sleep. The Veteran was diagnosed with obstructive sleep apnea, confirmed by a July 2013 sleep study, and continuous positive airway pressure (CPAP) therapy was ordered. Thus, the current diagnosis element to establish service connection has been met. At a primary care visit in April 2013, the Veteran complained of atypical chest pain. In December 2018, an assessment was provided of obstructive sleep apnea following a two-week history of sharp chest pain complicated by shortness of breath. The Veteran is service connected for PTSD from April 3, 2013, the same date he filed his sleep apnea, chest pains, and breathing claim. At VA examinations for his PTSD, it was noted in May 2015 and October 2016 the Veteran experienced early and middle insomnia and chronic sleep impairment, and documented at the May 2015 VA examination that the Veteran had fluctuating insomnia, and averaged three to four hours of sleep three times per week with eight hours of broken sleep the remaining nights of the week. Following review of the Veteran’s claims file, in a January 2020 medical opinion, Doctor M.V.R. wrote that the Veteran’s obstructive sleep apnea was primarily related to his service-connected PTSD with chronic, longstanding sleep disorder, requiring medications. She concluded that it is more likely than not that the Veteran’s sleep condition is secondarily caused by his PTSD. The physician provided citations to support her opinion regarding the relationship between sleep apnea and PTSD among veterans, and discussed this Veteran’s specific chronic symptoms, medical history, and prescription medications. As the physician explained the reasons for her conclusions based on an accurate characterization of the evidence of record, her opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). There is no contrary opinion in the evidence of record. As the preponderance of the evidence indicates that the Veteran’s disability of sleep apnea with chest pain and breathing difficulties is caused by his service-connected PTSD, entitlement to service connection is warranted on a secondary, causation basis. As service connection is being granted on a secondary basis, the Board need not consider other theories of entitlement. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Kuczynski, Associate 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.