Citation Nr: 21023694 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 17-10 689A DATE: April 21, 2021 ORDER Entitlement to service connection for sleep apnea is granted. FINDING OF FACT The evidence of record establishes that the Veteran’s sleep apnea is proximately caused or aggravated by service-connected posttraumatic stress disorder (PTSD). CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea have been 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 duty service from June 1973 to June 1977. This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision dated May 2015 issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely appealed. The Veteran testified at a January 2021 Board virtual hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been reviewed and associated with the Veteran’s claims file. This issue was first denied in a May 2014 rating decision. New and material evidence was submitted within one year, leading to a July 2014 readjudication. New and material evidence was submitted within one year, leading to the May 2015 readjudication. Therefore, the original March 2014 claim remains pending and this is an original service connection claim. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection In order to prevail on the issue of entitlement to secondary service connection, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence, generally medical, establishing a connection between the service-connected disability and the current disability. 38 C.F.R. § 3.310; Wallin v. West, 11 Vet. App. 509, 512 (1998). Entitlement to service connection for sleep apnea as secondary to PTSD The Veteran seeks entitlement to service connection for sleep apnea as secondary to PTSD. Following a review of the Veteran’s medical records, the Board concludes that the Veteran has sleep apnea which was caused or aggravated by her PTSD. The first and most fundamental requirement for any service-connection claim is the existence of a current disability. 38 U.S.C. §§ 1110, 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In an April 2014 VA examination, the VA examiner noted that the Veteran had a diagnosis of obstructive sleep apnea that was diagnosed in 2012. See VA Examination dated April 2014. Therefore, the Board finds that the Veteran has satisfied the first prong of secondary service connection, the existence of a current disability. Regarding the second element, the Veteran is currently service-connected for PTSD, among other disabilities. Accordingly, the Board finds that the Veteran has satisfied the second element, evidence of a service-connected disability. Finally, with respect to the third requirement, a causal relationship between the service-connected disability and the current disability, the Board finds that all probative nexus evidence that addresses the question of whether sleep apnea is due to PTSD is positive. During the Veteran’s hearing, she testified that she first began having trouble sleeping in the early 1980s, right after she got out of the military. She noted that she experienced sleep disturbances while in service, which consisted of nightmares. She said that she suffers from these symptoms “frequently. A lot.” Her physician told her that her PTSD medication could aggravate her sleep apnea symptoms. She had been on a CPAP machine since 2013. She stated that her sleeping issues had continuously become worse because of her obesity. The Veteran’s representative argued that when her stress hormones were activated, her upper airway dysfunction was activated, which is what caused her sleep apnea. Her representative also stated that obesity is one of the most significant risk factors for sleep apnea and the Veteran has indicated in the past that she sometimes ate as a coping mechanism. See Hearing Transcript dated January 2021. The Veteran was provided a VA examination in April 2014 for her sleep apnea. The VA examiner determined that the Veteran’s service connection for sleep apnea is less likely as not secondary to her service connected PTSD. She reasoned, “Post-traumatic stress disorder has no known causal relationship to obstructive sleep apnea.” However, the examiner did not consider the treatise evidence of record. As discussed below, there is ample treatise and medical evidence of record showing a relationship between sleep apnea and PTSD. Therefore, the Board finds this opinion is not probative as to the question of nexus. The Veteran’s representative submitted three separate articles about the relationship between PTSD and sleep apnea. All three articles discussed the connection between PTSD and sleep apnea and how the Veteran population was especially at high risk for sleep-disordered breathing. See Correspondence dated April 2016 and Appellate Brief dated January 2021. A private physician provided an opinion regarding the Veteran’s sleep apnea in January 2021. The physician noted that he had been providing ongoing treatment for the Veteran’s PTSD, generalized anxiety disorder, and major depressive disorder since July 2011. He provided a summary of the Veteran’s PTSD symptomatology and discussed her declining ability to tolerate work related stressors. He noted that as her sensitivity to stress increased, so did her sleep apnea symptoms. He wrote, “Additionally, her sleep disruption increased as well as her sleep apnea…her sleep apnea has persisted to this day.” He concluded by stating, It is my opinion that, more likely than not, [her] sleep apnea was caused or aggravated by her PTSD. I’ve worked with [her] since 2011 for treatment of her PTSD. Over the last five years, her sleep apnea has developed and worsened. Recent sleep study showed chronic awakenings at night due to sleep apnea. I believe her chronic sleep apnea is secondary to and results from PTSD. Increasing research and data studies validate this connection. The Board finds this private opinion provides clear and well-reasoned explanations with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the Board places great probative value on this positive nexus opinion. The Board finds that the only probative evidence supports the Veteran’s claim that her sleep apnea is secondary to her service-connected PTSD. As the Board is granting this claim based on the theory of secondary service connection, there is no need to address the theory of obesity as an intermediate step between her sleep apnea and PTSD. Service connection for sleep apnea is granted. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bristor 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.