Citation Nr: 21024223 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 18-03 942 DATE: April 22, 2021 ORDER Service connection for sleep apnea is granted. FINDING OF FACT The Veteran’s sleep apnea was cause by service-connected sinusitis status post septoplasty, antrostomy, and interior turbinate resection. CONCLUSION OF LAW The criteria are met for service connection for sleep apnea. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1990 to January 1994. This appeal is from a January 2016 rating decision. In January 2020, the Veteran had a personal hearing with the undersigned VLJ. Service connection for sleep apnea is granted. Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310. 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 establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran asserts that his sleep apnea is related to his service-connected sinusitis status post septoplasty, antrostomy and interior turbinate resection. Specifically, he reports that his sleep apnea began within weeks of having surgery to repair airway obstruction that had resulted from an in-service surgery to repair dental malocclusion. A VA examination opinion was obtained in December 2015. That examiner opined against a relationship indicating that “status post septoplasty, antrostomy and interior turbinate resection is not listed as a risk factor for [obstructive sleep apnea] in UpToDate (a review of the most current medical literature)….” The examiner indicated the Veteran’s weight was the cause of his sleep apnea. This opinion has limited probative value. The opinion is based on a review of the record and the medical literature, but it is somewhat conclusory and does not address the Veteran’s full history, including his in-service surgery. It also does not address aggravation. In November 2017, another opinion was obtained. However, the VA examiner opined that sleep apnea was not permanently aggravated beyond its normal progression, which is an incorrect standard. 38 C.F.R. § 3.310. In February 2020, the Veteran’s private treatment provider opined that the Veteran’s septoplasty, antrostomy, and interior turbinate resection were more than 50 percent likely to be the cause of his sleep apnea. He indicated that review of the literature revealed that there was a high occurrence of sleep apnea in patients with mandibular fractures who underwent surgical repair. He indicated that surgeries for nasal airflow obstructions are controversial and shown to have no benefit in half the cases. He concluded that the studies showed there was an association between postoperative mandibular manipulation and postoperative nasal surgeries as a complication for development of sleep apnea. He opined that the Veteran’s more recent sinus surgery increased inflammation and scar tissue, leading to the Veteran’s sleep apnea. He cited to numerous medical studies. Based on the above, the Board finds the February 2020 opinion the most probative, as it contains the most detail and explanation. The VA examinations do not address all theories of causation, and the accompanying negative opinions are outweighed by the private opinion. Accordingly, service connection for sleep apnea is granted secondary to service-connected sinusitis. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Gibson 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.