Citation Nr: 21024666 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 19-00 501A DATE: April 23, 2021 ORDER Entitlement to service connection for obstructive sleep apnea (OSA) as secondary to service-connected post-traumatic stress disorder (PTSD) is granted. FINDING OF FACT The competent and probative evidence of record establishes the Veteran’s OSA is proximately due to his service-connected PTSD. CONCLUSION OF LAW The criteria for entitlement to service connection for OSA have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. Introduction The Veteran served honorably on active duty in the United States Army during the Gulf War Era, from September 2003 to September 2007 and July 2009 to June 2010 This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 Rating Decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge (VLJ) in April 2021. A transcript of the hearing shall be associated with the claim’s file. REASONS AND BASES FOR FINDING AND CONCLUSION Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 1131; 38 C.F.R. § 3.303(a). Generally, service connection requires competent evidence of: (1) the existence of a present disability; (2) 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. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004)). 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). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.303(a); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competency must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or, whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran. See Gilbert, 1 Vet. App. at 53. Entitlement to service connection for OSA as secondary to service-connected PTSD is granted. The Veteran seeks entitlement to service connection for OSA, which he claims is secondary to his service-connected PTSD currently rated 50 percent disabling. At the outset, the Board finds a current diagnosis of OSA is confirmed by the evidence of record. For example, a sleep study conducted by the VA in June 2016 revealed moderate OSA, and VA treatment records report the Veteran’s use of CPAP dating back to 2017. A private medical nexus opinion authored by Dr. F.W.N., and dated March 2021 (submitted April 2021) is contained in the claims file. According to Dr. F.W.N., the Veteran’s OSA “has the nexus of or aggravated by his military-related PTSD more likely than not.” By way of rationale, Dr. F.W.N. reported that, “PTSD contains both mental and emotional/physical components.” Dr. F.W.N. indicated that, “the brain controls sleep patterns and breathing” and that, “[p]art of PTSD is being ‘keyed up’ at night … and ‘sleep disturbances,’” and a “[p]art of sleep disturbances for severely anxious people is [OSA].” Moreover, Dr. F.W.N. referenced several “peer-reviewed scientific studies showing a connection between anxiety, PTSD and [OSA].” For example, he cited recent medical research demonstrating a higher incidence of OSA in patients with PTSD, particularly with discussions regarding the correlation of OSA and PTSD among OEF/OIF/OND Veterans. One particular study concluded that OEF/OIF/OND (Afghanistan and Iraq) Veterans with PTSD screen as a high risk for OSA at much higher rates than those seen in community studies and may not show all classic predictors of OSA (i.e., older and higher BMI). Finally, Dr. F.W.N. reported the Veteran as “negative for many other factors” and “alternative possible causes for [OSA].” The Board observes no contradictory medical opinion of record. The Board finds Dr. F.W.N.’s private medical nexus opinion the most probative evidence of record, as it is based upon a review of the Veteran’s claims file including, inter alia, lay and medical evidence, medical literature, and consideration of his reported history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Further, the opinion contains a clear conclusion with supporting data and well-reasoned rationale consistent with the evidence of record. Id. Finally, Dr. F.W.N.’s opinion is not inconsistent with the Veteran’s testimony. Based upon the foregoing, the Board finds the evidence supports the claim for entitlement to service connection for OSA as secondary to service-connected PTSD, and the benefit sought on appeal is granted. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Worsham, Attorney Advisor 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.