Citation Nr: 21025333 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-41 079 DATE: April 27, 2021 ORDER Service connection for obstructive sleep apnea is denied. FINDING OF FACT Obstructive sleep apnea is not shown to be causally or etiologically related to any disease, injury, or incident during service. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1976 to August 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal form a rating decision issued in June 2014 by a Department of Veterans Affairs (VA) Regional Office. In March 2019, the Veteran was advised that her requested Board hearing was scheduled for May 2019; however, she failed to report for it. Furthermore, she has not offered good cause for her failure to attend or requested that it be rescheduled. Therefore, the Veteran’s request for a Board hearing is considered withdrawn. 38 C.F.R. § 20.704(d). In December 2020, the Board remanded the claim for additional development and it now returns for further appellate review. Entitlement to service connection for obstructive sleep apnea. Service connection may also be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran’s service treatment records reflect that she reported trouble sleeping, in addition to depression or excessive worry, in March 1981. In March 1982, she again reported trouble sleeping, which was attributed to minor insomnia related to tension. Post-service VA treatment records reflect that the Veteran first reported difficulty sleeping in August 2014. Shortly thereafter, she underwent a sleep study and was diagnosed with obstructive sleep apnea in December 2014. However, in light of the aforementioned in-service complaints, the Board remanded the case in December 2020 in order to afford the Veteran a VA examination so as to determine the nature and etiology of her obstructive sleep apnea. Thereafter, the Veteran was afforded a VA examination in February 2021. At such time, the examiner confirmed the diagnosis of obstructive sleep apnea, and noted the Veteran’s report that there was a constant interruption of sleep during service, but the medical staff did not provide help. She also noted that the Veteran indicated that, after service, her husband told her she snores a lot and she was getting tired during the day. Nonetheless, after completing such interview and examination, and reviewing the record, the examiner opined that it was less likely than not that the Veteran’s obstructive sleep apnea was related to her military service. In support of such opinion, she noted that, although the Veteran reported frequent trouble sleeping on her separation examination, such was attributed to insomnia related to tension, and there was no suggestion of the presence of sleep apnea at that time. Further, the examiner explained that insomnia is a separate condition from sleep apnea, as sleep apnea most often relates to relaxation of the upper airways during sleep. She also noted that the Veteran’s body mass index (BMI) was normal at separation but was obese at the time of the December 2014 sleep study. The examiner explained that, per medical literature, such change in BMI is significant in the development of sleep apnea. In this regard, she noted that obesity is a potent risk factor for sleep apnea as such increases pharyngeal collapsibility through mechanical effects, constricting airway control. Notably, as patients with sleep apnea lose weight, upper airway function improves. Based on such findings, the examiner found that the Veteran’s report of trouble sleeping or minor insomnia related to tension noted at separation with a normal BMI was not suggestive enough of probable sleep apnea. Rather, she found that the increase in BMI up to the time of the sleep study is the most significant factor contributing to the diagnosis of sleep apnea. Therefore, she concluded that the Veteran’s sleep apnea is less likely than not related to, or had its onset in, service. The Board affords great probative weight to the February 2021 VA examiner’s opinions as such considered all of the pertinent evidence of record, to include the Veteran’s statements, her relevant medical history, and relevant medical literature, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Notably, there is no medical opinion to the contrary. In this regard, the Board acknowledges the Veteran’s assertions as to the etiology of her obstructive sleep apnea; however, as a lay person, she does not have requisite training and experience necessary to address such a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Specifically, such requires knowledge of the respiratory system, to include the structure therein. Therefore, such matter may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Moreover, whether the symptoms the Veteran reportedly experienced during or after service, to include trouble sleeping, snoring, and daytime tiredness, are in anyway related to her currently diagnosed obstructive sleep apnea is a matter that also requires medical expertise to determine. Clyburn v. West, 12 Vet. App. 296, 301 (1999) (“although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with.”). Accordingly, the Veteran’s opinion as to the onset and etiology of her obstructive sleep apnea is not competent evidence and, consequently, is afforded no probative weight. In conclusion, the Board finds that obstructive sleep apnea is not shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for such disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for service connection for obstructive sleep apnea, that doctrine is not applicable in the instant appeal and such claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Waite 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.