Citation Nr: 21026079 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 19-34 460 DATE: April 29, 2021 ORDER Entitlement to service connection for obstructive sleep apnea as secondary to service-connected acute, subacute, or old myocardial infarction with coronary artery disease and service-connected diabetes mellitus, type II is granted. FINDING OF FACT The Veteran’s obstructive sleep apnea is proximately due to or aggravated by his service-connected acute, subacute, or old myocardial infarction with coronary artery disease and service-connected diabetes mellitus, type II. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea as secondary to service-connected disability are 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 served on active duty in the United States Army from June 1968 until June 1970. In March 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c). Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected acute, subacute, or old myocardial infarction with coronary artery disease and service-connected diabetes mellitus, type II The Veteran asserts that his obstructive sleep apnea is proximately due to or aggravated by his service-connected conditions of acute, subacute, or old myocardial infarction with coronary artery disease and diabetes mellitus, type II. Service connection on a secondary basis may be granted for a disability which is proximately due to, the result of, or aggravated by an established service-connected disorder. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). A review of the record shows that the Veteran is diagnosed with obstructive sleep apnea. The question for the Board is whether the Veteran’s obstructive sleep apnea is proximately due to or aggravated by his acute, subacute, or old myocardial infarction with coronary artery disease or diabetes mellitus, type II. The Board concludes that service connection for sleep apnea is warranted as secondary to the service-connected heart and diabetes disabilities. The record contains several medical opinions. The Veteran submitted an opinion from his private cardiologist, Dr. J.K, M.D., in June 2018. Dr. J.K. provided a positive secondary nexus opinion, but did not include any supporting rationale. That opinion is inadequate and nonprobative. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Following a July 2018 VA sleep apnea examination in July 2018, the examiner reached a negative nexus opinion, but addressed only the causation prong of secondary service connection. The examiner did not address aggravation. the issue of causation and did not address the aggravation prong of secondary service connection. That opinion is inadequate. The Veteran submitted a second private medical opinion in August 2020. The opinion provider, Dr. D.A, M.D., J.D., provided a positive secondary nexus opinion stating that it is at least as likely as not that the Veteran’s obstructive sleep apnea is caused or aggravated by the Veteran’s service-connected coronary artery disease and diabetes mellitus, type II. Dr. D.A. supported his positive nexus opinions by citing to medical literature and explaining that sleep apnea is common in men with coronary artery disease and that there is significant association between coronary artery disease and sleep apnea even after adjustment for age, hypertension, body mass index, diabetes, and smoking. Dr. D.A. also cited to medical literature and explained there is a significant association between diabetes mellitus and sleep apnea. Because the opinion was proffered following review of pertinent medical records and recent medical literature, an interview with the Veteran, based upon his own expertise, and contained clear conclusions supported by clinical and scientific data, the opinion of Dr. D.A. is given significant probative weight. (Continued on the next page)   The Board finds that the opinion of Dr. D.A. is the only probative medical evidence of record regarding nexus, and that it supports a grant of secondary service connection. Therefore, the preponderance of the evidence is in favor of entitlement to service connection on a secondary basis. Service connection for sleep apnea secondary to service-connected coronary artery disease and service-connected diabetes mellitus, type II is granted. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.