Citation Nr: 21026083 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-37 459 DATE: April 29, 2021 ORDER Entitlement to service connection for hypertension as secondary to service-connected obstructive sleep apnea (OSA) is granted. Entitlement to service connection for headaches as secondary to service-connected OSA is granted. FINDINGS OF FACT 1. Resolving all doubt in the Veteran’s favor, the diagnosed hypertension is proximately due to his service connected OSA. 2. Resolving all doubt in the Veteran’s favor, the diagnosed headaches are proximately due to his service connected OSA. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension as secondary to OSA are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for headaches as secondary to OSA are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from April 1988 to April 1992. He had additional service in the Army National Guard. In March 2019 and April 2020, the Board remanded the claims on appeal. Service Connection for Hypertension and Headaches The Veteran asserts that his hypertension and headaches are related to his service-connected PTSD. Alternatively, he asserts that his headaches and hypertension are attributable to service. Notably, when these matters were last before the Board of Veterans’ Appeals (Board), service connection for OSA had yet to be established. In a rating decision dated in April 2020, just a few days after the Board issued its Remand of the present claims, the agency of original jurisdiction (AOJ) granted entitlement to service connection for OSA as secondary to service-connected PTSD. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a veteran must show:” (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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In addition to service connection on a direct basis, service connection may also be granted on a secondary basis for a disability which is proximately due to or aggravated by a service-connected disability. 38 C.F.R. § 3.310. 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 Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board has remanded the present claims twice to obtain medical opinions to address whether hypertension and headaches are secondary to the Veteran’s PTSD. The Board’s development has largely been unfruitful on this question. Notwithstanding, the Board concludes that the Veteran’s hypertension and headaches are, as likely as not, proximately due to the Veteran’s service-connected OSA. A March 2016 VA Sleep Apnea Disability Benefits Questionnaire (DBQ) reflects an assessment of OSA. The VA physician that conducted the examination attributed hypertension and headaches to the assessed OSA. Thus, upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current hypertension and headaches are proximately due to his service connected OSA. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that entitlement to service connection for hypertension and headaches is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. Yaffe Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph R. Keselyak, 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.