Citation Nr: 21027331 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 14-10 005 DATE: May 5, 2021 ORDER Service connection for obstructive sleep apnea (OSA) is granted. FINDING OF FACT The Veteran's OSA is related to service. CONCLUSION OF LAW The criteria to establish service connection for OSA have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from December 1970 to December 1972. This matter comes before the Board of Veterans' Appeals (Board) from a March 2012 rating decision by the Agency of Original Jurisdiction (AOJ). This issue was remanded by the Board in January 2018 and July 2019. The Veteran maintains that symptoms of OSA first began during active service. Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service); 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when 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 may 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). The report of a May 1973 VA examination indicates the Veteran's complaint of shortness of breath. On VA examination in June 1976, the Veteran described himself as "short-winded." Upon complaint of shortness of breath and dyspnea in November 1979, a chest X-ray revealed no active pulmonary disease. In his May 2012 notice of disagreement, the Veteran maintained that OSA is related to service, and that he began to have shortness of breath, fatigue, and sleep difficulty within months following service. He indicated that over the years, his breathing problems became worse, and that his wife observed apneas during sleep and would wake him when he stopped breathing. He stated that over the years, his symptoms worsened, and that he also began to experience frequent headaches and sore throat. A February 2018 report from Virginia Neurology and Sleep Centers indicates that on history and physical examination, the Veteran reported a 47 year history of snoring, witnessed apneas, daytime sleepiness, frequent awakenings, restless sleep, unrefreshing sleep, difficulty maintaining sleep, and apnea. He stated that he had been prescribed continuous positive airway pressure (CPAP) more than 25 years previously. He noted that he had an old machine that caused discomfort and was noisy. A February 2018 letter from Virginia Neurology and Sleep Centers indicates that the Veteran was under N.B., M.D.'s care for sleep apnea. Dr. B. noted that the Veteran had been diagnosed with OSA multiple times over the past several decades, most recently on sleep study in February 2018. He also noted the Veteran's report of having suffered from OSA symptoms during service. Having carefully reviewed the record, the Board has determined that service connection for the Veteran's OSA is warranted. In reaching this conclusion, the Board notes that the Veteran has consistently reported that he experienced symptoms of OSA during service and continuously in the years following separation from service. The post-service records reflect his complaint of respiratory symptoms, and on initial examination with Dr. B., he reported progressively worsening symptoms over the previous 47 years, which would place symptom onset in service. Indeed, Dr. B. noted the Veteran's sleep apnea symptoms "initially presented" 47 years prior (which was during service) and "have progressed" since that time. Considering the record as a whole, the Board concludes that the evidence is in approximate balance as to whether the Veteran's OSA is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for OSA is warranted. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.