Citation Nr: 21028753 Decision Date: 05/12/21 Archive Date: 05/11/21 DOCKET NO. 19-26 608 DATE: May 12, 2021 ORDER Entitlement to service connection for obstructive sleep apnea (OSA) is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his obstructive sleep apnea arose in service. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran honorably served in the United States Navy from June 1963 to March 1971. This matter appears before the Board of Veterans' Appeals (Board) on appeal of a September 2018 rating decision of the Regional Office (RO). In April 2021, the Veteran testified before the undersigned Veterans law Judge via a televirtual hearing; a transcript is not of record, but today's grant cures this defect. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Entitlement to service connection for OSA Resolving reasonable doubt in the Veteran's favor, the evidence is at least in equipoise to support granting his claim of entitlement to service connection for OSA. The Veteran contends that he is entitled to service connection for OSA because he has had the symptoms of it since service. The Board finds that the evidence is at least in equipoise to grant the Veteran's claim of entitlement. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Veteran underwent VA examination to determine the nature and etiology of OSA. The Veteran reported a history of loud snoring since service. Additionally, his wife reported observing apnea throughout their marriage since 1966. The Veteran denied daytime sleepiness in service and post service and wasn't prescribed a CPAP until 2003. The examiner found that the Veteran's OSA was less likely than not incurred in or caused by his military service. Specifically, the examiner explained that he was not diagnosed until 32 years after separating from service. The examiner opined that the Veteran's OSA is more likely than not related to aging and weight gain. The Veteran submitted an October 2018 private opinion by Dr. C.L.S., where she opined that the Veteran's OSA more likely than not developed while on active duty. Specifically, Dr. C.L.S. explained that OSA does not have a sudden onset and typically takes years to develop and worsen. Generally, she explained that OSA will being with snoring in a young man and gradually worsen to multiple breathing paused, more oxygen desaturation episodes, more sleep impairment, and cardiac involvement. Next, she explained that the Veteran reported sleep difficulties while on a submarine in service, which would be related to the poor air quality in a submarine. The examiner noted that since a sleep study was not done during service, she needed to examine other evidence to make an opinion. She noted that the having untreated sleep apnea for many years causes significant biological stress to the cardiovascular system resulting in hypertension. She referenced many articles describing the relationship between sleep apnea and various cardiac diagnoses. In summary, she wrote "the development of these medical disorders and abnormalities provides medical evidence of underlying, undiagnosed, and untreated sleep apnea. It is not usual for an individual to have symptoms of sleep apnea for years before the primary care doctor refers the individual for a sleep evaluation." (Continued on the next page) The Veteran also submitted a May 2018 statement by his wife. She reported that since their marriage in 1966, the Veteran has snored loudly and stopped breathing while asleep. She reported needing to wake him up. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current OSA arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for OSA is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. N. Fournier, 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.