Citation Nr: 21031314 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 08-36 353 DATE: May 21, 2021 ORDER Entitlement to service connection for insomnia is denied. FINDING OF FACT A preponderance of the evidence is against finding that insomnia, as a chronic disorder, was manifested in, or shown to be etiologically related to, the Veteran's service. CONCLUSION OF LAW The criteria for entitlement to service connection for insomnia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from May 1969 to May 1971. This matter was last before the Board of Veterans' Appeals (Board) in March 2021 and remanded by a Department of Veterans Affairs (VA) Regional Office (RO) for additional development. The Veteran contends he has insomnia related to his active duty service and asserts that service connection is warranted for the claimed insomnia. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish service connection, the evidence generally must show: (1) the existence of 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 disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In this case, the Veteran indicated on his May 1971 service separation medical history report that he had frequent trouble sleeping. In elaborating on that symptom in the report, the examiner described it as "occasional insomnia." There is no other mention of insomnia in service treatment records or service medical examination reports. Medical evidence after separation from service is silent regarding insomnia until August 2003, when the Veteran underwent a VA mental disorders examination and on mental status examination the examiner noted the Veteran has insomnia because of the low back pain or a headache or worry. In March 2005 the Veteran presented at a VA mental health clinic with schizophrenia and depression and was at that time taking risperidone and sertraline; he reported having some "initial insomnia." There was no treatment or diagnosis rendered for insomnia. The Board finds that the Veteran's occasional insomnia noted in the service separation medical history report is acute and transitory because there is no mention of insomnia in the Veteran's service treatment records prior to the May 1971 report, and it was more than 30 years after service that insomnia was mention in the Veteran's post-service medical record. Consequently, service connection based on insomnia manifested in service and persisting since is not warranted. As for presumptive service connection and service connection based on continuity of symptomatology, insomnia is not a chronic disease subject to such forms of service connection. 38 C.F.R. §§ 3.303, 3.307, 3.309. In January 2020 a VA-contract examination was conducted for mental health disorders and insomnia. Recurrent insomnia disorder was diagnosed. In a March 2021 VA-contract addendum medical opinion, by the same examiner who conducted the January 2020 examination, the examiner opined that the diagnosed recurrent insomnia disorder was less likely than not incurred in or caused by the claimed inservice injury, event, or illness. The examiner's rationale for the opinion addressed the Veteran's past medical history and prior examinations as directed in the March 2021 Board remand. The examiner considered the Veteran's service records noting that the Veteran had occasional insomnia. The examiner referenced an October 2006 medical report that diagnosed a sleep disorder, but also pointed out there were multiple examinations since 2006 where both a psychiatrist and a psychiatric nurse practitioner did not diagnose the Veteran with having sleep disturbance or mention an insomnia disorder. The Veteran was not diagnosed with an insomnia disorder on evaluations in October 2014 or June 2016. The examiner noted that the best conclusion he can make regarding the Veteran's sustained diagnosis of an ongoing insomnia disorder dating back to 1971 is that it is "inconclusive." The most probable conclusion is that the Veteran's sleep disturbance has both been circumstantial and situational as with "Katrina" as well as being encompassed or subsumed under the Veteran's other psychiatric illnesses. Thus, the examiner opined that the medical records as related to the Veteran's claimed condition of insomnia disorder reflect a condition that is less than 50 percent or less likely than not related to his in-service incident or his active service. The Board finds this examination highly probative of the matter being considered here because the examiner based the conclusions on a thorough review of the available lay and medical evidence and supported conclusions with a sufficient rationale. While the Veteran may substantiate this claim by competent evidence that insomnia is etiologically related to service, he has presented no such evidence, and there is no credible evidence of a related disease or injury in service. Moreover, as a lay person, the Veteran is competent to provide an opinion on some medical issues. However, the specific issue in this case, the etiology of his insomnia, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, the probative value of the contentions of the Veteran is outweighed by the medical opinion of record. The preponderance of the evidence is against the claim of service connection for insomnia. Accordingly, the appeal in this matter must be denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Young, 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.