Citation Nr: 21031802 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-24 621 DATE: May 24, 2021 ORDER Entitlement to service connection for sleep apnea is granted. FINDING OF FACT The evidence is in equipoise as to whether the Veteran's sleep apnea is proximately due to his service-connected paroxysmal supraventricular tachycardia. CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea, as secondary to the Veteran's service-connected paroxysmal supraventricular tachycardia, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1982 to September 2002. This matter comes to the Board of Veterans' Appeals (Board) on appeal from February 2015 and April 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in November 2019, when it was remanded for further development. 1. Entitlement to service connection for sleep apnea, to include as due to service-connected disabilities, is granted. Service connection will be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first 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). Service connection requires competent evidence showing (1) a present disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Before deciding a claim, the Board is required to evaluate all relevant evidence on appeal, including lay and medical evidence. See 38 U.S.C. § 7104(a); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a determination as to the competency, credibility, and weight of the evidence. Lay evidence may be competent and sufficient to establish a claim for service connection. Specifically, lay evidence may be sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition, the layperson is reporting a contemporaneous medical diagnosis, or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board must then determine whether the evidence is credible or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of the relevant evidence, the Board must weigh its probative value. The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran contends that his sleep apnea is secondary to his service-connected disabilities. The first element for secondary service connection is satisfied in that the Veteran was diagnosed with sleep apnea in numerous post-service treatment records. The second element for secondary service connection is also satisfied as the Veteran is service-connected for paroxysmal supraventricular tachycardia. The remaining determination, therefore, is whether there is a link between the two. Pursuant to Board remand instructions in November 2019, the Veteran was afforded a VA telehealth examination in October 2020, and an etiological opinion was associated with the claims file. Pertinently, the October 2020 VA examiner opined that the Veteran's sleep apnea was less likely than not incurred in or caused by service, including Camp Lejeune contaminants and asbestos; and further that his sleep apnea was neither caused nor aggravated by service-connected disabilities, to include GERD. However, for the secondary service connection opinions, the examiner reasoned that the Veteran's medical history is notable for multiple medical conditions which are known risk factors in the development and promotion of sleep apnea, includingas relevant to this claimparoxysmal supraventricular tachycardia. Based on the above, the Board finds that the evidence in this case is at least in equipoise with regard to whether the Veteran's sleep apnea is proximately caused by his service-connected paroxysmal supraventricular tachycardia. In so finding, the Board affords weight to the October 2020 etiological opinion that the etiology of the Veteran's sleep apnea is likely multifactorial, including his paroxysmal supraventricular tachycardia. Although the examiner ultimately offered a negative opinion regarding a relationship between the Veteran's sleep apnea and his service-connected disabilities, the Board finds compelling the fact that the examiner specifically stated that the Veteran's service-connected paroxysmal supraventricular tachycardia is a "known risk factor" for sleep apnea. Weighing the positive findings of the October 2020 VA examiner against that examiner's ultimate negative opinion, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's sleep apnea is proximately caused by his service-connected paroxysmal supraventricular tachycardia. Accordingly, and resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107. The appeal is granted. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.