Citation Nr: 21032789 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 16-41 066 DATE: May 28, 2021 ORDER Service connection for a sleep disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from April 1975 to March 1979; he has been 100 percent disabled based on unemployability since July 2015. 2. A sleep disorder, currently diagnosed as obstructive sleep apnea (OSA), was not shown in service, is not causally or etiologically related to service, and was not caused by or permanently worsened in severity by a service-connected disability. CONCLUSION OF LAW A sleep disorder was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Turning to the medical evidence, the Veteran was diagnosed with mild OSA after an October 2015 sleep study. While he has also complained of insomnia, the medical treatment records reflect that insomnia is a symptom of a service-connected psychiatric disability and does not warrant a separate diagnosis. As such, a current diagnosis of OSA has been shown and the first element of service connection has been met. As to in-service incurrence, the service treatment records (STRs) reflect complaints of difficulty sleeping and insomnia. Specifically, an August 1976 record showed a two-week history of poor sleep and insomnia. In addition, a February 1979 medical summary showed that the Veteran had difficulty falling asleep in the past year and had been awoken by coughing. Further, it was reported that the Veteran rarely awoke in the morning feeling fresh and rested; however, no diagnosis of a sleep disorder was made in service. The February 1979 separation examination did not indicate a diagnosis of OSA or any other sleep disorder. Accordingly, the medical evidence does not support the in-service incurrence of a chronic sleep disorder. To the extent that the Veteran asserts a connection between the in-service sleep complaints and current diagnosis of OSA, the medical evidence does not support a nexus. Specifically, a July 2020 VA examiner opined that OSA was less likely than not incurred in or caused by service. The examiner noted that while the Veteran separated from service in 1979, he was not diagnosed with OSA until 2015. Further, he explained that the Veteran's morbid obesity was the more likely cause of OSA. There are no contradictory medical opinions of record. Therefore, the medical evidence does not support the claim for service connection on a direct basis. Next, the Veteran has contended that a sleep disorder is secondary to service-connected disabilities, including a knee disability and psychiatric disability. As the Veteran has been diagnosed with OSA and is service connected for a knee disability and psychiatric disability, the first two elements of service connection have been met. Weighing in support of the appeal is a September 2013 private opinion reflecting that the Veteran was diagnosed with a sleep disorder due to a knee pain; however, the clinician did not provide any further clarification or rationale for his opinion. Accordingly, this evidence is insufficient to establish a medical link between a sleep disorder and service-connected knee disability. Weighing against the appeal is a May 2019 VA examiner opinion that it was less likely than not that a sleep disorder was proximately due to or the result of a service-connected knee condition. He explained that OSA involved a recurring collapse of the airway during sleep, which resulted in loss of airflow. He stated that OSA was an anatomical dysfunction which was not impacted by a service-connected knee disability. Further, a May 2019 VA examiner concluded it was less likely than not that a sleep disorder was proximately due to or the result of a service-connected psychiatric disability. She explained that decreased sleep was a symptom of the Veteran's major depressive disorder; however, it did not warrant a separate diagnosis. She also noted that OSA was a separate sleep-related disorder. In addition, the May 2019 VA examiner noted that OSA was less likely than not aggravated beyond its natural progression by a service-connected disability. He explained that there was no documentation of worsening OSA due to a psychiatric disability. He further indicated that the Veteran's sleep problems, which included nightmares and insomnia, were symptoms of major depressive disorder and were not an aggravation of OSA. The Board finds that the May 2019 examination was adequate for adjudicative purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. In addition, unlike the September 2013 opinion, the May 2019 examiner offered a rationale based on medical principles. Therefore, the Board finds the VA examiner's opinion to be of great probative value. Accordingly, the weight of the medical evidence does not support service connection on either a direct or secondary basis. The Board has considered the Veteran's lay statements that his disorder was caused by service or due to a service connected disability. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.