Citation Nr: 21040672 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 18-19 098 DATE: July 6, 2021 ORDER Entitlement to service connection for obstructive sleep apnea is granted. FINDING OF FACT The Veteran's obstructive sleep apnea had its onset in service. CONCLUSION OF LAW The criteria for entitlement to 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 served on active duty in the United States Marine Corps from August 1964 to August 1968, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned in June 2021. The Veteran asserts that his obstructive sleep apnea was incurred in and/or manifested during service and that service connection is therefore warranted. The Veteran has previously been granted service connection for posttraumatic stress disorder (PTSD. He alternatively claims the obstructive sleep apnea disability was caused or aggravated by his PTSD. Thus, in light of his contentions, the Board would generally be obliged to consider his instant claim on both a direct and secondary basis. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009). Nevertheless, given the particular circumstances of this case, the Board finds that direct service connection for obstructive sleep apnea is warranted and, thus, for the sake of judicial economy will confine its analysis to that theory of entitlement. 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. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the current disability and an in-service precipitating disease, injury or event. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Here, the Veteran has been diagnosed with obstructive sleep apnea, satisfying the first element of service connection. See December 2017 VA examination report. Regarding element two, the Veteran's service treatment records are negative for a diagnosis of obstructive sleep apnea. Significantly, however, the Veteran and his wife have reported that he had sleep apnea symptoms since his active military service. Further, the Veteran testified at his June 2021 Board hearing and in an August 2017 statement, that his bunk bed was relocated away from others due to his excessive snoring. His wife reported that during the Veteran's active service, she observed pauses in his breathing during sleep, causing her to hit him in his chest. See August 2017 Correspondence. The Veteran and his wife are competent to report what they have observed regarding the Veteran's sleep patterns. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board further finds their statements internally consistent, credible, and probative. Thus, the second element of service connection, incurrence of a disease or injury in service, is met. Regarding the final element, nexus, in December 2017, a reviewing VA examiner opined that it is less likely than not that the Veteran's sleep apnea was proximately due to or aggravated by the Veteran's PTSD due to the absence of a pathophysiological relationship between PTSD and sleep apnea. This opinion is inadequate, as it does not include sufficient rationale as to the issue of aggravation, or address direct service connection. See El-Amin v. Shinseki, 26 Vet. App. 136, 414 (2013). In support of his claim, the Veteran submitted a medical opinion from Dr. C.F.M., who is board-certified in sleep medicine, in April 2021. Following an overview of the Veteran's medical history, Dr. C.F.M. opined that the Veteran' obstructive sleep apnea had its onset in service, based on the severity of the Veteran's sleep disordered breathing. In support of his conclusion, Dr. C.F.M. highlighted the Veteran's report and his spouse's observation of loud snoring, nonrestorative sleep, and excessive daytime tiredness since 1964. In sum, as the only probative nexus opinion is in favor of the claim, all elements of service connection are established, and the benefit sought on appeal is granted. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Forde, 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.