Citation Nr: 21041144 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 17-67 049 DATE: July 8, 2021 ORDER Service connection for obstructive sleep apnea as aggravated by posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT Obstructive sleep apnea is aggravated beyond its normal progression by service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for sleep apnea as aggravated by PTSD have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Army from April 1979 to February 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision. It was previously remanded for additional development in November 2018 and October 2020. The Veteran contends that his obstructive sleep apnea is related to his period of active service. 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. The Board concludes that, while the Veteran has a current diagnosis of obstructive sleep apnea, the preponderance of the evidence weighs against finding that the Veteran's diagnosis began during service or is otherwise related to an in-service injury, event, or disease. The Veteran, his wife, and the available treatment records indicated that he was diagnosed with sleep apnea around 1996 to 1998, many years after his separation from service. They asserted that he had symptoms of sleep apnea, including snoring and daytime fatigue, during service and for years afterward. Service treatment records contain multiple entries relating to a variety of health concerns, but are negative for any complaints, treatment, or diagnoses related to sleep apnea. Moreover, an April 2021 VA examiner stated that while snoring and daytime fatigue can be caused by sleep apnea, not all such symptoms are actually due to sleep apnea. Based on this, as well as the lack of any treatment records from service related to sleep apnea, the examiner concluded that it was less likely than not that sleep apnea had its onset during service or was otherwise related to service. There is no competent medical opinion to refute this conclusion or otherwise relate obstructive sleep apnea to service. To the extent that the Veteran and his wife have asserted that sleep apnea was present during service, they do not have the necessary medical knowledge or training to provide a nexus opinion regarding this issue. The issue is medically complex and is therefore outside the competence of lay witnesses in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Veteran has also asserted that his sleep apnea is secondary to his service-connected PTSD. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Regarding causation, the April 2021 VA examiner stated that sleep apnea was not caused by PTSD. Per the medical literature, sleep apnea is caused by narrowing of the airways, which itself is not caused by PTSD. Again, there is no competent medical opinion to refute this conclusion or otherwise causally link sleep apnea to PTSD. With respect to aggravation, however, the VA examiner stated that sleep apnea was at least as likely as not aggravated beyond its natural progression by PTSD. Per the medical literature, PTSD and the medication used to treat it can exacerbate symptoms of sleep conditions, including sleep apnea. VA will not concede that a nonservice-connected condition was aggravated by a service-connected disability unless the baseline level of severity of the nonservice-connected condition is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected condition. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 CFR Part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 38 C.F.R. § 3.310(b). In this case, VA records from April 2004 show the Veteran had previously been diagnosed with sleep apnea but was not using a CPAP device. However, lay statements from the Veteran and his wife indicate the presence of daytime somnolence, which is consistent with a 30 percent rating for sleep apnea under 38 C.F.R. § 4.97, Diagnostic Code 6847. Additional VA records show that the Veteran was using a CPAP device by 2011, although it is not precisely clear exactly when it was first prescribed. Nevertheless, the use of a CPAP corresponds to a 50 percent rating under Diagnostic Code 6847. This establishes the extent of aggravation of sleep apnea by PTSD. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.