Citation Nr: 21042035 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 19-12 208 DATE: July 11, 2021 ORDER Service connection for obstructive sleep apnea (OSA) is denied. REMANDED Service connection for a right knee disorder. Service connection for a right hip disorder. FINDINGS OF FACT 1. The Veteran had active duty from January 1991 to May 1993 and from February 1994 to October 2011. 2. OSA was not shown in service and is not causally or etiologically related to service. CONCLUSION OF LAW OSA was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (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). Turning to the medical evidence, VA clinical treatment records reflect a current diagnosis of OSA. As such, a current disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the service treatment records (STRs) do not show complaints of, treatment for, or a diagnosis of OSA during service. During a June 2011 separation physical examination, the Veteran reported sleep disturbances; however, no sleep studies were performed during service and no finding of sleep apnea was made. Nonetheless, a fellow service member reflected that he recalled the Veteran snoring loudly while sleeping during service. In addition, he stated that the Veteran often had difficulty breathing while asleep. As such, this lay statement establishes the second element of service connection. As to nexus, the Veteran contends that OSA is due to service in Southwest Asia; however, the medical evidence does not support a nexus between current OSA and service. A July 2016 VA examiner noted that the STRs were negative for a diagnosis of OSA or any other primary sleep disorder. Further, the examiner noted that while the Veteran served in Southwest Asia, the medical literature does not support a causal pathoetiologic connection between such service and the subsequent development of sleep disturbances due to airway obstruction. There are no contradictory medical opinions of record. Accordingly, the medical evidence does not support a nexus between OSA and service. The Board has considered the Veteran's lay statements that his disorder was caused by service. 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 matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examination 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). REASONS FOR REMAND During the September 2020 Board hearing, the Veteran testified that the right knee disorder and right hip disorder were secondary to changes in body mechanics due to lower back and left hip disorders. While he is not service-connected for a left hip disorder, he is service-connected for lumbar spine degenerative arthritis and radiculopathy of the left lower and right lower extremity. A July 2016 VA examiner opined that a right knee and right hip disorder were related to age, but did not address the question of secondary service connection or aggravation. Therefore, the issues are remanded for a new medical opinion. The matters are REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Direct the claims file to a clinician to address whether right knee and right hip disorders are secondary to, caused by, or aggravated by service-connected disabilities, to include lumbar spine degenerative arthritis and radiculopathy of the lower extremities. 3. If the clinician determines that an examination is necessary in order to provide the requested opinions, then one should be scheduled. 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.