Citation Nr: 21042706 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-06 934 DATE: July 13, 2021 ORDER Entitlement to service connection for sleep apnea is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's currently diagnosed sleep apnea began during active service or is otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from October 1984 to October 2004. The Veteran's claim was previously before the Board in January 2019. At that time, the Board determined that the Veteran's record was incomplete and that he should be afforded a new VA examination. At the outset, the Board notes that the RO attempted to develop the record in accordance with the Board remand in an October 2019 subsequent development letter. Therein, the RO requested that the Veteran provide information such as treatment records and additional lay statements. Nonetheless, to date the Veteran has not provided subsequent information. The fulfillment of VA's duty to assist sometimes requires the cooperation of the Veteran to compile a complete medical record. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) ("The duty to assist is not always a one-way street."). The Board finds the RO made reasonable efforts to obtain the treatment records and additional lay statements and thus substantially complied with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for sleep apnea The Veteran contends that he has sleep apnea due to his active service. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.30(a). In order to establish service connection, the evidence must generally show three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). As noted in the prior Board decision, the Veteran has provided evidence of a current diagnosis of sleep apnea. See September 2011 Private Treatment Records. Additionally, he has provided statements from family members and friends regarding symptoms of snoring and trouble breathing during sleep both during service and post-service. As such the remaining question for the Board is whether there is a connection between the Veteran's service and his current diagnosis of sleep apnea. In a January 2020 VA examination, an examiner determined that the Veteran's sleep apnea was less likely than not incurred in or caused by the Veteran's service. The examiner reasoned that the Veteran's service records were reviewed which did not reveal any objective clinical evidence to support the diagnosis of obstructive sleep apnea. The examiner similarly reviewed all lay statements, and the examiner determined that some symptoms mentioned were not necessarily related to sleep apnea, such as clammy skin, sweating, and profuse shaking. The main symptom that was common among the lay statements was that the Veteran suffered from horrific snoring. However, the examiner explained, snoring is not sensitive or specific for the condition of sleep apnea; there are many individuals who snore, and once tested for sleep apnea, are not found to have the condition and vice versa as with individuals that do not snore. While snoring is associated with sensitivity of 80 to 90 percent for the diagnosis of sleep apnea, the specificity is below 50 percent. The actual percentage of snorers who have sleep apnea varies greatly and solid data is lacking. The complaint of snoring, while common in patients with sleep apnea, was found not to have predictive value in one study. On the other hand, the absence of snoring reduces the likelihood of diagnosis of sleep apnea. With sleep apnea, a positive sleep study in the absence of a clinical picture of sleep apnea does not provide a diagnosis of sleep apnea, as there are both false positives and negatives for any test. A test result cannot stand alone without clinical merit and thus ordering a test without appropriate supporting clinical rationale is contraindicated. Therefore, the examiner concluded that there was no symptomatology suggestive of sleep apnea during the Veteran's active duty, and even though the lay statements mention symptoms, they were not specific enough as to present a clinical picture of sleep apnea. The gold standard for diagnosing sleep apnea is a sleep study and along with clinical evidence and evaluation are needed to confirm a diagnosis. The Board places high probative weight on the January 2020 VA examination. The examiner reviewed the Veteran's medical records, lay statements, relevant medical studies, and provided an adequate rationale for the opinion that the Veteran's sleep apnea did not begin in active military service. The examiner specifically referred to the Veteran's lay statements and statements from family and friends regarding his symptomatology. In addition, the examiner thoroughly explained the basis for their reasoning. The Board notes that there is no medical evidence of record to the contrary. The Board has considered the lay statements of record regarding the Veteran's sleep apnea. In this regard, the Veteran and his family and friends are certainly competent to report symptoms, or matters within their personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, and 1376-77 (Fed. Cir. 2007). However, without medical training, the aforementioned have not demonstrated the competency to opine on matters requiring medical expertise, such as the etiology of obstructive sleep apnea. See id. As such, the Board assigns little probative weight to the assertions of record finding that the Veteran's sleep apnea was caused by his military service. After review of the record, the Board finds that the evidence of record is insufficient to grant service connection for sleep apnea. While the Veteran has a current diagnosis of sleep apnea, there is a probative VA examination on file which provides that the Veteran's sleep apnea is not related to service. Therefore, service connection for sleep apnea is not warranted. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection for sleep apnea and there is no doubt to be otherwise resolved. As such, this claim is denied. The evidence in this case is not so evenly balanced to allow application of the benefit-of- the-doubt rule. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Vosburgh, 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.