Citation Nr: 22011807 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 18-43 683 DATE: March 2, 2022 ORDER Service connection for obstructive sleep apnea is granted. FINDING OF FACT Giving the Veteran the benefit of the doubt, his obstructive sleep apnea was caused by his service-connected posttraumatic stress disorder (PTSD). CONCLUSION OF LAW The criteria for entitlement to service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from May 1987 to April 1993. This matter comes before the Board of Veterans Appeals (Board) on appeal from a September 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. In July 2021, the Board remanded the Veteran's claim for additional development. The claim has since been returned to the Board for further appellate action. 1. Entitlement to service connection for obstructive sleep apnea The Veteran contends that his sleep apnea is secondary to his service-connected posttraumatic stress disorder (PTSD). Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Similarly, any increase in severity of a non-service-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the non-service-connected disease, will be service-connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the non-service-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. In January 2014 the Veteran was referred for a sleep study by a VA doctor, and in June 2015 he was diagnosed with sleep apnea after undergoing the study. Thus, the Veteran has a current diagnosis, and the remaining question is whether the condition onset in or was caused by service or was caused or aggravated by any of his service-connected disabilities, including PTSD. In a December 2021 letter, a private psychologist opined that the Veteran's sleep apnea is due as likely as not to his service-connected PTSD. He cited studies showing a connection between anxiety, PTSD, and sleep apnea. He explained that PTSD contains both mental and emotional and physical components. He stated that pathogenic effects include anxiety and/or psychological trauma constricting the muscles of the airway and the effect of chronic stress hormones released during normal stress on the respiratory system. He also stated that being male and African American are the only predisposing factors the Veteran has for sleep apnea. A VA opinion was obtained in August 2021. The VA examiner opined that the Veteran's sleep apnea was less likely than not caused by service, noting that sleep apnea was diagnosed many years after service. The VA examiner further opined that the Veteran's sleep apnea is less likely than not caused by his PTSD. The examiner stated that associative relationship exists between psychiatric disorders, such as PTSD, and sleep apnea, but current literature does not support a causative relationship as of now. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current sleep apnea is proximately due to his service-connected PTSD. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Christensen 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.