Citation Nr: 22014071 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 20-22 956 DATE: March 11, 2022 ORDER Service connection for obstructive sleep apnea is granted. FINDING OF FACT The Veteran's obstructive sleep apnea is caused by his service-connected posttraumatic stress disorder (PTSD). CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea, as secondary to service-connected PTSD, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1967 to January 1970, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Secondary Service Connection Service connection is warranted for disability proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310 (a), (b). Service connection for obstructive sleep apnea. The Veteran claims that his obstructive sleep apnea is secondary to service-connected PTSD. See, e.g., Veteran's claim (August 2018). The Veteran also reports that his obstructive sleep apnea is due to his military service. In this case, the evidence supports that the Veteran's obstructive sleep apnea is secondary to his service-connected PTSD, which will be explained below; and thus, service connection on a direct service connection basis will not be discussed further. For the reasons below, service connection for obstructive sleep apnea, on a secondary basis, is warranted. The medical evidence shows a diagnosis of obstructive sleep apnea. See VA examination report (September 2018); private treatment report (July 2019). Therefore, the current disability element has been satisfied. In this case, the evidence, taken together as a whole, reflects that the Veteran's service-connected PTSD caused his obstructive sleep apnea. For example, in a July 2019 treatment record, the Veteran's private treatment provider (who specializes in pulmonary, sleep, and critical care medicine) physically examined the Veteran, provided a medical history of the Veteran's obstructive sleep apnea, indicated that the Veteran was currently being treated for his PTSD symptoms, and stated that the Veteran's obstructive sleep apnea is "as likely as not to be caused in part by PTSD". Also, in May 2020 email correspondence, a Doctor of Philosophy, R.R. (who is a post-doctoral research fellow in the division of sleep and circadian disorder) stated that a medical article, titled Journal of Clinical Sleep Medicine, found a "strong link between PTSD and OSA." Specifically, R. Robbins indicated that the medical article shows that males who are 55 and older with PTSD were 83 percent more likely to have obstructive sleep apnea. The Board finds that the July 2019 treatment provider's statement that the Veteran's obstructive sleep apnea is "as likely as not to be caused in part by PTSD" is highly probative as to whether the Veteran's obstructive sleep apnea was caused by his service-connected PTSD. To this extent, although the July 2019 physician did not provide a rationale following his statement, the July 2019 private treatment record reflects that the statement was based on a physical examination of the Veteran, his history of sleep apnea and PTSD, and the July 2019 treatment provider's medical expertise. To this extent, the July 2019 treatment provider specializes in sleep disorders. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). While the May 2020 email correspondence may not specifically indicate that the Veteran's obstructive sleep apnea was caused by his service-connected PTSD, the May 2020 email correspondence is probative as to whether there is a relationship between obstructive sleep apnea and PTSD, as the Doctor of Philosophy, R.R., cited to a medical article which found that individuals (who are males and 55 and older-such as the Veteran) with PTSD are at a very high risk of developing obstructive sleep apnea. Also, the medical article was provided by a Doctor of Philosophy, R.R., who is a post-doctoral research fellow in the division of sleep and circadian disorder. There is one VA negative opinion of record, dated in November 2018, that found that the Veteran's obstructive sleep apnea is less likely than not due to or the result of his PTSD. The November 2018 opinion is afforded no probative value, as the favorable evidence of record was not addressed or considered. See Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (the Board may not simply adopt a medical examiner's opinion that fails to discuss favorable evidence of record but must instead account for that favorable evidence with an adequate statement of reasons or bases). In sum, the Board finds that the evidence weighs persuasively in favor of finding that the Veteran's obstructive sleep apnea was caused by his service-connected PTSD. See 38 U.S.C. § 5107(b); Lynch v. McDonough, No. 20-2067 (Fed. Cir. 2021). Accordingly, service connection for obstructive sleep apnea, as secondary to service-connected PTSD, is warranted. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Castillo, 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.