Citation Nr: 22014529 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 18-10 030 DATE: March 14, 2022 ORDER Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is denied. FINDING OF FACT The Veteran's sleep apnea did not incur during and was not caused by active-duty service; and sleep apnea was not caused or aggravated by PTSD. CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1968 to February 1970. The Veteran testified before the Board of Veterans' Appeals (Board) and the undersigned Veterans Law Judge in August 2021. During the hearing, the Veteran waived regional office review of new evidence. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. Id. Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran contends that his sleep disorder is secondary to his service-connected PTSD. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by PTSD. The Board concludes that, while the Veteran has a current diagnosis of obstructive sleep apnea (OSA), the evidence persuasively favors finding that the Veteran's OSA is not proximately due to or the result of, or aggravated beyond its natural progression by service-connected PTSD. The Veteran was provided with a VA examination in February 2018. The VA examiner determined the OSA was not caused or aggravated by service-connected PTSD. The examiner explained that sleep apnea is caused by a structural defect in the upper airway. Additionally, the symptoms mentioned by the Veteran were related to PTSD. PTSD does not cause or affect the structures leading to OSA. The Board has considered the Veteran's own assertions that he has a sleep disorder related to his service-connected disabilities. In the August 2017 notice of disagreement, the Veteran asserted that his panic attacks and shortness of breath impacted his sleep apnea. During the August 2021 Board hearing, the Veteran's representative made a general statement that there is documentation that PTSD can lead to sleep apnea. The Veteran reported noticing symptoms before he was diagnosed with OSA, and his diagnosis for OSA was within a year or two of his diagnosis for PTSD. The Board notes the Veteran is competent to report his symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, the VA examiner is a medical professional who reviewed the claims file and considered the reported history. The examiner, in providing the requested medical opinion, utilized their expertise in reviewing the facts of this case and determined that based on medical principles, the Veteran's OSA was not related to PTSD. Although the Veteran's representative alluded to evidence of an association between OSA and PTSD, no such evidence has been provided by the Veteran or his representative. The Board thus finds the opinion of the VA examiner to be more probative. The medical evidence outweighs the lay evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The most probative and credible evidence establishes that the Veteran's OSA is not related to PTSD. Service connection may also be granted on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, the Veteran's STRs are silent for a diagnosis of OSA or symptoms of OSA, and neither the Veteran nor his representative has provided any contentions that the OSA began during active-duty service or is related to the Veteran's active-duty service. Based upon a thorough review of the medical and lay evidence, the record is negative for any evidence showing the Veteran's OSA incurred during or was caused by active service. Therefore, the evidence is also against finding that the Veteran's OSA is related to an in-service injury, event, or disease. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In summary, there is no probative evidence of record which indicates that the Veteran's OSA incurred during service, was caused by service, was caused by PTSD, or was aggravated by PTSD. Based on the analysis above, the Board must find that the evidence is not in approximate balance and that the evidence persuasively favors finding that the criteria for service connection have not been met. Accordingly, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a sleep condition is denied. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. N. Quarles, 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.