Citation Nr: 22017117 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 14-09 235 DATE: March 24, 2022 ORDER Entitlement to service connection for hypersomnolence and narcolepsy is granted. FINDING OF FACT The evidence persuasively shows that the Veteran's hypersomnolence and narcolepsy began in service. CONCLUSION OF LAW The criteria for service connection for hypersomnolence and narcolepsy have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from January 2009 to July 2009. This matter comes before the Board of Veterans' Appeals on appeal from a June 2012 rating decision of the VA Regional Office (RO). The Board previously remanded this matter for additional development in January 2018 and May 2021. Entitlement to service connection for narcolepsy The Veteran contends that her sleep disorder symptoms began during active duty training in 2009. She further contends that medications that were used to treat urinary symptoms in service caused her sleep disorder. See September 2020 statement. 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. § 3.303 (a). Establishing service connection generally requires competent evidence of 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). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be established by showing evidence of a chronic disease in service, which requires a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303 (b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. The provisions of 38 C.F.R. § 3.303 (b) pertaining to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Organic diseases of the nervous system are listed among the chronic diseases in 38 C.F.R. § 3.309 (a). Moreover, certain chronic diseases, including organic diseases of the nervous system, may be presumed to have been incurred or aggravated during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1110, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may be established under 38 C.F.R. § 3.303 (b), if a chronic disease or injury is shown in service, and subsequent manifestations of the same chronic disease or injury at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. For a showing of a chronic disorder in service, the mere use of the word chronic will not suffice; rather, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. The Board concludes that the Veteran has a current disability that began during ative service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA treatment records dated in September 2019 reflect that a VA neurologist diagnosed the Veteran with narcolepsy, with symptoms since 2009, and excessive daytime hypersomnolence. During service, in June 2009, the Veteran reported sleep complaints. A June 2009 treatment record showed that the Veteran had been on Ditropan for several months for urge incontinence, but it had not helped her symptoms. She reported that she was awakened several times a night with symptoms, and it was beginning to interfere with her ability to be awake and alert in class. She was diagnosed with urge incontinence of urine. A second June 2009 entry in the service treatment records shows that the Veteran reported extreme drowsiness since being on Ditropan for urge incontinence. She complained of falling asleep in formation and reported that she had to rush to the toilet immediately upon urge, wearing pads to try to prevent soiling. Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. In August 2021, a VA examiner provided a negative opinion for a sleep disorder secondary to service-connected disabilities. The examiner opined that there is no evidence that the veteran's claimed narcolepsy condition was caused by a service-connected disability. Therefore, the veteran's claimed narcolepsy is less likely than not proximately due or the result of the veteran's service-connected condition. In August 2021, a VA examiner opined that narcolepsy is at least as likely as not related to service. The examiner noted that an August 2008 examination showed that the Veteran did not have a sleep disorder prior to service. A June 2009 entry in the service treatment records noted that the Veteran had extreme drowsiness since starting Ditropan for urge incontinence. She reported falling asleep in formation. The examiner reviewed medication notes indicating that pain medications for the Veteran's knee injury and Ditropan may cause somnolence. The examiner observed that most other substitutes have somnolence as adverse effects. The examiner noted that records showed that it was felt that Enablex may be less likely to cause drowsiness, but it was not carried in formulary. The examiner concluded that the Veteran's hypersomnolence condition is chronic and recurrent and it had an onset while the veteran was in service. Therefore, the veteran's claimed hypersomnolence condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. Upon review of the record, the Board finds that the evidence persuasively shows that the onset of hypersomnolence and narcolepsy occurred in service as a result of medications used to treat the Veteran's urinary symptoms in service. Accordingly, the Board finds that service connection for hypersomnolence and narcolepsy is warranted. J. Nichols Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Catherine Cykowski 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.