Citation Nr: 22019768 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 13-24 605 DATE: April 3, 2022 ORDER Service connection for obstructive sleep apnea is granted. FINDING OF FACT Affording the Veteran the benefit of doubt, the evidence of record is approximately balanced ("nearly equal") in favor of finding the Veteran's currently diagnosed obstructive sleep apnea (See August 2017 VA examination which noted first diagnosis in 1996) is secondary to his other service-connected disabilities because his obstructive sleep apnea was either caused, in part, or aggravated by his service-connected disabilities due to an increase in weight and body fat brought on by the symptoms associated with his service-connected disabilities. Specifically, the Board finds the Veteran's testimony and statements are competent and credible evidence of symptoms, in some form, related to sleep apnea in service and his lack of desire to exercise due to pain caused from his service-connected musculoskeletal disabilities and lack of motivation caused by his PTSD. The Board finds that, although the VA examinations and medical opinions of record present negative causal link opinions, when considering all of these medical opinions as a whole, they support the Veteran's assertion that 1) he is service connected for many disabilities which have contributed to his weight gain and 2) obesity is a major cause, risk factor, or aggravation of his sleep apnea. To name a few for example, a July 2012 VA treatment record notes that the Veteran was identified as "at risk" for obesity related conditions, which included, among others, sleep apnea; a June 2015 VA treatment record noted the Veteran stated he could not walk very far because of his service-connected knee surgery, leg operation, and reported poor balance and falls; an April 2021 VA medical examiner stated that obesity is the leading risk factor in the development of obstructive sleep apnea due to neck fat obstructing the upper airway and opined that the Veteran's obese body habitus provides the most likely etiology for his obstructive sleep apnea. However, the Board affords the negative causal link VA opinions less probative value because they fail to adequately address the crux of the question at hand with adequate reasons and rationale, which has resulted in numerous remands as noted below. The Board finds those opinions do not persuasively refute the aforementioned evidence indicating observable symptoms of sleep apnea did significantly worsen due to the Veteran's obesity brought on, at least in part, by his service-connected disabilities. The Board notes that this finding is specific to the facts of this case with the specific medical evidence of this case showing a causal relationship between the Veteran's disabilities and associated symptoms, increasing weight, and the development or worsening of sleep apnea symptoms. The Board has reviewed all evidence in the claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Accordingly, service connection for obstructive sleep apnea is warranted. CONCLUSION OF LAW The criteria for secondary service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1970 to January 1972, with service in Vietnam. His discharge certificate shows that he was awarded the Purple Heart Medal. These matters are before the Board of Veterans' Appeals (Board) on appeal from a May 2011 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In May 2016, a videoconference hearing was held before the undersigned; a transcript is in the record. In September 2016, November 2018, December 2020, and August 2021, these matters were remanded for additional development. For the reasons outlined in more detail above in the Findings of Fact section, the appeal for service connection for obstructive sleep apnea is granted. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Williams, 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.