Citation Nr: 23014591 Decision Date: 03/10/23 Archive Date: 03/10/23 DOCKET NO. 18-51 628 DATE: March 10, 2023 ORDER Entitlement to service connection for obstructive sleep apnea (OSA) is denied. FINDING OF FACT The competent evidence of record does not show any complaints of, treatment for, or diagnosis of OSA or in the service treatment records (STRs), or an OSA condition manifesting to a compensable level within one year of his separation from service, nor is there a competent diagnosis of OSA, or any competent medical nexus opinion which connects an OSA disability to his military service. CONCLUSION OF LAW The criteria for entitlement to a service connection for OSA have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from December 1972 to December 1975. This matter comes to the Board of Veterans' Appeals (Board) on the Veteran's appeal of a February 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction. In his November 2018 Appeal to the Board of Veterans' Appeals, VA Form 9, he requested a Board hearing. However, in a September 2021 written letter, the request for a Board hearing was withdrawn. 38 C.F.R. § 20.704(e). Service Connection To establish service connection for a disability, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The failure to establish any of the above elements mandates that the claim must be denied. When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). 1. Entitlement to service connection for obstructive sleep apnea The Veteran has pursued an appeal of entitlement to service connection for OSA. He has not presented any specific arguments or assertions as to how he believes OSA was diagnosed or how it is related to service. There is also no assertion that he has OSA on a secondary service connection basis due to his other service-connected disabilities. The Veteran's medical service treatment records (STRs) do not contain entries for complaints of, treatment for, or diagnosis of OSA or any related symptoms or conditions, nor is there a record of OSA manifesting to a compensable level within one year of his separation. The evidence of record also does not contain a competent diagnosis of OSA for the Veteran. There is no record of a sleep study which diagnosed OSA and no medical record containing any diagnosis of OSA. The Veteran's VA treatment records contain no report of diagnosed OSA. There is a September 29, 2010, note which indicated a discussion with the Veteran about the possibility of sleep apnea. However, there is no later reference to follow-up evaluation or any diagnosis of sleep apnea, nor is there any indication of symptoms associated with OSA. The Board notes that in a November 2019 private medical report related to psychological issues, prepared by Dr. M.C., Dr. C noted that on November 29, 2016, the Veteran was diagnosed with OSA. See Report page 4. However, no additional information was provided, such as who made the diagnosis, where it was made, or what evidence supported this diagnosis, such as a sleep study. Nor was there stated a link between this diagnosis and his military service. No other records were provided which substantiated this assertion, and it is clear from the medical report that Dr. C did not physically examine the Veteran in any way and had stated that only a video interview related to the psychiatric matter was conducted. An adequate medical opinion "must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions" and must "provide sufficient detail for the Board to make a fully informed evaluation of whether direct service connection is warranted." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, the Board finds this evidence to have no probative value. Obert v. Brown, 5 Vet. App. 30, 33 (1993) (Medical evidence that is speculative, general or inconclusive in nature cannot support a claim); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). The Board finds that there is no competent evidence which establishes that the Veteran suffered from OSA during his period of military service or that he has a current diagnosis of OSA. The Board finds that the etiology of OSA generally requires an opinion from a trained medical provider. In addition, other than filing the claim for entitlement to service connection for OSA, the Veteran himself has not asserted that a diagnosis has been given or that he ever underwent a sleep study. Therefore, there is no competent evidence of a diagnosis of OSA or any sleep disorder. To the extent that some medical records show the Veteran has reported sleep disturbance, it is shown to be due to and rated as part of his service-connected posttraumatic stress disorder. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The claim for entitlement to service connection for OSA is denied. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Bannach 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.