Citation Nr: A26041013 Decision Date: 04/30/26 Archive Date: 04/30/26 DOCKET NO. 251009-596396 DATE: April 30, 2026 ORDER The request to readjudicate the claim for service connection for a lumbar spine disorder is granted. Service connection for obstructive sleep apnea is granted. Service connection for right knee disorder is denied. REMANDED Service connection for a lumbar spine disorder back is remanded. Service connection for left leg disorder is remanded. FINDINGS OF FACT 1. New and relevant evidence was received sufficient to readjudicate the claim for service connection for a lumbar spine disorder. 2. The Veteran's sleep apnea has been related to his service connected posttraumatic stress disorder (PTSD). 3. The Veteran's right knee disorder is less likely than not related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for readjudicating the claim for service connection for a lumbar spine disorder have been met. 38 U.S.C. §§ 5103, 5108; 38 C.F.R. § 3.2501. 2. The criteria for service connection for obstructive sleep apnea as secondary to PTSD have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 3. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2011 to June 2015. His service decorations include the Sea Service Deployment Ribbon. In the October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March, May, and August 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding the claims for service connection for lumbar spine and left leg disorders, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). The Board notes that the Veteran identified a March 2025 rating decision as on appeal in this matter. However, in provide the most beneficial outcome for the Veteran, the Board has presumed that the Veteran intended to appeal May and August 2025 rating decision in addition to the March 2025 decision identified. This provides a longer evidentiary window for review by the Board. New Relevant Evidence VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d). "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501 (a)(1). Lumbar Spine Disorder Here, the Veteran submitted a supplemental claim application in December 2024 seeking service connection a lumbar spine disorder. Following the SCA, VA obtained medical records associated with the Veteran's treatment. After review of the record, the Board finds that the evidence obtained after receipt of the Veteran's December 2024 SCA does tend to prove or disprove the claims at issue. Accordingly, the Board finds that new and relevant evidence has been presented to readjudicate the previously denied claim for service connection for a lumbar spine disorder. As such, the claim is reconsidered. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Sleep Apnea In February 2025, the Veteran filed a SCA seeking service connection for sleep apnea. The Veteran has a conceded diagnosis of sleep apnea. See May 2023 rating decision. Concurrent with his SCA, the Veteran submitted a medical opinion from a private provider regarding the relationship between his sleep apnea and his service connected PTSD. The private examiner noted review of the Veteran's file, including his medical records and his service treatment records (STRs). The examiner discussed in detail the relationship between PTSD and sleep apnea and the mechanism by which PTSD can exacerbate sleep apnea, including inflammation which contributes to sleep apnea. Ultimately, after review of the Veteran's record, the examiner found that there was a nexus between the Veteran's PTSD and his sleep apnea. The Veteran's sleep apnea was found to be aggravated by his PTSD. As such, the Board finds that service connection for sleep apnea as secondary to PTSD is warranted. The Veteran has a confirmed diagnosis of sleep apnea, and a medical professional has provided a qualified, well-reasoned and supported opinion that his sleep apnea is aggravated by his PTSD. The Board is aware that a February 2023 VA examiner found the Veteran's sleep apnea was less likely than not related to his conceded in-service toxic exposures. However, that examination did not provide any opinion as to the possible relationship between the Veteran's PTSD and his sleep apnea. Furthermore, an October 2025 VA examination opinion was obtained after May 2025 rating decision on appeal as it pertains to sleep apnea. Thus, the Board is precluded from consideration of that examination report. Service connection for sleep apnea, then, is granted. Right Knee The Veteran sought service connection for a right knee disorder. The Veteran has a conceded right knee diagnosis and had treatment for right knee pain while on active duty. See August 2025 rating decision. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). Thus, the first and second elements of service connection have been met. The issue presented to the Board, then, is if the Veteran's currently diagnosed right knee strain is related to his in-service right knee treatment. The record shows that the Veteran reported right knee pain while on active duty in December 2011 and was diagnosed with right patellar tendonitis. The Veteran's STRs contain no other treatment for or diagnosis of a right knee disorder. The Veteran's right knee separation medical history and separation examination are without documentation of right knee pain or diagnosis. Furthermore, there are no medical records of evidence which indicate that the Veteran had continuity of symptomology in and since service. There are no private or VA medical records which document right knee treatment or reports of pain since service. The Veteran was provided a VA examination regarding his right knee in February 2023. He reported slow onset of right knee pain in 2011/2012. The examiner found that the Veteran's currently diagnosed right knee strain was less likely than not related to his active duty, including his documented in-service noting that the Veteran did not have any treatment for his right knee disorder since his 2011 in-service treatment. After review of the foregoing, the Board finds that the persuasive evidence of record is against finding that the Veteran's currently diagnosed right knee strain is related to his active duty service. The Veteran has not provided any statement which indicates that his right knee has been painful since his active duty. There are no medical records which show that the Veteran has had report of or treatment for right knee pain since his active duty. Additionally, the VA examiner found that it was less likely than not that the Veteran's right knee strain was related to his active duty service. As such, the Veteran's claim must be denied. In so finding, the Board has considered the Veteran's statements. The Board finds that though the Veteran is competent to report observable symptoms he experienced through his senses, the Veteran has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). The Board affords more probative weight to the VA examiner, who conducted examination of the Veteran, considered his statements, and did a thorough review of the record, which included the lay statements of record. The Veteran and his representative have not indicated that the examination provided was inadequate or contradicted the examination findings in any manner. Accordingly, as the persuasive evidence of record is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Lumbar Spine The Veteran has sought service connection for a lumbar spine disorder as secondary to his service connected left knee disability. A VA examination opinion obtained in February 2023 found that the Veteran's lumbar spine disorder was not due to or caused by his service connected left knee disability. That is not, however, the correct standard by which secondary service connection is evaluated. As such, the February 2023 VA examination opinion is inadequate for adjudication purposes. This represents a pre-decisional duty to assist error which must be corrected on remand. Left Leg The Veteran has also sought service connection for a left leg disorder. A VA examination opinion obtained in February 2023 found that the Veteran's left leg disorder was less likely than not related to his active duty service. However, the examiner stated that the Veteran did not have in-service treatment for his left leg disorder after 2013. Review of the Veteran's STRs, however, shows the Veteran did have complaint of and treatment for left quadricep pain in January 2014. Thus, the VA examination opinion is inadequate for adjudication purposes. This represents a pre-decisional duty to assist error which must be corrected on remand. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his lumbar spine and left leg disorders. The claims file should be made available to the examiner for review. As to the Veteran's lumbar spine, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his lumbar spine disorder was caused or aggravated by his service connected left knee disability. The examiner is advised that for secondary service connection, "aggravation" need not be permanent in nature. Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). The opinion as to whether a claimed disability has been aggravated by a service-connected disability should be provided without regard to the phrase "beyond its natural progression." See Spicer v. McDonough, 61 F.4th 1360, 1364 (2023). As to the Veteran's left leg, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his left leg disorder was incurred in, or due to, the Veteran's service. The Veteran's lay statements regarding onset and continuity of symptomology should be recorded and considered. (Continued on the next page) ? A rationale for all opinions must be provided. Ardie A. Bland Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.P. 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.