SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, an Army Veteran who served from October 1965 to October 1967, including service in Vietnam, appeals the denial of service connection for obstructive sleep apnea (OSA) as secondary to his service-connected psychiatric condition, diabetes, and hypertension. The Veteran's service is noted with decorations including the Purple Heart, Bronze Star Medal, and Combat Infantry Badge. The case has a history of remands from the Court of Appeals for Veterans Claims. The Board reviewed medical evidence, including VA examinations from October 2012, January 2023, and March 2024. The March 2024 VA examiner provided a negative nexus opinion, attributing the OSA primarily to obesity and age. However, the same report suggested that PTSD, hypertension, and diabetes could cause or affect OSA. The Board found the evidence evenly balanced, applying the benefit of the doubt to grant service connection for OSA as secondary to his service-connected psychiatric condition, diabetes, and hypertension, citing 38 C.F.R. § 3.310.

Rationale

Medical evidence documents functional impairment and diagnosis of OSA.; VA examiner provided negative nexus for obesity/age but suggested link to PTSD, hypertension, diabetes.; Evidence found evenly balanced, with benefit of doubt applied.

Full Decision Text

Citation Nr: 24018466
Decision Date: 05/01/24	Archive Date: 05/01/24

DOCKET NO. 09-12 389
DATE: May 1, 2024

ORDER

Service connection for obstructive sleep apnea (OSA), as secondary to service-connected disabilities is granted.

FINDING OF FACT

The Veteran's OSA is related to his service-connected psychiatric condition, diabetes, and hypertension. 

CONCLUSION OF LAW

The criteria for service connection for OSA condition have been met.  38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from October 1965 to October 1967, including service in the Republic of Vietnam.  His decorations include the Purple Heart, Bronze Star Medal, and Combat Infantry Badge.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO).

In a June 2022 decision, the Board denied service connection for OSA.  The Veteran appealed the denial from the June 2022 Board decision to the United States Court of Appeals for Veterans Claims (Court).  In a November 2022 Order, the Court granted a Joint Motion for Remand (Joint Motion), and vacated the June 2022 Board decision, and remanded the matter.  

In March 2023, October 2023 and February 2024, the Board remanded for further development. 

Service Connection

In general, service connection may be granted for a disability or injury incurred in or aggravated by active military service.  See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303.  To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability.  See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303.  Service connection may also be established by credible lay evidence and medical evidence provided by the Veteran or otherwise.  See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2018).

Service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service-connected disability; or, aggravated by a service-connected disability.  See 38 C.F.R. § 3.310 (2018); see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 

Service connection for OSA.

The Veteran seeks secondary service connection for OSA condition due to his service-connected conditions.  

The medical evidence documents functional impairment with treatment and a diagnosis of OSA.  See VA medical treatment record (October 2012 and January 2023); VA medical examination (March 2024).  

A VA examination was conducted in March 2024 and addendum was provided later in the same month.  See VA medical examination and addendum (March 2024).  The March 2024 examiner provided a negative nexus opinion noting that the likely cause of the Veteran's OSA was obesity and age.  Nevertheless, the same examination report suggests that post traumatic stress disorder (PTSD), hypertension, and diabetes can cause or affect OSA.  See VA medical examination (March 2024).  

For the above reasons, the evidence for and against the claim is evenly balanced. After resolving any reasonable doubt in favor of the Veteran
 (October 2012 and January 2023); VA medical examination (March 2024).  

A VA examination was conducted in March 2024 and addendum was provided later in the same month.  See VA medical examination and addendum (March 2024).  The March 2024 examiner provided a negative nexus opinion noting that the likely cause of the Veteran's OSA was obesity and age.  Nevertheless, the same examination report suggests that post traumatic stress disorder (PTSD), hypertension, and diabetes can cause or affect OSA.  See VA medical examination (March 2024).  

For the above reasons, the evidence for and against the claim is evenly balanced. After resolving any reasonable doubt in favor of the Veteran, the Board finds that service connection for OSA, as contributed, caused, or aggravated, at least in part, due to service-connected PTSD, diabetes, and hypertension, is warranted.  See 38 C.F.R. § 3.310.

 

 

SHAUN S. SPERANZA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Alvarado

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.