PTSD DUE TO COMBAT

Summary

The Veteran served from August 2001 to August 2004, including service in Southwest Asia. The Veteran appeals the denial of service connection for a sleep disorder, specifically sleep apnea, claimed as secondary to service-connected PTSD. The Board recharacterized the claim to include sleep apnea. Evidence presented includes the Veteran's testimony, lay statements from her mother, and multiple VA examinations. The Veteran reported sleep difficulties and fatigue throughout her service and post-service, with a formal diagnosis of obstructive sleep apnea occurring 13 years after service. A November 2019 VA examiner opined that sleep apnea was less likely than not related to service, citing the delayed diagnosis and obesity as causes. However, earlier VA examinations in December 2008 and August 2013 noted that the Veteran's PTSD caused chronic sleep impairment and sleep disturbances. A January 2024 VA examiner opined that PTSD was not causally related to service and that sleep apnea was less likely than not related to PTSD, attributing it to obesity and noting a lack of in-service sleep complaints. The Board found the earlier opinions more probative, assigning less weight to the November 2019 opinion due to its reliance on the lack of in-service obstructive sleep apnea documentation, and to the January 2024 opinion for not addressing the earlier findings of PTSD-induced sleep impairment. The Board concluded that the evidence supports a causal link between the Veteran's PTSD and her sleep disturbances, including sleep apnea. Service connection for sleep apnea secondary to PTSD was granted.

Rationale

Veteran has current diagnosis of sleep disorder including sleep apnea.; Earlier VA opinions found PTSD causes chronic sleep impairment.; Board found earlier opinions more probative than later negative opinions.

Full Decision Text

Citation Nr: 26000166
Decision Date: 01/07/26	Archive Date: 01/07/26

DOCKET NO. 20-01 546
DATE: January 7, 2026

ORDER

Service connection for a sleep disorder secondary to service-connected posttraumatic stress disorder (PTSD) is granted. 

FINDING OF FACT

The probative evidence of record supports a finding that the Veteran's sleep disturbances, to include sleep apnea, are causally related to her service-connected PTSD. 

CONCLUSION OF LAW

The criteria for service connection for a sleep disorder as?secondary?to a service-connected PTSD are met.?38?U.S.C. §§?1110, 1131, 5107;?38?C.F.R. §§?3.102, 3.310.?  

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from August 2001 to August 2004, including active service in Southwest Asia.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2018 rating decision. In September 2023, the Veteran testified at a hearing before the undersigned Veterans Law Judge, a transcript of which is of record.

This matter was previously before the Board in December 2023 and was remanded for further development. 

As a preliminary matter, upon review of the evidence of record, the Board has elected to recharacterize the Veteran's claim as one for service connection for a?sleep?disorder to?include?sleep?apnea. See Clemons v. Shinseki,?23?Vet. App.?1, 5?(2009) ("the Veteran's claim cannot be "limited only to that diagnosis but must rather be considered a claim for any mental disability that may be reasonably encompassed.")?Id.?? 

Service connection for a sleep disorder secondary to service-connected PTSD is granted. 

Legal Criteria 

Service connection may be?granted?for a disability that is proximately due to, or the result of, a service-connected disability. See?38?C.F.R. §?3.310?(a). When service connection for a?secondary?condition, the?secondary?condition?shall be considered a part of the original service-connected disability. See id; Harder v. Brown,?5?Vet. App.?183, 187?(1993). The controlling regulation has been interpreted to permit a?grant?of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown,?7?Vet. App.?439, 448?(1995).? 

In other words, service connection may be?granted?for a disability found to be proximately due to, or aggravated by, a service-connected disease or injury. To prevail on the issue of?secondary?service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West,?11?Vet. App.?509, 512?(1998); Reiber v. Brown,?7?Vet. App.?513, 516-17?(1995).? 

Service connection can also be established on the basis of continuation of symptomatology. Continuity?of?symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence?of?post-service?continuity?of?the same symptomatology; and (3) medical or, in certain circumstances, lay evidence?of?a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson,?21?Vet. App.?303, 307?(2007). 

Factual Background

The Veteran reported poor sleep and fatigue at an October 2005 psychiatric treatment. 

The Veteran was afforded a December 2008 VA examination during which she reported that she has had trouble sleeping for two years. The conducting examiner noted that the Veteran has not been sleeping well since she developed her mental condition. The examiner further noted that the Veteran has persistent difficulty falling or staying asleep due to a mental health condition.  

The Veteran reported at a July 2011 psychiatric evaluation that her sleep has not been good and that she requires the use of Ambien to fall asleep. 

The Veteran was afforded an August 2013 medical examination for her PTSD during which the conducting examiner noted that her condition produces symptoms of chronic sleep impairment and difficulty falling or staying asleep. 

The Veteran reported at a March 2019
2005 psychiatric treatment. 

The Veteran was afforded a December 2008 VA examination during which she reported that she has had trouble sleeping for two years. The conducting examiner noted that the Veteran has not been sleeping well since she developed her mental condition. The examiner further noted that the Veteran has persistent difficulty falling or staying asleep due to a mental health condition.  

The Veteran reported at a July 2011 psychiatric evaluation that her sleep has not been good and that she requires the use of Ambien to fall asleep. 

The Veteran was afforded an August 2013 medical examination for her PTSD during which the conducting examiner noted that her condition produces symptoms of chronic sleep impairment and difficulty falling or staying asleep. 

The Veteran reported at a March 2019 medical treatment that her sleep is inconsistent, and she only gets 2-3 hours of sleep some nights. The Veteran reported at an October 2019 medical treatment that her PTSD produces symptoms of sleep disturbances.

The Veteran was afforded a November 2019 VA examination during which the conducting physician indicated that the Veteran had a diagnosis of obstructive sleep apnea. The physician opined that it was less likely than not that the Veteran's sleep apnea was causally related to service. As a rationale, the physician explained that the Veteran's condition was not diagnosed until 13 years after exiting from service. The examiner noted that the Veteran's sleep apnea was caused by excessive weight. 

The Veteran testified that at the Board hearing, she noticed symptoms of sleep apnea during service and that she required the usage of Benadryl to fall asleep. The Veteran submitted a buddy statement from her mother, who stated that the Veteran often complained of not being able to sleep and was constantly tired. 

The Veteran was afforded a January 2024 VA examination for her sleep apnea during which the conducting examiner explained that it was less likely than not that the Veteran's PTSD was causally related to service. As a rationale, the examiner explained that the Veteran's service treatment records were silent for any sleep-related complaints that suggest the presence of obstructive sleep apnea during service. 

The examiner also opined that it is less likely than not that the Veteran's obstructive sleep apnea was causally related to her PTSD. As rationale, the examiner explained that is more likely that the Veteran's obesity caused her obstructive sleep apnea. 

The examiner noted that while the Veteran reported poor sleep and insomnia during service, this does not suggest that she was experiencing sleep apnea. The examiner stated that while some individuals with sleep apnea may report insomnia or poor sleep quality, these symptoms alone are not sufficient to diagnose the condition without further evaluation, such as a sleep study. See addendum opinion. 

Analysis 

The Veteran has a current diagnosis of sleep disturbances, including obstructive sleep apnea. Accordingly, the first prong of service connection has been met. See November 2019 VA examination.

What remains for consideration is whether the Veteran's sleep disorder is causally related to her service-connected PTSD.

The Board assigns probative value to the December 2008 and March 2013 medical examiners' opinions, who indicated that the Veteran's PTSD produces symptoms of chronic sleep impairment. 

The Board does not assign probative value to the November 2019 VA examiner's negative opinion because they relied on a lack of documentation of in-service reports of obstructive sleep apnea. See Dalton v. Peake, 21 Vet. App. 23 (2007). Accordingly, the Board does not assign probative value to this negative opinion.

While the January 2024 VA examiner opined that the Veteran's obstructive sleep apnea was not causally related to or aggravated by his service-connected PTSD, the Board notes that they did not remark on the December 2008 and March 2013 examiners' findings that the Veteran's PTSD caused sleep disturbances and sleep impairment. Accordingly, the Board does not assign probative value to this negative opinion.

Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran's sleep disturbances, to include sleep apnea, are causally related to her service-connected PTSD.

As such, service connection is granted. 

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bahus, Alexander

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.