SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

PAULETTE VANCE BURTON · 2026 · Case ID: 26000852

DENIED

Summary

The Veteran, who served in the U.S. Navy from February 1989 to February 1992, appeals the denial of service connection for obstructive sleep apnea (OSA), including a claim that it is secondary to his service-connected posttraumatic stress disorder (PTSD). The Board previously remanded this issue for additional development, including VA examinations to assess the nexus between the Veteran's OSA and his service. The subsequent VA examinations and medical opinions consistently found that the Veteran's OSA was less likely than not caused by his service. The examiners cited the lack of in-service complaints, treatment, or diagnosis of OSA, with the first documented diagnosis occurring in August 2014, well after service. One opinion specifically stated OSA is not medically related to PTSD according to current literature and is more likely caused by post-service factors like obesity, male sex, and age. The Board found the private medical opinions, which attributed OSA to factors other than service, to be more persuasive than the Veteran's lay assertions. The Board concluded that the evidence was not evenly balanced, and the weight of the competent and credible evidence was against the claim, leading to the denial of service connection for OSA.

Rationale

No in-service complaints, treatment, or diagnosis of OSA.; Private treatment records and VA records did not mention OSA symptoms until 2009, with diagnosis in 2014.; Multiple VA medical opinions found OSA less likely than not caused by service or PTSD.; Examiners cited lack of nexus and alternative causes (obesity, age) for OSA.; Lay assertions regarding etiology lack probative value for complex medical matters.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-05 014

Full Decision Text

Citation Nr: 26000852
Decision Date: 01/22/26 Archive Date: 01/22/26

DOCKET NO. 16-05 014
DATE: January 22, 2026

ORDER

Service connection for obstructive sleep apnea (OSA), to include as due to service-connected posttraumatic stress disorder (PTSD) is denied.

FINDING OF FACT

The Veteran's obstructive sleep apnea (OSA) is not secondary to service-connected posttraumatic stress disorder (PTSD) and is not otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for obstructive sleep apnea (OSA), to include as due to service-connected posttraumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the United States Navy from February 1989 to February 1992.

These issues were previously before the Board. In November 2023, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to schedule VA examinations that, in pertinent part, provide an opinion as to whether the Veteran's OSA was caused by his service, to include the reports of the Veteran and his spouse of having symptoms of OSA in-service and since service.

The AOJ scheduled a VA examination for the Veteran's OSA in October 2024 and additional medical opinions from November and December 2024. Thus, the Board finds that the Regional Office (RO) substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998).

Following evidentiary development, the VA Appeals Management Center (AMC) continued the previous denials in a supplemental statement of the case (SSOC) issued in January 2025. The Veteran's VA claims file has been returned to the Board for further appellate proceedings.

Before the matter was certified to the Board, in a January 2025 rating decision, the RO granted service connection for coronary artery disease with cardiomyopathy, atrial fibrillation, myocardial infarction and AICD implantation and assigned an initial 30 percent rating, effective June 17, 2011. The award of service connection constitutes a complete grant of the benefit sought on appeal. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of downstream elements such as the disability rating or effective date assigned).

The Veteran appeared at a March 2019 videoconference hearing before a Veterans Law Judge. The hearing transcript is of record. In February 2025, the Veteran was notified that the Veterans Law Judge who conducted the March 2019 hearing had retired and he had the right to another Board hearing if he responded within 30 days of the February 2025 notice. If he did not respond, the letter stated that the VA will assume that the Veteran did not want another hearing. The 30-day window passed and the neither the Veteran nor his representative wanted an additional hearing. Instead, the Veteran's representative submitted a Post-remand brief in February 2025.

Service Connection

Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. Id.; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). "It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran." Gilbert, 1 Vet. App. at 54.

1. Service connection for obstructive sleep apnea (OSA), to include as due to service-connected posttraumatic stress disorder (PTSD)

The Veteran contends that his OSA was caused by his service.

The Veteran's service treatment records do not show any complaints of, treatment for, or diagnoses of sleep apnea. In a February 1992 medical examination, the Veteran weighed 208 pounds and was noted as having a medium build.

Private treatment records for the Veteran's heart from October 2003 show that the Veteran weighed 235 pounds with no complaint of any sleep apnea related symptoms. In November 2003, his wife reported "symptoms suggestive of sleep apnea." The plan was for a follow-up in 3 months and to be tested for sleep apnea. There was no mention of any OSA symptoms in the follow-up visit that happened in February 2004. Due to insurance issues, the Veteran did not see the private practitioner in 2006. He reported that he had trouble sleeping as he worked the night shift. There are no mentions of sleep apnea or symptoms suggestive of sleep apnea, even through 2008.

VA Medical Center treatment records show that the Veteran reported fatigue in August 2006, but there were no complaints regarding sleep. Other treatment records show that the Veteran's sleep problems are associated with his PTSD, but do not mention a diagnosis of OSA.

An October 2009 private medical opinion attributes fatigue to the Veteran's heart problems, although it mentions that the Veteran was "diagnosed with sleep apnea in 2008" and that he is to be "evaluated for sleep apnea."

VA Medical Center treatment records from November 2010 shows the Veteran reporting that he is diagnosed with sleep apnea but was not using continuous positive airway pressure and that he had been smoking half pack of cigarettes per day for 10 years.

In a January 2013 Gulf War General Medical Examination, the Veteran did not endorse sleep apnea or sleep disturbances.

In August 2014, the Veteran underwent a sleep study and was diagnosed with obstructive sleep apnea.

In March 2019, the Veteran and his spouse testified that while the Veteran had symptoms as early as in 1998, or 6 years after discharge, he was not diagnosed with sleep apnea until 2014.

The Veteran underwent a VA examination for the Veteran's OSA in October 2024. The examiner opined that the Veteran's OSA was less likely than not caused by his service. As rationale, the examiner based the opinion on the lack of complaints, treatment, or diagnosis during service and diagnosis in August 2014, while noting a reference to OSA in May 2009. The examiner added that the first documented report of the symptoms was in 2009.

Another medical opinion was added in November 2024. Here, the examiner opined that OSA was less likely than not caused by the Veteran's service-connected PTSD as they are not medically related according to existing medical literature. The examiner opined that a more likely cause was a post-service event, illness, or injury.

Yet another VA medical opinion was added in November 2024 that attributed the Veteran's difficulty sleeping to his heart problems. The examiner, however, did not suggest that the Veteran's sleeping problems were indicative or related to sleep apnea which had not yet been diagnosed at the time of the Veteran's complaint in 2009.

In December
the first documented report of the symptoms was in 2009.

In December 2024, a medical examiner opined that the Veteran's OSA was less likely than not caused by any Toxic Exposure Risk Activities (TERA). Rather, the examiner explained that the most common causes of OSA were obesity, male sex, and advancing age. The examiner added that there is no medical or scientific evidence supporting a causal relationship between the Veteran's OSA and TERA.

After reviewing the evidence of record, the Board finds that the Veteran's OSA was less likely than not caused by his service.

As discussed at length above, there is no medical opinion supporting the Veteran's contentions. All of the medical opinions of record attribute the Veteran's OSA to factors other than his active service, his PTSD, or TERA and have supported their medical opinions with adequate rationale. There are no medical opinions to the contrary.

To the extent the Veteran asserts that a relationship exists between his OSA and his symptoms, the Board finds that such assertions do not provide persuasive evidence in support of the claim. The matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals. Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the etiology of the Veteran's OSA is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, lay assertions as to the etiology of the Veteran's OSA have no probative value. In summary, the absence of competent medical or scientific evidence documenting a relationship between the Veteran's OSA and his service, service connection must be denied.

The Board is cognizant that the lay evidence of record demonstrates that the Veteran has a longstanding history of sleep apnea related symptoms. Although the Veteran has a longstanding history of sleep apnea related symptoms, this evidence does not demonstrate that the suspected sleep apnea related symptoms developed into a clinical diagnosis in accordance with the diagnostic criteria until the August 2014 sleep study. The diagnosis of sleep apnea requires special testing, and therefore the evidence of record establishes that the Veteran's suspected sleep apnea related symptoms did not develop into a clinical diagnosis of sleep apnea until August 2014.

Therefore, the evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54. The weight of the competent and credible evidence is against the Veteran's claim, and as such entitlement to service connection for OSA is denied.

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board H. Yun

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.

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