SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, who served honorably in the U.S. Army from March 1970 to December 1971, with subsequent Reserve service, appeals the denial of service connection for obstructive sleep apnea (OSA). The veteran contends OSA is related to service, caused or aggravated by his service-connected acquired psychiatric disorder, or linked to in-service sleep complaints like nightmares and insomnia. The Board acknowledged the veteran's in-service complaints of nightmares and insomnia, and his current OSA diagnosis made nearly 45 years post-service. However, the Board found the evidence persuasively weighed against a service connection. The Board assigned great probative weight to October 2025 VA addendum opinions, which concluded it was less likely than not that OSA began during service, related to in-service sleep complaints, or was due to or aggravated by the acquired psychiatric disorder. These opinions cited a 45-year gap, genetic predisposition, and idiopathic etiology as more likely causes. The Board also found no causal link between asbestos exposure and OSA. Lay statements from the veteran and family were deemed not competent to diagnose OSA or establish its etiology. The Board found the evidence not in equipoise, thus the benefit of the doubt did not apply. Service connection for OSA was denied.

Rationale

Current diagnosis of OSA; In-service complaints of nightmares and insomnia; 45-year gap between service and OSA diagnosis; Acquired psychiatric disorder is service-connected; Opinions found OSA less likely than not related to service, psychiatric disorder, or in-service sleep complaints; Lay statements not competent to diagnose OSA or establish etiology

Full Decision Text

Citation Nr: 26000916
Decision Date: 01/22/26	Archive Date: 01/22/26

DOCKET NO. 19-14 888A
DATE: January 22, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea (OSA) is denied.

FINDING OF FACT

The evidence persuasively shows that the Veteran's OSA began many years after separation from active service, is not otherwise related to symptoms noted during active service, is not related to participation in Toxic Exposure Risk Activity (TERA) during active service, and is not proximately due to or aggravated by a service-connected disability. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for OSA have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably on active duty in the United States Army from March 1970 to December 1971. Following separation from active duty, the Veteran served in the United States Army Reserve from November 1972 to March 1977. This matter comes to the Board of Veterans' Appeals (Board) from a May 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 

This matter was previously before the Board in April 2023, at which time it was remanded to the Agency of Original Jurisdiction (AOJ) for further evidentiary development. Following such development, the matter was returned to the Board and in May 2024, the Board issued a decision denying entitlement to service connection for OSA. The Veteran subsequently appealed this denial to the United States Court of Veterans Claims (Court). Before the Court, the Veteran and VA filed a Joint Motion for Remand (JMR) in January 2025, in which the parties agreed that the Board erred as a matter of law when it failed to ensure compliance with the April 2023 remand directives. See 38 U.S.C § 5103A; Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that the Board errs as a matter of law when it fails to ensure compliance with remand orders); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that once the Secretary undertakes the effort to provide an examination, he must provide an adequate one).

The Court granted the JMR in a January 2025 order and returned the claim to the Board for readjudication consistent with its findings. In June 2025, the Board remanded the claim to the AOJ for additional evidentiary development. Pursuant to the June 2025 Board remand's first directive, the AOJ was able to obtain and associate with the Veteran's file the April 2016 diagnostic polysomnography report and corresponding medical record details. Then, in September 2025, the Board again remanded the claim for entitlement to service connection for OSA because addendum medical opinions were still necessary pursuant to Stegall v. West, 11 Vet. App. 268, 271 (1998) and D'Aries v. Peake, 22 Vet. App. 97, 105 (2008).

Following the September 2025 Board remand, the RO obtained two addendum opinions which the Board finds are in substantial compliance with the September 2025 remand decision and directives. Therefore, additional remand is not necessary. See Stegall, supra; D'Aries, supra. 

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. Generally, service connection requires three elements: (1) a current disability diagnosis; (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 established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires sufficient evidence to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated
 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 established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires sufficient evidence to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 

Opinions regarding secondary service connection must address both causation and aggravation. El-Amin v. Shinseki, 26 Vet. App. 136 (2013). 

In adjudicating such claims, reasonable doubt that exists because of an approximate balance of positive and negative evidence concerning any point will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derinski, 1 Vet. App. 49, 53 (1990).

1. Entitlement to service connection for obstructive sleep apnea (OSA) is denied. 

The Veteran contends that his OSA is related to service, or is caused or aggravated by his service-connected major depressive disorder with anxious distress and nightmare disorder with mild cognitive impairment (acquired psychiatric disorder). 

The Veteran's service treatment records (STRs) reveal complaints and treatment for nightmares and insomnia in 1971 during active military service and the Veteran reported trouble sleeping and nightmares during his November 1971 separation examination. See VBMS document titled, "Medical Treatment Record - Government Facility," receipt date 07/17/2009; see also VBMS document titled, "STR-Medical," receipt date 06/07/2010, page 10 of 21. 

The Veteran was initially diagnosed with OSA, a sleep-related respiratory disorder, in 2016, nearly 45 years following separation from active service. See VBMS document titled, "CAPRI," receipt date 11/16/2016, page 153 of 1292.

In May 2019, the Veteran submitted a lay statement asserting a theory of secondary service connection, pondering whether his OSA is due to or aggravated by his service-connected acquired psychiatric disorder. See VBMS document titled, "NOD," receipt date 05/25/2019. 

A November 2023 Toxic Exposure Risk Activity (TERA) memorandum is positive for exposure to asbestos. The TERA memorandum does not indicate participation in any other TERA during the Veteran's service. See VBMS document titled, "Other," receipt date 11/10/2023. 

Accordingly, the Board finds that the Veteran has a current diagnosis of obstructive sleep apnea (OSA), that he complained of and was treated for insomnia and nightmares during active service, and his primary disability of acquired psychiatric disorder is service-connected. 

Therefore, the issue before the Board is whether the Veteran's OSA began during active service, is related to sleep disorder symptoms including nightmares and insomnia that occurred during active service, or is due to or aggravated by the Veteran's service connected acquired psychiatric disorder. 

The Board concludes that the evidence persuasively weighs against finding that the Veteran's OSA began during active service, is related to nightmares and insomnia documented during active service, is related to TERA participation during active service, and/or is due to or aggravated by his service connected acquired psychiatric disorder. 

Evidence & Analysis

The Veteran has been afforded several examinations in connection with his claim for service connection for OSA. As noted in the prior Board remand from June 2025, the Board found that the July 2023 and October 2023 VA examination and opinions were inadequate because the VA examiner did not incorporate or discuss the Veteran's lay reports of his in-service and post-service symptoms and how they relate to his current disability. The June 2025 Board remand further found that the July 2023 and October 2023 VA examination and opinions were inadequate because they failed to discuss or explain why the Veteran's post-service medical history in relation to his service-connected acquired psychiatric disorder, is not relevant or contributory to the Veteran's current OSA disability. 

Then, the September 2025 Board remand found that the July 2025 VA opinions were inadequate and failed to comply with the June 2025 remand directives in that they failed to incorporate or discuss relevant evidence of
 VA examination and opinions were inadequate because the VA examiner did not incorporate or discuss the Veteran's lay reports of his in-service and post-service symptoms and how they relate to his current disability. The June 2025 Board remand further found that the July 2023 and October 2023 VA examination and opinions were inadequate because they failed to discuss or explain why the Veteran's post-service medical history in relation to his service-connected acquired psychiatric disorder, is not relevant or contributory to the Veteran's current OSA disability. 

Then, the September 2025 Board remand found that the July 2025 VA opinions were inadequate and failed to comply with the June 2025 remand directives in that they failed to incorporate or discuss relevant evidence of record. 

Following the September 2025 Board remand, the AOJ obtained new VA opinions in October 2025 with a November 2025 addendum. These opinions address direct, secondary, and aggravation theories of service connection. The Board assigns great probative weight to the October 2025 opinions with November 2025 addendum because they are based on a comprehensive review of the record, considered and discussed implications of the relevant lay evidence and medical history, and the examiners possess the requisite medical expertise, knowledge, training, and skills to make such determinations. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). 

The October 2025 and November 2025 VA examiner opined that it is less likely than not that the Veteran's OSA began during active service or is otherwise related to reports of sleep disorders and symptoms of sleep disorders noted during active service and found that it is less likely than not that the Veteran's OSA is due to or aggravated by his service connected acquired psychiatric disorder. The examiner explained that even though the relevant STRs reveal in-service complaints and treatment related to nightmares and insomnia, and considered that the lay evidence includes the Veteran's assertions that his OSA began during active service, these in-service complaints and noted symptoms are not suggestive of OSA having its onset during active service because of the 45 year gap between separation from service and diagnosis of OSA, and more likely explanation of genetic predisposition or idiopathic etiology. See VBMS documents titled, "C&P Exam," receipt date 10/09/2025, 11/03/2025. 

As to secondary causation, the examiner opined that the Veteran's OSA is less likely than not due to his service-connected acquired psychiatric disorder and explained that his acquired psychiatric disorders are not a known primary etiology of OSA and although OSA is common in patients with the Veteran's diagnosed mental health condition, the medical literature shows that the OSA is more likely secondary to genetic predisposition or idiopathic etiology. Id. 

As to aggravation, the examiner opined that the Veteran's OSA is less likely than not aggravated beyond its natural progression by his service-connected acquired psychiatric disorder and explained that the medical evidence shows that the characteristics of the Veteran's OSA, including "mild" symptoms, adequately treated with CPAP, does not require invasive procedures, fall within the natural history of the condition, and does not represent an aggravation beyond the known natural progression. Id. 

In a separate October 2025 opinion, the examiner also opined that the Veteran's OSA is less likely than not due to exposure to asbestos during active service after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran because asbestos is not a known cause of OSA and there is no probative evidence of record suggestive of a causal relationship between asbestos exposure and the Veteran's OSA. See VBMS document titled, "C&P Exam," receipt date 10/21/2025. 

The opinions show that the VA examiner considered the Veteran's military records and toxic exposures, STRs, lay statements, post-service medical history, web-based medical literature submitted by the Veteran to support his assertions, and medical literature that the examiner noted to support the negative nexus opinions. The examiner indicated that the 45 year gap between separation from active service and diagnosis of OSA is evidence that suggestive of a separate disease process that is unrelated to service and that the medical literature, medical history, and circumstances specific to the Veteran indicate an etiology more likely to be due to genetic predisposition or idiopathic etiology without relation or connection to the Veteran's service, service connected disabilities, and/or in-service TERA participation.

There is no probative medical nexus opinion that supports the Veteran's contentions. 

The record includes 2010 Board hearing testimony by the Veteran, his wife, and other family members who described the Veteran's nightmares and insomnia but their testimonies are silent for any mention of snoring, gasping, and any other symptoms of
 the 45 year gap between separation from active service and diagnosis of OSA is evidence that suggestive of a separate disease process that is unrelated to service and that the medical literature, medical history, and circumstances specific to the Veteran indicate an etiology more likely to be due to genetic predisposition or idiopathic etiology without relation or connection to the Veteran's service, service connected disabilities, and/or in-service TERA participation.

There is no probative medical nexus opinion that supports the Veteran's contentions. 

The record includes 2010 Board hearing testimony by the Veteran, his wife, and other family members who described the Veteran's nightmares and insomnia but their testimonies are silent for any mention of snoring, gasping, and any other symptoms of a sleep disorder other than nightmares and insomnia. See VBMS document titled, "Hearing Testimony," receipt date 01/07/2010. 

The Board has considered the lay opinions, statements, and reports of record that his documented in-service complaints and treatment of nightmares and insomnia were symptoms of undiagnosed OSA, or related to his currently diagnosed OSA. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence may also be competent to establish medical etiology or nexus in certain circumstances where such determination is capable of lay observation alone. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, lay persons such as the Veteran and his family members are not competent to provide a diagnosis of OSA, discern which symptoms are due to OSA or indicative of OSA, nor to render nexus opinions regarding the nature and etiology of the Veteran's OSA because OSA is a complex medical condition that requires medical training and expertise to diagnose, discern symptomatology, and establish etiological relationships. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Therefore, it is outside the competence of the Veteran and his family members in this case to render competent diagnoses, symptomatology findings, and nexus opinions because the record does not show that they have the medical training or credentials to make such determinations. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Thus, the lay statements and reports regarding the onset, related symptoms, and nature and etiology of the Veteran's OSA cannot be afforded probative weight.

In summary, the October 2025 opinions and November 2025 addendum opinion are highly probative of the issues before the board, they are the only probative medical nexus evidence of record, and are therefore the most probative medical evidence that weighs persuasively against finding that the Veteran's OSA began during active service, is related to sleep disorder symptoms during active service, or is due to or aggravated by the Veteran's service connected acquired psychiatric disorder. Absent a relative balance of the evidence for and against the claim, the evidence is not in equipoise and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the weight of the evidence is against the claim for service connection for OSA. Accordingly, the claim is denied.

 

 

Bethany L. Buck

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Webb, Katherine S.

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.