SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

C. CRAWFORD · 2026 · Case ID: 26003457

GRANTED

Summary

The Veteran, who served in the U.S. Navy from July 1988 to May 1992, appeals the denial of service connection for sleep apnea and a back condition. The Board found service connection for sleep apnea warranted, granting the claim. The Veteran reported trouble sleeping and fatigue in service, and a private medical opinion from Dr. R.P. in July 2025 provided a cogent rationale linking the sleep apnea to in-service sleep issues and operational stressors, finding it at least as likely as not related to service. This opinion was found more probative than a VA fee-based opinion which found the condition less likely than not related to service, citing a delayed diagnosis and minimal in-service complaints. For the back condition, the Board found the Veteran had a current disability and met the second element of service connection through her contentions of carrying heavy equipment and awkward positions as an airplane mechanic, which the Board found consistent with service. However, service treatment records were negative for back complaints. The Board afforded no probative weight to private opinions from December 2019 and November 2022 due to lack of rationale or inconsistency with the record. A VA fee-based opinion in October 2020 found the back condition less likely than not related to service, citing lack of objective in-service complaints and a 15-20 year gap before treatment. However, a subsequent private opinion from Dr. R.P. in July 2025 linked the back condition to in-service duties, and the Board found the evidence in relative equipoise. Resolving doubt in the Veteran's favor, service connection for the back condition was granted.

Rationale

Current diagnosis of sleep apnea established.; In-service complaints of trouble sleeping and fatigue, and reports of snoring, support second element.; Private opinion from Dr. R.P. (July 2025) found sleep apnea at least as likely as not related to service, with cogent rationale.; VA fee-based opinion (Oct 2020) found less likely than not related to service, afforded less probative weight.; Benefit of the doubt resolved in Veteran's favor.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

15-40 301

Full Decision Text

Citation Nr: 26003457
Decision Date: 03/17/26 Archive Date: 03/17/26

DOCKET NO. 15-40 301
DATE: March 17, 2026

ORDER

Entitlement to service connection for sleep apnea, to include as secondary to service-connected persistent depressive disorder is granted.

Entitlement to service connection for a back condition, to include as secondary to a service-connected left shoulder condition is granted.

FINDINGS OF FACT

1. The Veteran's sleep apnea was incurred during her active duty.

2. Resolving all reasonable doubt in favor of the Veteran, her back condition is etiologically related to her active service.

CONCLUSIONS OF LAW

1. The criteria for service connection for sleep apnea, to include as secondary to service-connected persistent depressive disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a back condition, to include as secondary to a service-connected left shoulder condition have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Navy from July 1988 to May 1992.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

The issues on appeal previously were denied by the Board in October 2023. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In an October 2024 Order, pursuant to a October 2024 Joint Motion for Partial Remand (JMPR), the Court vacated the Board's October 2023 decision and remanded the claim for action consistent with the terms of the parties' JMPR.

In August 2019, August 2022, and June 2025 the Veteran testified at hearings before the undersigned Veterans Law Judge (VLJ). The transcripts are of record.

The Board remanded the claims on appeal in February 2020 for additional development. The Board's remand directives have been substantially completed. See Stegall v. West, 11 Vet. App. 268 (1998).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, to establish service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307, so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b).

Service connection may be established for chronic diseases, to include arthritis, manifesting to a certain degree within a year after service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a).

In addition to service connection on a direct basis, service connection may also be granted for a disability that is caused by or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence persuasively favors one side or the other. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal," and does not require that the evidence be in exact equipoise. Id.; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).

1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected persistent depressive disorder.

The Veteran primarily contends that her sleep apnea is related to her active military service. For the reasons that follow, the Board finds that service connection is warranted.

There is no dispute that the Veteran has a current diagnosis of sleep apnea. See Private treatment records; October 2020 VA fee-based examination. Accordingly, the first element of service connection has been met.

Regarding in-service incurrence, the Veteran contends that she snored, had trouble sleeping, and experienced fatigue in service. See August 2019 hearing transcript; August 2022 hearing transcript; June 2025 hearing transcript. On her April 1992 Report of Medical History at separation, the Veteran reported "yes" to "frequent trouble sleeping." The examining provider noted that the Veteran had difficulty falling asleep twice per week. In light of the foregoing, the Board also finds that the second element of service connection has been met.

Turning to the third element of service connection, a causal nexus, the Board finds this element also has been met.

The Veteran has reported that she experienced trouble sleeping, including insomnia, and fatigue in service which continued until her diagnosis of sleep apnea in 2008. See June 2025 hearing transcript. The Veteran also has reported that she was told that she snored in service. See August 2019 hearing transcript.

Pursuant to the Board's February 2020 remand, a VA fee-based opinion was obtained in October 2020. The examiner opined that it was less likely than not that the Veteran's sleep apnea was related to her active service. The examiner noted that the Veteran was diagnosed with sleep apnea in 2008, 16 years after the reported of sleeping issues at separation. Regarding such report, the examiner noted that the assessment during her separation exam revealed that the duration of the complaint of sleep issues was two weeks. The examiner also noted a September 1989 service treatment record noting frequent syncopial episodes that were the cause of her accident which led to her admission for three days for observation. It was noted that she was anemic and near term in her pregnancy. She further noted that there was no mention of sleep issues while in the hospital or any medical records to indicate objective evidence of reported fainting episodes continued or were in any way related to falling asleep. Thus, the examiner concluded that the Veteran's sleep apnea was less likely than not caused by the reported fainting spells or the complaints of trouble sleeping for approximately two weeks prior to separation.

In December 2019, the Veteran submitted a private opinion by Dr. R.N.P. However, no rationale is provided for the opinion, and as such, it is afforded no probative weight.

In an October 2022 opinion, Dr. R.T. opined that it was least as likely as not that the Veteran's sleep apnea is related to her active service. Dr. R.T. explained that generally diagnoses of sleep apnea are generally delayed for a number of years until symptoms become obvious or a physician specifically elicits them. He opined that given the natural history of sleep apnea, it is very reasonable to associate the Veteran's in-service sleep issues with a diagnosis of sleep apnea.

In a July 2025 opinion, Dr. R.P. opined that it was at least as likely as not that the Veteran's sleep apnea was related to her active service. Dr. R.P. opined that the Veteran's in-service snoring and unrefreshing sleep were early manifestations of her sleep apnea and also explained that there is a strong correlation between military-related stress and the onset of sleep disorders such as sleep apnea. She explained that the persistent operational stressors may
of years until symptoms become obvious or a physician specifically elicits them. He opined that given the natural history of sleep apnea, it is very reasonable to associate the Veteran's in-service sleep issues with a diagnosis of sleep apnea.

In a July 2025 opinion, Dr. R.P. opined that it was at least as likely as not that the Veteran's sleep apnea was related to her active service. Dr. R.P. opined that the Veteran's in-service snoring and unrefreshing sleep were early manifestations of her sleep apnea and also explained that there is a strong correlation between military-related stress and the onset of sleep disorders such as sleep apnea. She explained that the persistent operational stressors may have played a critical role in the development of her condition.

The Board finds the July 2025 opinion by Dr. R.P. to be the most probative in this case. The opinion is supported by the most complete rationale of all three opinions, and although the VA examiner considered the Veteran's reports of snoring and fatigue in service, she did not specifically address why the Veteran's sleep apnea was not related to such complaints. Thus, the Board affords the VA fee-based opinion less probative weight.

Accordingly, as the most competent and probative evidence of record indicates that the Veteran's sleep apnea is related to her active service, service connection for sleep apnea is warranted, and the claim is granted.

2. Entitlement to service connection for a back condition, to include as secondary to a service-connected left shoulder condition

The Veteran primarily contends that her back condition is related to her active military service, specifically her duties as an airplane mechanic. For the reasons that follow, and resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection is warranted.

The evidence of record shows a current disability related to the Veteran's back. See October 2020 VA fee-based examination. As such, the first element of service connection is met.

A review of the Veteran's STRs does not show any complaints, treatment, or diagnoses related to the Veteran's back. On her April 1992 Report of Medical Examination her back was noted as normal, and she reported "no" to "recurrent back pain" on the accompanying Report of Medical History.

As noted above, the Veteran contends that her current back condition is related to carrying heavy equipment and laying in awkward positions as an airplane mechanic. See December 2019 correspondence. The Board finds that the Veteran's contentions are consistent with the circumstances, conditions, and hardships of her service. Thus, the second element of service connection, an in-service event, is met.

Turning to the third element of service connection, a causal nexus, the Board finds that this element also has been met when resolving all reasonable doubt in favor of the Veteran.

While positive private opinions were submitted in December 2019 and November 2022, the Board affords them to be of no probative weight. With regards to the December 2019 opinion by Dr. R.N.P., no rationale for the opinion was provided. Regarding the opinion submitted in November 2022, the rationale for the opinion simply restates the Veteran's in-service duties without an explanation as to how the Veteran's current back condition is related to such. Additionally, the opinion also is based on the Veteran's reports of experiencing back pain in and since service which are inconsistent with the other evidence of record, including multiple private treatment records noting that the Veteran's back pain began in 2009. See also April 1992 Report of Medical History; Curry v. Brown, 7 Vet. App. 59, 68 (1994) (holding that contemporaneous records can be more probative than history as reported by a Veteran). Thus, the Board assigns the December 2019 and October 2022 opinions no probative weight.

Pursuant to the February 2020 Board remand, a VA fee-based opinion was obtained in October 2020. The examiner opined that the Veteran's back condition was less likely than not related to her active service. The examiner explained that there is no objective medical evidence of the Veteran complaining of lower back pain while in service while carrying out her duties of carrying heavy loads and laying in weird positions. He further noted that the earliest records regarding a back condition were 15-20 years after service. Thus, the examiner concluded that the Veteran's back condition was less likely than not related to her active service.

Following the October 2024 JMPR, the Veteran submitted a private opinion by Dr. R.P. who opined that the Veteran's back condition was at least as likely as not related to her duties as an airplane mechanic. Dr. R.P. provided a cogent rationale explaining how
less likely than not related to her active service. The examiner explained that there is no objective medical evidence of the Veteran complaining of lower back pain while in service while carrying out her duties of carrying heavy loads and laying in weird positions. He further noted that the earliest records regarding a back condition were 15-20 years after service. Thus, the examiner concluded that the Veteran's back condition was less likely than not related to her active service.

In light of the foregoing, the Board finds that the evidence for and against the claim is at least in relative equipoise. As such, the Board will resolve all reasonable doubt in favor of the Veteran and find that service connection for a back condition is warranted. Accordingly, the claim is granted.

C. CRAWFORD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Mortimer, Associate Counsel

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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