SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, who served from June 1964 to January 1984, appeals the denial of service connection for obstructive sleep apnea. The Veteran claimed the sleep apnea was secondary to or aggravated by his service-connected depressive disorder with insomnia, diabetes mellitus, and hypertension. The Board reviewed the evidence, including the Veteran's service medical records, which showed no complaints, diagnosis, or treatment for sleep apnea during service, and normal findings on separation examinations. The Veteran submitted private treatment letters from August 2021 and December 2021, asserting his physician found sleep apnea aggravated by his service-connected conditions, but these lacked rationale and were given less probative value. The Board gave more weight to three VA medical opinions. A December 2021 VA examiner opined that sleep apnea was less likely than not aggravated by the service-connected conditions, citing the anatomical and physiological nature of sleep apnea and the lack of association between diabetes/depression and the airway defects. A January 2022 VA opinion concluded sleep apnea was not caused or aggravated by hypertension due to a lack of pathological connection. An August 2022 VA opinion reiterated that sleep apnea was less likely than not caused or aggravated by the service-connected disabilities due to anatomical airway issues. The Board found the weight of the evidence against service connection and denied the claim.

Rationale

Service medical records negative for sleep apnea complaints, diagnosis, or treatment.; Private opinions lacked rationale and were given less probative value.; VA examinations provided negative nexus opinions with medical rationale.; Weight of evidence against service connection.

Full Decision Text

Citation Nr: A23004600
Decision Date: 03/07/23	Archive Date: 03/07/23

DOCKET NO. 230209-321830
DATE: March 7, 2023

ORDER

Entitlement to service connection for obstructive sleep apnea, claimed as secondary to depressive disorder with insomnia, diabetes mellitus, and hypertension, is denied.

FINDING OF FACT

Obstructive sleep apnea is not secondary to service-connected depressive disorder with insomnia, diabetes mellitus, or hypertension, and is not related to service otherwise related to any event, injury, or disease during service.

CONCLUSION OF LAW

The criteria for service connection for obstructive sleep apnea due to service or service-connected disability are not 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 June 1964 to January 1984.

This matter comes before the Board of Veterans' Appeals (Board) from a December 2022 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).  The Veteran timely appealed that rating decision to the Board and requested direct review.

Entitlement to service connection for obstructive sleep apnea, claimed as secondary to depressive disorder with insomnia, diabetes mellitus, and hypertension

The Veteran asserts that he is entitled to service connection for sleep apnea because the claimed disability was caused or aggravated by service-connected depressive disorder with insomnia, diabetes mellitus, and hypertension.

Service connection can be established for disability due to event, injury, or disease during service.  38 U.S.C. § 1110.  Service connection may be established for a disability that is proximately due to or aggravated by a service-connected disability.  38 C.F.R. § 3.310.

The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of or is aggravated beyond the natural progress by a service-connected disability, or is related to service or any event, injury, or disease during service.

The Board concludes that, while the Veteran has a current disability of sleep apnea, the evidence of record persuasively weighs against finding that the Veteran's sleep apnea is proximately due to or the result of or aggravated beyond its natural progression by service-connected disability, or is related to service or any event, injury, or disease during service.  38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. §§ 3.303, 3.304, 3.310(a).  

The service medical records do not show any complaint, diagnosis, or treatment for sleep apnea.  At a December 1983 service separation examination, the head, face, neck, and scalp; and mouth and throat examinations were normal.  There were no findings or complaints related to sleep apnea.

In an August 2021 statement, the Veteran asserted that his physician found that sleep apnea was aggravated by service-connected insomnia, diabetes mellitus, and hypertension.

In an August 2021 private treatment letter, the doctor noted being the attending physician for the Veteran.  The doctor stated that the Veteran's sleep apnea was made considerably worse by the service-connected disabilities.  No rationale was provided for that conclusion.  The doctor included a prescription for a CPAP machine.  It is unclear whether that doctor was familiar with or reviewed the Veteran's medical history or the information contained in the claims file.  Therefore, that medical opinion is found to be of less probative value.  In a December 2021 private treatment letter, that same doctor provided as similar opinion regarding sleep apnea and the service-connected disabilities.  

At a December 2021 VA examination, the examiner noted a diagnosis of sleep apnea.  The examiner also noted that the Veteran was status post home sleep study in July 2021.  The examiner opined that the claimed disability was less likely than not aggravated beyond the natural progression by the service-connected diabetes mellitus, or depressive disorder with insomnia.  The rationale provided was that based on a review of the medical evidence of record medical literature, "sleep apnea is an anatomical/physiological disorder most commonly caused by airflow obstruction from the oropharynx to the lungs."  The examiner reasoned that diabetes mellitus and the depressive disorder with insomnia are not associated with the anatomical defects that are connected with sleep apnea.  The examiner also noted that there "there is no clear-cut evidence to support the finding that obstructive sleep apnea is aggravated by diabetes mellitus or depressive disorder with insomnia. 
2021.  The examiner opined that the claimed disability was less likely than not aggravated beyond the natural progression by the service-connected diabetes mellitus, or depressive disorder with insomnia.  The rationale provided was that based on a review of the medical evidence of record medical literature, "sleep apnea is an anatomical/physiological disorder most commonly caused by airflow obstruction from the oropharynx to the lungs."  The examiner reasoned that diabetes mellitus and the depressive disorder with insomnia are not associated with the anatomical defects that are connected with sleep apnea.  The examiner also noted that there "there is no clear-cut evidence to support the finding that obstructive sleep apnea is aggravated by diabetes mellitus or depressive disorder with insomnia.  The examiner stated that sleep apnea is a condition with a clear and specific etiology."

A January 2022 VA medical opinion concluded that sleep apnea was not caused or aggravated by the service-connected hypertension disability.  The rationale provided was that "there is no significant pathological connection or condition whereby hypertension would cause obstructive sleep apnea."

In an August 2022 VA medical opinion, the examiner opined that the sleep apnea disability was less likely than not caused or aggravated by the service-connected disabilities.  The rationale provided was that obstructive sleep apnea is due to anatomical issues within the airway that restrict airflow.  The examiner stated that the service-connected disabilities did not affect the airway anatomy, and therefore, no pathological connection could be made."

The Veteran believes sleep apnea is proximately due to, the result of, or aggravated beyond the natural progression by a service-connected disability.  The Veteran is not competent to provide an etiology opinion regarding this issue.  The issue is medically complex, as it requires knowledge of anatomical relationships.  Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or knowledge to make such a determination.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011).  Consequently, the Board gives more probative weight to the December 2021, January 2022 and August 2022 VA medical opinions.  Those opinions considered the bases for service connection and provided a rationale for the negative opinions with reference to medical principles and literature, after review of the medical history.  The Veteran has not submitted any competent medical evidence that supports a finding that sleep apnea was incurred in service, is related to service, or is caused or aggravated by the service-connected disabilities.

Accordingly, the Board finds that the weight of the evidence is against a finding that sleep apnea is related to service or caused or aggravated by the service-connected disabilities.  The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran.  Therefore, the claim is denied.

 

 

Harvey P. Roberts

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Cross, 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.