SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, an Army veteran who served from March 1988 to July 1990, appeals the denial of service connection for obstructive sleep apnea (OSA), claiming it is secondary to his service-connected posttraumatic stress disorder (PTSD). The Veteran's claim is based on the contention that psychiatric medications prescribed for PTSD caused his OSA. The Board found that while service treatment records did not indicate any OSA complaints during service, post-service VA treatment records and a private examination report from August 2023 supported the claim. The private examination, conducted by a clinician who reviewed the Veteran's history, lay statements, and medical literature, opined that OSA is secondary to and/or aggravated by PTSD and associated psychiatric medication. The Board found this private opinion to be competent, credible, and probative, providing a detailed rationale and supporting data. In contrast, two VA examinations in October 2022 and October 2023 provided negative opinions, stating that medical literature does not support a causal link between OSA and PTSD, but the Board found these opinions to have low probative value due to a lack of alternative etiology and insufficient rationale. Applying the benefit of the doubt doctrine, the Board found the evidence persuasively favored the Veteran, granting service connection for OSA on a secondary basis.

Rationale

Private opinion found competent, credible, and probative.; Private opinion provided detailed rationale and supporting data.; VA opinions found to have low probative value due to lack of alternative etiology and insufficient rationale.; Benefit of the doubt applied in favor of the Veteran.

Full Decision Text

Citation Nr: A25045848
Decision Date: 05/21/25	Archive Date: 05/21/25

DOCKET NO. 240530-444657
DATE: May 21, 2025

ORDER

Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service connected disabilities, is granted subject to the laws and regulations governing monetary awards.

FINDING OF FACT

The Veteran's OSA is proximately due to and/or aggravated by his service connected posttraumatic stress disorder (PTSD).

CONCLUSION OF LAW

The criteria for entitlement to service connection for OSA, to include as secondary to service connected disabilities, are met.  38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310, 3.317.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably in the United States Army from March 1988 to July 1990.

This appeal falls under the provisions of the Appeals Modernization Act (AMA).  84 Fed. Reg. 138, 169 (Jan. 18, 2019); 38 C.F.R. § 19.2.  This law creates a new framework for veterans dissatisfied with the Department of Veterans Affairs' (VA) decision on their claim to seek review.  This Board decision is consistent with the new AMA framework.

In the May 2024 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the December 2023 agency of original jurisdiction (AOJ) decision on appeal.  38?C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

The rating decision on appeal explicitly determined that new and relevant evidence has been received to warrant readjudication of the claim on appeal.  The Board is bound by this favorable finding.  38 C.F.R. § 3.104 (c).  As such, the Board will procced to adjudicate this claims on the merits.

The Veteran contends that his OSA is proximately due to and/or aggravated beyond its normal progression by his service-connected PTSD.  Specifically, he contends that his use of psychiatric medication caused him to develop OSA.  His claim for compensation was received by VA in September 2022.

A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service.  38 U.S.C. § 1110, 1131.  Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may be also established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.310 (a).  Establishing service connection on a secondary basis requires evidence sufficient 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) 

In order to prevail on the issue of secondary service connection, the record must
2004).

Service connection may be also established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.310 (a).  Establishing service connection on a secondary basis requires evidence sufficient 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) 

In order 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 service-connected disability and the current disability.  Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence.? Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in approximate balance.? It is only when the weight of the evidence is against the claim that the claim must be denied.? 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

As an initial matter, the Veteran does not contend, and the evidence does not demonstrate, that the OSA is the direct result of military service.  As such, service connection on a direct basis is unwarranted.  The Board will now proceed to analyze this claim under a theory of secondary service connection.   

The rating decision on appeal specifically determined that the Veteran currently experiences OSA and that the Veteran is currently service connected for PTSD.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104 (c).  The remaining issue, therefore, is whether the Veteran's OSA is proximately due to and/or aggravated beyond its normal progression by his PTSD.  The Board finds that the evidence is persuasively in favor of the Veteran.  As such, service connection is warranted for this claim.  

Factual History

The Veteran submitted lay statements detailing how his use of psychiatric mediation for his PTSD treatment led to the development of his OSA symptoms.  There is no reason for the Board to question the veracity of the lay statements in support of this claim.  As such, it is afforded probative value.  

A review of the service treatment records (STRs) reveal no complaints or treatment for OSA or associated sleep issues.  The Veteran specifically denied experiencing such issues on his May 1987 Report of Medical History (RMHs).  Additionally, clinical examination was normal on entrance.  The Board notes that the Veteran elected not to undergo a separation examination.  A review of the post-service VA treatment records note complaints and treatment for OSA.  Of note, the Veteran submitted a private examination report in August 2023.  After reviewing the evidence of record and conducting an examination of the Veteran, the clinician gave a positive opinion that the OSA is secondary to, related to, and/or aggravated by his service-connected PTSD with associated psychiatric medication.  He noted several medical studies that demonstrate a potential link between OSA and mental health conditions, including the usage of psychiatric medication.        

The Veteran underwent a VA examination in October 2022.  He was diagnosed with OSA.  The examiner then gave a negative opinion that the OSA is proximately due to the Veteran's low back disability.  He noted that the medical literature does not support that OSA is due to PTSD.  No other opinions or rationale were provided.  The Veteran underwent a second VA examination in October 2023.  He was diagnosed with OSA.  The examiner then gave a negative opinion that the OSA is proximately due and/or aggravated beyond its normal progression by the Veteran's service connected PTSD.  He noted that medical research does not demonstrate a causal relationship between OSA and PTSD.  No other opinions or rationale were provided.     

Analysis

The Board finds that the pertinent evidence persuasively demonstrates that the Veteran's OSA is proximately due to and/or aggravated by his service connected PTSD.  The Board finds the private opinion to be competent, credible, and probative.  The clinician provided detailed rationale that took into consideration the Veteran's lay statements and history, a clinical examination of the Veteran, and the evidence of record, and
  He was diagnosed with OSA.  The examiner then gave a negative opinion that the OSA is proximately due and/or aggravated beyond its normal progression by the Veteran's service connected PTSD.  He noted that medical research does not demonstrate a causal relationship between OSA and PTSD.  No other opinions or rationale were provided.     

Analysis

The Board finds that the pertinent evidence persuasively demonstrates that the Veteran's OSA is proximately due to and/or aggravated by his service connected PTSD.  The Board finds the private opinion to be competent, credible, and probative.  The clinician provided detailed rationale that took into consideration the Veteran's lay statements and history, a clinical examination of the Veteran, and the evidence of record, and provided a clear explanation that contained a clear conclusion and supporting data.  Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Moreover, the Board finds no adequate basis to reject the competent medical opinions based on a lack of credibility or probative value.  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998).  Furthermore, the private opinion is the only probative evidence that addresses the issue of medical nexus.  The Board notes that the VA opinions are entitled to low probative value, as the VA examiner failed to articulate an alternative etiology for the Veteran's OSA.  As such, they are entitled to low probative value.  

Based on the pertinent medical evidence and the Veteran's credible lay statements, the Board finds that service connection for OSA is warranted on a secondary basis.  The claim is therefore granted.  

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.T. Massey, 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.