RHEUMATOID ARTHRITIS

L. HOWELL · 2026 · Case ID: A26000793

DENIED

Summary

The veteran, who served from February 1995 to February 1999, appeals the denial of service connection for rheumatoid arthritis (RA) and obstructive sleep apnea (OSA). The Board denied service connection for RA, finding no evidence of in-service incurrence, continuity of symptomatology, or manifestation within one year of service. The VA examiner concluded RA was less likely than not related to service, and no contradictory opinions were presented. For OSA, the Board found a current diagnosis but no in-service complaints or treatment. While the Board acknowledged the duty to assist, it found no error in not remanding for a VA opinion, as the veteran's claim of a nexus via obesity from a service-connected back disability lacked competent lay evidence and was contradicted by a VA examiner. The examiner opined OSA was less likely than not related to the service-connected back disability, citing risk factors for OSA unrelated to the back condition and insufficient evidence that the back disability caused obesity or OSA. The Board afforded greater weight to the VA examinations over lay statements regarding etiology, ultimately denying both claims.

Rationale

No in-service complaints or treatment for RA; No continuity of symptomatology since service; RA did not manifest within one year of separation; VA examiner opined less likely than not related to service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250627-559386

Full Decision Text

Citation Nr: A26000793
Decision Date: 01/06/26 Archive Date: 01/06/26

DOCKET NO. 250627-559386
DATE: January 6, 2026

ORDER

Service connection for rheumatoid arthritis (RA) is denied.

Service connection for obstructive sleep apnea (OSA) is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from February 1995 to February 1999.

2. RA was not shown in service, was not shown to a compensable degree within one year of service, symptoms not continuous since service; RA is not causally or etiologically related to service.

3. OSA was not shown in service, is not causally or etiologically related to service, and was not caused by or permanently worsened in severity by a service-connected disability.

CONCLUSIONS OF LAW

1. RA was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2025).

2. OSA was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In August 2024, the agency of original jurisdiction (AOJ) denied the claims. In March 2025, the Veteran filed a Supplemental Claim, which the AOJ denied in June 2025.

Later in June 2025, the Veteran appealed the claims to the Board via a VA Form 10182 and elected the Evidence Submission docket. Therefore, the Board will review the evidence of record at the time of the AOJ's decisions on appeal, in addition to evidence submitted with the VA Form 10182 or within 90 days following receipt of the VA Form 10182. 38 C.F.R. § 20.303.

Initially, under 38 C.F.R. § 20.202(c)(2), the veteran may modify the information identified in the appeal to the Board (VA Form 10182) for the purpose of selecting a different evidentiary record option; however, requests to modify the appeal option must be made by completing a new VA Form 10182.

The new VA Form 10182 must be received at the Board within one year from the date that the AOJ mailed the notice of the decision on appeal, or within 60 days of the date that the Board receives the original VA Form 10182, whichever is later. Requests to modify an appeal option will not be granted if the veteran has submitted evidence or testimony as described in 38 C.F.R. §§ 20.302 and 20.303. See 38 C.F.R. § 20.202(c)(2).

This decision is within one year of the June 2025 rating decision notification letter to the Veteran; nevertheless, she submitted evidence with the June 2025 VA Form 10182 in support of the appeal. Accordingly, she cannot change dockets at this point. Consequently, the appeals are ripe for the Board's consideration.

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

In addition to the laws and regulations above, service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service
present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

In addition to the laws and regulations above, service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

Arthritis, including RA, is recognized by VA as a "chronic disease" under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. §§ 3.303(b), 3.307, and 3.309 apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015).

Additionally, service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Service connection may be granted on a secondary basis with an intercurrent cause of obesity if a service-connected disability caused or aggravated a veteran's obesity, and the aggravation of obesity was then a substantial factor in causing or aggravating the claimed disorder, and whether the claimed disorder would have occurred but for obesity aggravated by the service-connected disability. See Walsh v. Wilkie, 32 Vet. App, 300, 307 (2020).

The Board also notes the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) created a new presumption for service connection for certain conditions based on exposure to burn pits and other toxins (BPOT) and added new examination requirements where toxic exposure risk activities (TERA) were implicated. 38 U.S.C. § 1119.

Nevertheless, an April 2024 VA memorandum concluded that the Veteran had not been exposed to a TERA while on active duty. Consequently, presumptive service connection based on a TERA is not for application for either RA or OSA. However, the Board will consider all relevant theories of entitlement to service connection reasonably raised in the record.

As to direct service connection, the Veteran was diagnosed with RA by a private physician in 2006. As such, the first element is met.

As to an in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of RA or any symptoms reasonably associated with RA such a joint pain. While the Veteran sought treatment for other issues, including low back pain, upper respiratory infections, and sinusitis, she did not get medical care for RA. As such, this medical evidence does not support the in-service incurrence of RA.

To the extent the Veteran asserts a medical nexus between RA and service, a January 2024 VA examiner noted the 2006 diagnosis but indicated the earliest laboratory results showing RA abnormalities were in 2002, but only laboratory results from 2007 were in the record. As such, the examiner concluded that RA was less likely than not, incurred in, or caused by service. There is no contradictory medical opinion. Accordingly, the medical evidence does not support direct service connection.

As to presumptive service connection, no chronic disease or injury was shown in service. While the Veteran was treated for other illnesses and injuries in-service as noted above, there are no STRs indicating symptoms of or treatment for RA. Therefore, the medical evidence does not support presumptive service connection on a "chronic disease or injury shown in service" basis.

Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the Veteran did not seek treatment for RA until
in the record. As such, the examiner concluded that RA was less likely than not, incurred in, or caused by service. There is no contradictory medical opinion. Accordingly, the medical evidence does not support direct service connection.

Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the Veteran did not seek treatment for RA until 2006, approximately 7 years after discharge. Private treatment records dated in August 2006 indicate that she first noted RA symptoms in February 2006. As she was discharged from active duty in February 1999 and symptoms were not identified until February 2006 at the earliest, the medical evidence does not support service connection on a "continuity of symptomatology" basis.

Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The evidence does not support presumptive service connection on a "manifest within one-year from separation" basis as symptoms were not identified until February 2006, which is more than one year after the separation in February 1999. Therefore, the medical evidence does not support presumptive service connection on any basis. Consequently, the medical evidence does not support service connection for RA under any theory of entitlement.

OSA

As to direct service connection, the Veteran was diagnosed with mild OSA following July 2011 and July 2023 sleep studies. Accordingly, a current diagnosis is shown, and the first element of service connection is met.

As to an in-service incurrence, the STRs do not reflect complaints of, treatment for, or a diagnosis of OSA during the Veteran's active duty. While she sought treatment for other issues, as noted above, she did not get medical care for sleep problems, to include apnea or related symptoms such as snoring or daytime fatigue. As such, this medical evidence does not support the in-service incurrence of OSA.

The Board recognizes that no VA medical opinion regarding direct service connection has been obtained in conjunction with the claim. For service connection claims, VA is obliged to provide an examination or obtain a medical opinion in a claim when (1) the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, (2) the record indicates that the disability or signs and symptoms of disability may be associated with active service, and (3) the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for finding a link between current disability and service is low.

However, a remand for a direct service connection medical opinion is not warranted. In this regard, although the Veteran has a current disorder, the contemporaneous record does not reflect any in-service complaints. The low threshold is not met in this case because there is only the unsupported lay contention of a medical nexus (insofar as the Veteran filed the claim and made bare assertions). As such, remand is not warranted for a medical opinion as no duty to assist error has occurred.

Moreover, the Veteran does not contend that OSA began in service; rather, the primary contention is that obesity caused OSA and obesity resulted from a service-connected back disability. In this regard, obesity may act as an "intermediate step" between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a).

As noted previously, in order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin, 11 Vet. App. at 512.

The first element is met based on the diagnoses noted above. As to the evidence of a service-connected disability, at the time of the June 2025 rating decision on appeal, the Veteran was service connected for chronic sinusitis at 30 percent, an acquired psychiatric disorder at 30 percent, and a chronic lumbosacral spine strain at 20 percent, which had been recently increased from 0 percent effective July 2023. As such, the second element is met.

As to the medical evidence establishing a link between the service-connected disability and the current disability, the Veteran provided a health care article from Cleveland Clinic, which indicated that chronic pain was a frequent cause of insomnia; however, the Veteran is not diagnosed with insomnia. Rather, she is diagnosed with OSA. As such, the medical literature provided by the Veteran is inapposite and unrelated to an OSA claim.

In addition to the medical article, the Veteran provided various buddy statements from her mother, sister, spouse, and former co-workers, some of which indicate she had gained weight due to inactivity and has OSA, presumably as a result. However, there is no indication that any of the individuals that provided a statement in support of the Veteran's claim has the requisite medical expertise to provide an opinion regarding OSA etiology, including obesity as an intermediary step from the back disability.

Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). To the extent that the buddy statements opine on etiology or a link between OSA, obesity, and the service-connected back disability, those statements are given little probative weight.

Weighing against a medical nexus or link, a May 2024 VA medical examiner found that OSA was less likely than not related to, proximately due to, or the result of the service-connect back disability. The examiner reasoned that the medical records indicated that the Veteran had a current diagnosis of OSA and it was clinically known that OSA occurred when the trachea collapsed during the sleep cycle due to weakened muscles in the neck that caused a pause in breathing.

The examiner further identified OSA risk factors to include but are not limited to excess weight, older age, narrowed airway, high blood pressure, smoking, diabetes, sex (male), family history of sleep apnea, and asthma and more than one could contribute at the same time. The examiner concluded that clinically, the chronic lumbosacral strain did not cause the throat to collapse during the sleep cycle.

Next, the same examiner opined in a second May 2024 VA medical opinion that while clinically it was known that obesity was defined as the intake of excessive calories, obesity was a complex disease that also had other contributing factors such as age, race, height, ethnicity, and genetic factors including but not limited hereditary and metabolism. The examiner concluded that there was insufficient evidence in the medical records to conclude that the service-connected chronic lumbosacral spine strain caused the claimant to become obese.

Further, the examiner explained that OSA was not defined by obesity, and there were many people who suffered from OSA that were underweight and normal weight, therefore obesity did not play a substantial role in the Veteran developing OSA. Importantly, there are no contrary medical opinions in the record.

While it is reasonable to conclude that the back disability resulted in some degree of functional impairment as evidenced by the 20 percent rating, which had previously been noncompensable prior to July 2023, the medical evidence does not show that the Veteran has been unable to exercise or maintain a healthy weight through dieting due to the back disability.

Notably, the Veteran had two VA back examinations in August 2023 and March 2024. As to the functional impact of the back disability, the August 2023 examiner indicated the Veteran could participate in minimal lifting and physical activity. The March 2024 VA examiner noted that during flare-ups, the Veteran should avoid heavy lifting. Otherwise, there were no functional limitations related to walking, other low impact exercises, or lifting lighter weights. Further, no medical professional has advised that the Veteran should refrain from diet or exercise due to the back disability.

In sum, the weight of the medical evidence does not support the claim that OSA is due to obesity that resulted from a service-connected back disability. As such, the medical evidence does not support service connection on a secondary basis.

The Board has considered the Veteran's and other lay statements that RA was caused by service and OSA was caused by a service-connected disability. While they are competent to report symptoms as this
physical activity. The March 2024 VA examiner noted that during flare-ups, the Veteran should avoid heavy lifting. Otherwise, there were no functional limitations related to walking, other low impact exercises, or lifting lighter weights. Further, no medical professional has advised that the Veteran should refrain from diet or exercise due to the back disability.

The Board has considered the Veteran's and other lay statements that RA was caused by service and OSA was caused by a service-connected disability. While they are competent to report symptoms as this requires only personal knowledge as it comes to through the senses, they are not competent to offer an opinion as to the etiology of the current disorders due to the medical complexity of the matters involved.

Such competent evidence concerning the nature and extent of the Veteran's OSA and obesity has been provided by the medical personnel who examined her during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations.

Specifically, the Veteran is not competent to attribute the etiology of OSA to obesity to a back disability. Moreover, while she has stated that she was unable to perform exercise due to chronic back pain, the Board affords more probative value to the medical evidence which suggests that she is still capable of exercising and maintaining a healthy weight.

Those findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disorders are evaluated. The VA medical professionals explained their reasoning based on an accurate characterization of the evidence. Therefore, the Board attaches greater probative weight to the VA examinations and clinical findings than to the lay statements regarding etiology.

In sum, after a careful review of the record, the evidence weighs persuasively against the claims for service connection, and there is no doubt to be resolved. As such, the appeals are denied.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not

required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. J. Ferguson, 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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