SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, a veteran who served from August 1989 to May 1993, appeals the denial of service connection for obstructive sleep apnea as secondary to his service-connected disabilities. The Veteran had a current diagnosis of obstructive sleep apnea, which was favorably noted in VA treatment records. The primary issue was establishing a nexus between this condition and his service-connected PTSD, bilateral knee, and right ankle disabilities. The Veteran submitted a private medical opinion from M.M., DNP, CNP, which opined that the obstructive sleep apnea was at least as likely as not secondary to weight gain caused by the service-connected PTSD, knee, and ankle conditions. The opinion noted the Veteran's obesity, chronic pain, limited mobility, and medication for PTSD known to cause weight gain, citing medical literature that links obesity to obstructive sleep apnea. The Board found this private opinion probative and persuasive, noting the accurate analysis and sound reasoning. The Veteran was not afforded a VA examination for this condition. Based on the persuasive private medical opinion, the Board found that the obstructive sleep apnea was caused by the service-connected disabilities, granting service connection on a secondary basis.

Rationale

Private medical opinion found obstructive sleep apnea at least as likely as not secondary to weight gain from service-connected PTSD, knee, and ankle conditions.; Opinion noted Veteran's obesity, chronic pain, limited mobility, and PTSD medication causing weight gain.; Medical literature links obesity to obstructive sleep apnea.

Full Decision Text

Citation Nr: A26001655
Decision Date: 01/07/26	Archive Date: 01/07/26

DOCKET NO. 200630-94539
DATE: January 7, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea as secondary to service-connected disabilities is granted.

FINDING OF FACT

The Veteran's obstructive sleep apnea is due to service-connected post-traumatic stress disorder (PTSD), bilateral knee, and right ankle disabilities. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for obstructive sleep apnea as secondary to PTSD, bilateral knee, and right ankle disabilities, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably from August 1989 to May 1993.  

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a March 2020 rating decision issued by a Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ).  

The Veteran timely appealed the rating decision in a June 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Hearing docket. A hearing was most recently scheduled for May 2024. On May 21, 2024, the Veteran, through his representative, withdrew the request for a hearing and requested 90 days to submit additional evidence and argument. Accordingly, the Board finds that the request for a hearing has been withdrawn. 38 C.F.R. § 20.704(e).

In view of the above, the Board may only consider the evidence that the AOJ was permitted to consider at the time of the issuance of the March 2020 rating decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing in May 2024. 38 C.F.R. § 20.302(b). 

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is adjudicating the claims herein, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306.  

To establish service connection the evidence must demonstrate: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability that is caused or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a), (b). Establishing service connection on a secondary basis requires competent and credible evidence demonstrating: (1) the existence of a current disability; (2) a service-connected disability; and (3) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). An increase in severity of a nonservice-connected disease or injury shall not be service-connected if it is due to the natural progression of the nonservice-connected condition. Id. at 447-48. 

Although VA does not consider obesity a disease in itself, obesity can be an intermediate step between a service-connected disability and a current disability. VAOP
 connection on a secondary basis requires competent and credible evidence demonstrating: (1) the existence of a current disability; (2) a service-connected disability; and (3) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). An increase in severity of a nonservice-connected disease or injury shall not be service-connected if it is due to the natural progression of the nonservice-connected condition. Id. at 447-48. 

Although VA does not consider obesity a disease in itself, obesity can be an intermediate step between a service-connected disability and a current disability. VAOPGCPREC 1-2017. Service connection may be established (1) if the service-connected disability caused the Veteran to become obese; (2) if obesity was a substantial factor in causing a subsequent disability; and (3) if the subsequent disability would not have occurred but for obesity. Walsh v. Wilkie, 32 Vet. App. 300 (2020).

Entitlement to service connection for obstructive sleep apnea. 

The Board adopts the AOJ's favorable finding that the Veteran had a current diagnosis of obstructive sleep apnea based on VA treatment records showing treatment for same. See 38 C.F.R. § 3.104(c) (stating that a favorable finding to the claimant made by a VA adjudicator or the Board is generally binding on all subsequent adjudications by the AOJ and the Board).

In July 2024, the Veteran submitted a private medical opinion in support of his claim. See April 2024 nexus letter to Jan Dils. In the medical opinion, M.M., DNP, CNP, opined that it is at least as likely as not (50 percent or greater probability) that the Veteran's obstructive sleep apnea is secondary to the weight gain caused by his service-connected PTSD, bilateral knee disability, and right ankle disability, which were incurred in or caused by military service. The clinician noted review of the Veteran's lay statements, medical treatment records, and medical literature, and noted that the Veteran was considered medically obese with chronic pain and limited mobility due to his knee and ankle disabilities. The clinician further explained that the medication the Veteran takes for his PTSD is known to cause weight gain. Additionally, the clinician noted that obesity is among the most important risk factors for obstructive sleep apnea and that 70 percent of obstructive sleep apnea patients are obese according to medical literature. The Board finds this private medical opinion probative as it derives from a factually accurate analysis and provides fully articulated conclusion based on sound reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-02 (2008).

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The Veteran was not afforded a VA examination for sleep apnea and there is no VA medical opinion of record. 

Based on the above, the Board finds the evidence of record persuasively establishes that the Veteran's obstructive sleep apnea was caused by his service-connected PTSD, bilateral knee, and right ankle disabilities. Accordingly, service connection for obstructive sleep apnea as secondary to service-connected disabilities is granted.

 

 

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. Cress, 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.