SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, who served from June 1987 to August 1987 and again from October 2004 to December 2005, appeals the March 2020 rating decision denying service connection for obstructive sleep apnea (OSA). The Veteran claims OSA is secondary to his service-connected sinusitis, tinnitus, and thoracolumbar arthritis. The Board reviewed evidence of record at the time of the March 2020 decision, as the Veteran withdrew a hearing request. The primary evidence considered was a July 2024 private medical opinion from Dr. R.P., which concluded that the Veteran's thoracolumbar arthritis caused obesity, which in turn caused OSA. Dr. R.P. also opined that sinusitis and tinnitus can cause or aggravate OSA, citing medical literature and the Veteran's diminished activity due to arthritis. The Board assigned substantial probative weight to this opinion. A March 2020 VA examination provided a negative nexus opinion for direct service connection but inadequately addressed OSA as secondary to sinusitis and failed to address aggravation. Given the overwhelming evidence favoring the Veteran's claim and the approximate balance of evidence, the Board applied the benefit of the doubt. Service connection for OSA as secondary to sinusitis, tinnitus, and thoracolumbar arthritis is granted.

Rationale

Private medical opinion found thoracolumbar arthritis caused obesity, which caused OSA.; Private medical opinion found sinusitis and tinnitus can cause/aggravate OSA.; VA examiner's opinion was inadequate for direct service connection and did not address aggravation.

Full Decision Text

Citation Nr: A26001932
Decision Date: 01/08/26	Archive Date: 01/08/26

DOCKET NO. 200728-100607
DATE: January 8, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea (OSA) is granted.

FINDING OF FACT

The evidence is at least in approximate balance as to whether the Veteran's OSA was caused by his service-connected sinusitis, tinnitus, and thoracolumbar arthritis. 

CONCLUSION OF LAW

The criteria for service connection for OSA as secondary to the service-connected sinusitis, tinnitus, and thoracolumbar arthritis disabilities are 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 on active duty from June 1987 to August 1987 and from October 2004 to December 2005.

The rating decision on appeal was issued in March 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applied.

In the July 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On April 24, 2024, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. 

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

Service connection is also warranted for a disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b).

Obesity is not a disability with an independent rating disability code, however it can be considered as an intermediate step between a service-connected disability and a disability claimed as secondary to that service-connected disability, based on the service-connected disability causing or aggravating the obesity. See Walsh v. Wilkie, 32 Vet. App. 300, 306-07 (2020).

In such a case, that evidence would need to reflect: (1) a service-connected disability or disabilities that caused the veteran to become obese; (2) the obesity was a substantial factor in causing another disability; and (3) the disability would not have occurred but for the obesity caused by the veteran's service-connected disability or disabilities. See VAOGCPREC 1-2017.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Entitlement to service connection for OSA

The Veteran contends that his OSA is due to service.  See February 2020 Claim. 

The Veteran is currently diagnosed with OSA.  See March 2020 Sleep Apnea Disability Benefits Questionnaire (DBQ).  

To that end, in a July 2024 private medical opinion, Dr. R.P., concluded that the Veteran
 See VAOGCPREC 1-2017.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Entitlement to service connection for OSA

The Veteran contends that his OSA is due to service.  See February 2020 Claim. 

The Veteran is currently diagnosed with OSA.  See March 2020 Sleep Apnea Disability Benefits Questionnaire (DBQ).  

To that end, in a July 2024 private medical opinion, Dr. R.P., concluded that the Veteran's thoracolumbar arthritis caused obesity, which in turn caused his OSA.  In addition, Dr. R.P. opined that sinusitis and tinnitus can cause and/or aggravate OSA. In support of the opinion, Dr. R.P. discussed that the Veteran's thoracolumbar arthritis has led to diminished activity which causes weight gain and obesity.  He then discussed that medical literature supports finding obesity as a direct cause of OSA.  The conclusion is based on the provider's review of the Veteran's medical records and medical literature and is based on his professional medical knowledge and serves to link the claimed OSA to the service-connected disabilities. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Therefore, the Board assigns this opinion substantial probative weight.

The Veteran also underwent a VA examination in March 2020.  In the negative nexus opinion, the examiner provided an opinion for direct service connection, however provided a rationale based on OSA as secondary to sinusitis.  The examiner's opinion is inadequate, as it fails to provide a sufficient rationale for direct service connection and did not address aggravation.  See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). 

Given the evidence and the medical opinions of record, the Board concludes that the evidence overwhelmingly favors the Veteran's claim that his OSA is due to his service-connected disabilities.  

Therefore, as the evidence is at least approximately balanced that the claimed OSA is secondary to the Veteran's service-connected sinusitis, tinnitus, and thoracolumbar arthritis disabilities, the Board resolves all reasonable doubts in the Veteran's favor and finds that service connection for OSA is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  His appeal is granted. 

 

 

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Smith, S. L.

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.