SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

L. HOWELL · 2026 · Case ID: A26009303

DENIED

Summary

The veteran, who served from September 1985 to December 1989, appeals the denial of service connection for obstructive sleep apnea (OSA), a low back disorder with radiculopathy, and left lower extremity (LLE) radiculopathy. The Board denied service connection for all three conditions. For OSA, the Board found a current diagnosis but no evidence of in-service complaints or diagnosis, and no indication of OSA symptoms at the time of discharge. The veteran contended OSA was secondary to a service-connected psychiatric disability, but the VA examiner found obesity to be the primary cause of OSA, with psychiatric disorders only having a bidirectional relationship and not being a direct physiological cause. A private physician's opinion was not afforded probative value as it merely recommended further evaluation rather than providing a nexus. For the low back disorder, the Board found evidence of in-service complaints of lumbar pain, but the imaging and clinical findings at discharge were normal, and the current condition was not chronologically consistent with in-service complaints. The VA examiner concluded the current lumbar disorder was less likely than not related to service or the in-service complaint. The veteran argued secondary service connection for the low back disorder due to a service-connected knee disability. While a private physician opined a link existed due to altered gait, the Board found this opinion lacked probative value as it was based on an inaccurate factual premise of altered gait, which was not supported by objective medical evidence. The Board afforded greater weight to the VA examiner's opinion, which found no causal relationship between knee issues and lumbar disorders, citing age-related spinal degeneration as a more likely etiology. The Board also noted the veteran's lay statements regarding etiology were not competent to offer medical opinions. Ultimately, the Board found the evidence weighed against all claims, denying service connection for OSA, the low back disorder, and LLE radiculopathy.

Rationale

No in-service complaints or diagnosis of OSA.; VA examiner found obesity to be the primary cause of OSA.; Psychiatric disorders not considered primary causative factors for OSA.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250627-559408

Full Decision Text

Citation Nr: A26009303
Decision Date: 02/02/26 Archive Date: 02/02/26

DOCKET NO. 250627-559408
DATE: February 2, 2026

ORDER

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

Service connection for a low back disorder is denied.

Service connection for left lower extremity (LLE) radiculopathy is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from September 1985 to December 1989.

2. 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.

3. A low back disorder, diagnosed as degenerative disc disease (DDD), lumbosacral strain, and lumbar radiculopathy, is not causally or etiologically related to service, to include an in-service low back strain; a current low back disorder was not caused by or permanently worsened in severity by a service-connected disability.

CONCLUSIONS OF LAW

1. 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. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2025).

2. A low back disorder 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. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2025).

3. LLE radiculopathy 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. §§ 1131, 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 May 2025, the agency of original jurisdiction (AOJ) denied the claim. In June 2025, the Veteran appealed to the Board via a Form 10182 and elected the Evidence Submission docket. Therefore, the Board will review the evidence of record at the time of the AOJ's May 2025 decision, in addition to evidence submitted with the Form 10182 or within 90 days following receipt of the Form 10182.

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).

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).

OSA

Turning to
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).

OSA

Turning to the medical evidence, a March 2025 VA examiner explained that OSA was first diagnosed in December 2015 following a VA sleep study. As such, a current diagnosis of OSA is shown, and the first element of service connection is met.

As to in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of OSA or related symptoms. While the STRs reflected complaints of knee pain and other various ailments, there are no symptoms shown which could reasonably be associated with OSA, such as snoring or daytime fatigue.

In August 1989, a Medical Board determined that the Veteran was unfit for active duty due to a knee disorder; therefore, he was discharged due to physical disability. There was no indication at the time of discharge that he was experiencing symptoms of OSA. Moreover, he does not contend that symptoms of OSA began during active duty. As such, the medical evidence does not support service connection on a direct basis.

Rather, the Veteran's main contention is that OSA is secondary to a service-connected psychiatric disability, diagnosed as generalized anxiety disorder and depressive disorder. In support of the claim, a September 2024 private physician noted that the Veteran was diagnosed with OSA. They explained that the Veteran would benefit from further psychological evaluation to determine the correlation of OSA and the diagnosed mental health disability; however, did not provide a medical opinion which linked OSA to a psychiatric disability. As noted above, they merely recommended that the Veteran seek further evaluation to determine the etiology of OSA. As such, this is not a medical opinion which may be afforded any probative value.

Weighing against the claim, a March 2025 VA examiner found it less likely than not that OSA was proximately due to or the result of a service-connected psychiatric disability. The examiner explained that OSA was a sleep disorder characterized by repetitive upper airway obstruction during sleep, which led to intermittent hypoxia and sleep fragmentation. Further, they explained that the primary risk factors for OSA included obesity, craniofacial anatomy, upper airway collapsibility, and genetic predisposition.

Next, the examiner noted that the Veteran's body mass index (BMI) was 36.3, which put him into the obese category. Accordingly, they found that the most likely etiology of OSA was obesity. The examiner cited to medical studies which showed that obesity was one of the strongest predictors of OSA due to increased airway collapsibility and obstruction.

Further, the examiner addressed the Veteran's contentions regarding a correlation between psychiatric disorders and OSA. They noted that while psychiatric disorders, such as generalized anxiety disorder and depressive disorder, had been associated with an increased prevalence of OSA, they were not considered primary causative factors.

Instead, the examiner explained that the relationship between OSA and psychiatric disorders was likely bidirectional, meaning that untreated OSA could also contribute to or exacerbate anxiety and depression symptoms. Further, he explained that medical studies did not indicate that psychiatric disorders alone could significantly increase upper airway collapsibility or anatomical obstruction (the primary mechanisms of OSA). In sum, they reasoned that while the Veteran's psychiatric disability could impact sleep architecture and sleep quality, it was not a direct physiological cause of OSA.

As such, the examiner concluded that obesity was the most likely cause of OSA due to BMI of 36.3 Accordingly, they found that OSA was less likely than not due to or the result of generalized anxiety disorder and depressive disorder. There are no conflicting medical opinions of record. As such, the medical evidence does not support service connection on this basis.

Moreover, the Board notes that service connection may be granted on a secondary basis through the intermediary step of obesity; however, the Veteran has not argued that obesity was caused by or aggravated by a service-connected disability. Further, the medical evidence does not suggest that obesity is the result of a service-connected disability.

For example, in February 2025, a VA clinician counseled the Veteran on the benefits of regular exercise, including aerobic exercise, flexibility, and endurance. The
36.3 Accordingly, they found that OSA was less likely than not due to or the result of generalized anxiety disorder and depressive disorder. There are no conflicting medical opinions of record. As such, the medical evidence does not support service connection on this basis.

For example, in February 2025, a VA clinician counseled the Veteran on the benefits of regular exercise, including aerobic exercise, flexibility, and endurance. The clinician also counseled the Veteran on the benefits of proper diet and nutrition. There was no indication that the Veteran was unable to exercise or diet to control his weight due to service-connected disabilities at that time.

Further, even considering that the Veteran may experience some degree of limitation in exercise due to service-connected disabilities, the VA examiners have not found that he was unable to manage his weight due to these symptoms. For example, a March 2022 VA examiner noted functional impact of the Veteran's knee disabilities includes a limitation on walking or standing for more than 30 minutes; however, he did not find that the Veteran could not complete any form of exercise.

Moreover, a January 2025 VA examiner found that a psychiatric disability resulted in occupational and social impairment with deficiencies in most areas, such as work, school, judgment, thinking, and mood. Despite this impairment, the examiner did not indicate that the Veteran's impaired mood would prohibit him from properly controlling his weight through diet and exercise.

In sum, the medical evidence does not reflect that the Veteran's obesity was caused by or aggravated by service-connected disabilities. There is no medical evidence to suggest that the Veteran cannot maintain a healthy weight due to his disabilities. As such, the medical evidence does not support service connection for OSA through the intermediary step of obesity.

Low Back Disorder with Radiculopathy

Turning to the medical evidence, a September 2024 private physician diagnosed the Veteran with lumbar discogenic pain with left radiculopathy. Further, a December 2024 VA examiner noted a current diagnosis of DDD (other than intervertebral disc syndrome (IVDS)), lumbosacral strain, and lumbar radiculopathy. As such, a current diagnosis is shown, and the first element of service connection is met.

As to in-service incurrence, the STRs show that the Veteran complained of persistent lumbosacral spine muscle pain in October 1989; however, an October 1989 radiologic report showed no evidence of fracture or bony destructive process in the lumbosacral spine. Further, the clinician noted no significant congenital defects or degenerative changes and indicated that the sacroiliac joints were normal. In conclusion, they found that the imaging showed a normal lumbosacral spine.

Nonetheless, the STRs reflect complaints of lumbar spine pain during active duty. As such, an in-service incurrence is shown, and the second element of service connection is met.

As to medical nexus, a March 2025 VA examiner found that a current low back disorder, to include lumbosacral strain, DDD, and lumbar radiculopathy, was less likely than not incurred in or caused by service, to include the complaint of persistent lumbar spine pain during service.

After reviewing the STRs and the relevant medical history, the examiner noted that there was no chronicity of complaints to support the claim that the current diagnosis was related to the lumbosacral complaints made in 1989. Due to this inconsistency, they concluded that it was less likely than not that a current lumbar spine disorder with radiculopathy was caused by or incurred in service. There are no conflicting medical opinions of record. As such, the medical evidence does not support service connection on a direct basis.

Next, the Veteran's main contention is that a lumbar spine disorder with radiculopathy is secondary to a service-connected knee disability. In support of the claim, a September 2024 private physician reported that it was at least as likely as not that current lumbar discogenic pain with radiculopathy was directly and causally related to constant and chronic compensation and adaptation to the weight shifting at altered gait caused by service-connected knee disabilities. They did not offer any further rationale for this opinion.

Weighing against the claim, a December 2024 VA examiner reported that it was less likely than not that a lumbar spine disorder with radiculopathy was proximately due to or the result of a service-connected knee disability. They explained that there was no causal relationship between arthritis in
spine disorder with radiculopathy is secondary to a service-connected knee disability. In support of the claim, a September 2024 private physician reported that it was at least as likely as not that current lumbar discogenic pain with radiculopathy was directly and causally related to constant and chronic compensation and adaptation to the weight shifting at altered gait caused by service-connected knee disabilities. They did not offer any further rationale for this opinion.

Moreover, the examiner cited to medical literature which showed that DDD often occurred when the cushioning in the spine wore away due to age-related spinal degeneration. As such, they concluded that there was no medical literature to support a nexus between a knee condition, such as patellofemoral pain syndrome or arthritis, and the development of lumbar spine disorders such as DDD, strain, or radiculopathy.

Based on the above, the medical evidence weighs against the claim for service connection on a secondary basis. The Board affords more probative value to the December 2024 VA examiner's opinion than the private consultant's opinion because it offered a clear and persuasive rationale based on the objective medical evidence.

Specifically, the VA examiner, based on professional medical expertise and the relevant medical literature, explained that there was no causal relationship between a bilateral knee disability and the development of the current lumbar spine disorders. They noted that these conditions could co-exist but were not the cause for one another. Further, the examiner offered an alternative etiology for the development of the current lumbar spine disorder with radiculopathy (age related spinal degeneration). The Board affords this opinion great probative value.

In contrast, the private opinion opined that a lumbar spine disorder with radiculopathy was caused by altered gait due to a service-connected knee disability; however, the objective medical evidence does not show that the knee disability results in altered gait. Specifically, the VA examinations related to the lumbar spine and the knees do not indicate that the Veteran's gait is altered. Moreover, clinical treatment records from January 2022 and December 2023 indicated that the Veteran had normal gait and balance with no problems.

In sum, there is no medical evidence to suggest that the Veteran's bilateral knee disability results in altered gait. Accordingly, the private consultant's opinion is based on an inaccurate factual premise. The consultant did not offer any other reasoning for their conclusion. As such, this opinion is afforded lesser probative value.

Therefore, the medical evidence does not support a causal nexus between a bilateral knee disability and a lumbar spine disorder with radiculopathy. As such, the medical evidence does not support service connection on a secondary basis.

The Board has considered the Veteran's lay statements that the current back and sleep disorders were caused by service. While he is competent to report symptoms and describe observations as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an opinion as to the etiology of the current disorders due to the medical complexity of the matter involved.

Specifically, the Veteran is not competent to attribute the etiology of OSA to a service-connected psychiatric disability, or suggest a particular etiology of a current lumbar spine disorder with radiculopathy. Such competent evidence concerning the nature and extent of the Veteran's OSA and low back disorder with radiculopathy has been provided by the medical personnel who examined him during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations.

Their 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 clinical findings than to the lay statements regarding etiology.

In sum, after a careful review of the record, the evidence weighs persuasively against the claim for service connection and there is no doubt to be resolved. As such, the appeal is 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'
the lay statements regarding etiology.

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

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kokolas, Thomas

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.

Analyze in VA Law Explorer