SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, an Army National Guard member who served from May 1989 to August 2008, appeals the denial of service connection for obstructive sleep apnea (OSA). The Veteran claims OSA is secondary to weight gain, which is itself secondary to service-connected depressive disorder with insomnia, bilateral hallux valgus, and right ankle strain. The Board reviewed the evidence, including a December 2024 rating decision, a February 2025 Notice of Disagreement, and a February 2025 Representative Brief. The primary evidence considered was a July 2021 and December 2024 VA nexus opinion and an August 2024 private examination and opinion. The VA opinions concluded OSA was not related to service, attributing it to diet, genetics, and sedentary lifestyle, despite acknowledging service-connected conditions could contribute to weight gain. The private opinion, however, found OSA secondary to obesity, which was secondary to the Veteran's service-connected mental health and foot conditions, citing literature supporting these links. The Board found the private opinion more probative due to its specific rationale and acknowledgment of the service-connected conditions' role in weight gain. Applying the benefit of the doubt, the Board found OSA secondary to the Veteran's service-connected conditions. Service connection for OSA is granted, secondary to depressive disorder with insomnia, right and left foot hallux valgus, and right ankle strain.

Rationale

Private opinion found OSA secondary to obesity, which was secondary to service-connected conditions.; VA opinions found OSA not related to service, attributing it to diet, genetics, and sedentary lifestyle.; Board found private opinion more probative due to specific rationale and acknowledgment of service-connected conditions' role in weight gain.

Full Decision Text

Citation Nr: A26010544
Decision Date: 02/04/26	Archive Date: 02/04/26

DOCKET NO. 250213-521440
DATE: February 4, 2026

ORDER

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

FINDING OF FACT

The Veteran's current OSA is secondary to her weight gain and obesity, which is itself secondary to her service-connected depressive disorder with insomnia, right and left foot hallux valgus, and right ankle strain.

CONCLUSION OF LAW

The criteria for entitlement to service connection for OSA are met. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

Introduction

The Veteran served on active duty in the Army National Guard from May 1989 to August 2008.

This case is before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 

The Veteran submitted her VA Form 10182, Notice of Disagreement, in February 2025 and selected direct review of the December 2024 rating decision, without a Board hearing or the submission of additional evidence.

Therefore, the Board may consider only evidence associated with the record before December 20, 2024, the date of the rating decision on appeal.

If the Veteran submitted evidence that was added to the record after this date, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying this evidence. See 38 C.F.R. § 3.2501.

Service Connection for OSA

The Veteran is seeking service connection for OSA. She contends that her current OSA is secondary to her weight gain, which is itself secondary to her service-connected depressive disorder with insomnia, right and left foot hallux valgus, and right ankle strain. See, e.g., February 2025 Representative Brief.

Generally, in order to prove service connection, there must be competent, credible evidence of: 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Further, service connection may be established on a secondary basis for a disability which was either caused or aggravated by a service-connected disability.  38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

Finally, in January 2017, VA's Office of General Counsel (OGC) issued a precedential opinion finding that although obesity cannot be service-connected on a direct basis, obesity may serve as an intermediate step between a service-connected disability and a condition claimed on a secondary basis. VAOPGCPREC 1-2017. Precedential opinions issued by OGC are binding on the Board. See 38 U.S.C. § 7104(c).

Here, the evidence reflects that the Veteran's obesity is secondary to her service-connected disabilities, and that her OSA is secondary to her weight gain and obesity, and thus service connection for OSA is warranted on a secondary basis.

In particular, an August 2024 private examination and opinion concluded that the Veteran's OSA was secondary to her obesity and weight gain which was itself secondary to her service-connected depressive disorder with insomnia, right and left foot hallux valgus, and right ankle strain. The private clinician cited literature showing that mental health and foot conditions can lead to obesity, for example by decreasing motivation and ability to exercise. The clinician also cited research showing a relationship between the Veteran's psychiatric medications and weight gain, between sleep disturbance (a symptom of the Veteran's service-connected depressive disorder) and weight gain, and between weight gain and OSA.

Weighing against the August 2024 private opinion are two VA nexus opinions, dated July 2021 and December 2024, both of which conclude that the Veteran's OSA is not related to service or secondary to her other service-connected conditions. The VA opinions point out that the Veteran's symptoms began in 2011, years after her active-duty service, and opine that her OSA is more likely due to a combination of poor diet, genetics, and a "sedentary lifestyle"
. The clinician also cited research showing a relationship between the Veteran's psychiatric medications and weight gain, between sleep disturbance (a symptom of the Veteran's service-connected depressive disorder) and weight gain, and between weight gain and OSA.

Weighing against the August 2024 private opinion are two VA nexus opinions, dated July 2021 and December 2024, both of which conclude that the Veteran's OSA is not related to service or secondary to her other service-connected conditions. The VA opinions point out that the Veteran's symptoms began in 2011, years after her active-duty service, and opine that her OSA is more likely due to a combination of poor diet, genetics, and a "sedentary lifestyle" (lack of exercise) than to inability to exercise alone.

However, the Veteran's service-connected conditions, if they prevented her from exercising, would still be a cause of her weight gain even if they were not the only cause, and the July 2021 and December 2024 VA opinions admit as much, even as they conclude that her service-connected disabilities did not cause her OSA. Therefore, the Board affords these opinions significantly less weight than the opinion of the August 2024 private clinician. (A September 2024 VA examination noted a diagnosis of OSA reported as "ongoing for years" but did not include a medical nexus opinion.)

Considering the greater probative value of the August 2024 private opinion, the Board finds that the Veteran's current OSA is secondary to her weight gain and obesity, which is itself secondary to her service-connected depressive disorder with insomnia, right and left foot hallux valgus, and right ankle strain. To the extent any reasonable doubt remains as to this finding, all such doubt is resolved in the Veteran's favor. 38 C.F.R. § 3.102.

Accordingly, service connection for OSA is warranted, secondary to depressive disorder with insomnia, right and left foot hallux valgus, and right ankle strain. 

 

S.C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Philip Timmerman

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.