SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, who served from August 1986 to August 1990, appeals the denial of service connection for obstructive sleep apnea (OSA). The veteran contended that OSA was secondary to service-connected left leg and back disabilities, with obesity acting as an intermediary step. The Board found that while the veteran had a current OSA diagnosis and service-connected left leg and back disabilities, the evidence did not establish the necessary link. Service treatment records were silent regarding OSA or related symptoms, and the separation examination showed the veteran denied sleep problems. The Board found the private medical opinion from the treating physician unpersuasive because it conflated being overweight with obesity and was inconsistent with objective medical evidence, as the veteran's BMI was 25.6 at the time of diagnosis, not obese (BMI 30+). The VA examiners also opined that OSA was less likely than not related to service, noting a lack of medical literature supporting a link between the specific service-connected conditions and OSA, and that the Veteran was not obese. The Board gave greater weight to the medical opinions over the veteran's lay statements regarding etiology. Service connection for OSA was denied.

Rationale

Service treatment records silent for OSA or related symptoms.; Separation examination showed denial of sleep problems.; Private medical opinion lacked probative value due to conflation of overweight with obesity and inconsistency with objective medical evidence.; VA medical opinions did not address obesity as an intermediary step.; Medical evidence does not support obesity as an intermediary step to OSA.

Full Decision Text

Citation Nr: A26010684
Decision Date: 02/04/26	Archive Date: 02/04/26

DOCKET NO. 250905-583262
DATE: February 4, 2026

ORDER

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

FINDINGS OF FACT

1. The Veteran served on active duty from August 1986 to August 1990; he has been 100 percent disabled based on unemployability since September 2024 plus in receipt of special monthly compensation (SMC).

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.

CONCLUSION OF LAW

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. §§ 3.102, 3.159, 3.303, 3.310 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

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 April 2024, the agency of original jurisdiction (AOJ) denied the claim. In September 2024, the Veteran filed a Supplemental Claim and the claim was again denied in January 2025 on the basis that no new and relevant evidence had been submitted. In September 2025, the Veteran appealed to the Board via a Form 10182 and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2025 AOJ decision on appeal. 38 C.F.R. § 20.301.

Turning first to whether new and relevant evidence has been submitted, when the Veteran submitted the September 2024 Supplemental Claim, he provided a medical release for VA to obtain medical records from the primary care provider and additional VA treatment records. Also, he provided medical literature discussing OSA and obesity, case law in support of the claim that obesity was an intermediary step between service-connected disabilities and OSA, a VA memorandum from the Acting General Counsel discussing service connection based on obesity, and lay statement and argument in support of the claim.

In the January 2025 rating decision, the AOJ list of evidence considered in the decision only references the VA medical records but did not identify the other evidence submitted by the Veteran and associated with the claims file. Moreover, a review of the claims file does not reveal that the unlisted evidence had been previously provided by the Veteran or had been before VA adjudicators at any point. As such, the Board finds that new and relevant evidence has been received and will address the issue on the merits.

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).

Initially, the Veteran's primary contention was that obesity caused OSA and obesity resulted from service-connected disabilities, including a left leg and back disabilities. 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). Nevertheless, the Board will consider all relevant theories of entitlement.

As to direct service connection, the Veteran was diagnosed with OSA in an October 2023 sleep study as confirmed in the October 202
 establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Initially, the Veteran's primary contention was that obesity caused OSA and obesity resulted from service-connected disabilities, including a left leg and back disabilities. 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). Nevertheless, the Board will consider all relevant theories of entitlement.

As to direct service connection, the Veteran was diagnosed with OSA in an October 2023 sleep study as confirmed in the October 2023 VA examination. As such, the first element of direct service connection has been met.

As to an in-service incurrence, while the service treatment records (STRs) reflect treatment for various injuries, including left leg pain, left ankle injury, and low back pain, they are silent for complaints of, treatment for, or diagnosis of OSA, or symptoms reasonably related to OSA, such as daytime hypersomnolence, snoring, and fatigue.

Here, the Board is not merely relying on the absence of evidence but also on the contemporaneous medical records that specifically show that the Veteran repeatedly denied sleep problems while in service, specifically the June 1990 Separation Examination, when it would be more likely for him to identify all medical problems, but he specifically denied having difficulty with sleeping. Consequently, the second element of direct service connection is not met, and the medical evidence does not support direct service connection.

As noted above, the Veteran's primary contention is that OSA is secondary to left leg and back disabilities with obesity as an intermediary step. The Board notes that in a common internet search, the Center for Disease Control (CDC) website reflects that the current body mass index (BMI) for obesity is 30. See https://www.cdc.gov/bmi/faq /index.html. 

As to secondary service connection, the Veteran is diagnosed with OSA as noted above and is service connected for a left leg and low back disabilities. Accordingly, the first and second elements of secondary service connection are met. 

As to medical evidence establishing a link between the service-connected disabilities and OSA, the Veteran provided medical literature, a private medical opinion from his treating physician, and other evidence suggesting a link between the service-connected disabilities, obesity, and OSA. He has also provided, as noted above, a VA memorandum from the Acting General Counsel regarding obesity as an intermediary step, and case law that supports that obesity can be considered in determining secondary service connection.

As to the treating clinician's July 2023 medical opinion, the private clinician concluded that it was as likely as not that the service-connected left leg and back disabilities contributed to the Veteran's weight gain by making physical activity, which is useful in weight management, more challenging. The Veteran's being overweight (BMI 26.2) heightened the risk for, contributes to, or exacerbates OSA. 

Interestingly, the private clinician's medical opinion is dated July 2023, however, the Veteran was not diagnosed with OSA until a home sleep study was completed in October 2023, and there are no other medical records reflecting an OSA diagnosis prior to the October 2023 sleep study; however, the private treatment records reflected an insomnia disorder. The Veteran also had a VA sleep study later in October 2023 in which he was diagnosed with OSA.

Moreover, the private medical opinion is not supported by the evidence as the medical evidence indicates that the Veteran was not obese at or near when he was diagnosed with OSA or the date of the medical opinion. Notably, the private clinician never stated that the Veteran was obese; rather, he was identified as overweight. Instead, the private clinician conflated the Veteran being overweight with obesity when concluding that being overweight contributed to or exacerbated OSA.

Thus, the private medical opinion does not establish an adequate medical nexus between the service-connected disabilities, obesity, and OSA. There is no competent medical evidence indicating the Veteran was obese at or near the time of the OSA diagnosis or at any time during the pendency of the claim. In fact, the Veteran's BMI at the time of the sleep study consult in October 2023 was 25.6.

In October 2023, the Veteran underwent a VA examination for OSA. The examiner noted that the Veteran was diagnosed with mild OSA based on an October 2023 home sleep study but opined, however, that it was less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the service-connected leg and back disabilities. In support of this opinion, the examiner noted that OSA was excess weight and obesity, which was associated
 Veteran was obese at or near the time of the OSA diagnosis or at any time during the pendency of the claim. In fact, the Veteran's BMI at the time of the sleep study consult in October 2023 was 25.6.

In October 2023, the Veteran underwent a VA examination for OSA. The examiner noted that the Veteran was diagnosed with mild OSA based on an October 2023 home sleep study but opined, however, that it was less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the service-connected leg and back disabilities. In support of this opinion, the examiner noted that OSA was excess weight and obesity, which was associated with soft tissue of the mouth and throat. The VA examiner did not address the intermediary step of obesity leading to OSA.

Next, a March 2024 VA examiner opined that OSA was less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the left leg or back disabilities. In support of the opinion, the examiner noted that there is no sufficient evidence found in medical literature that shows a connection with a lumbosacral strain with degenerative disc disease and spinal stenosis, impairment of lower leg - tibia and fibula, and OSA; therefore, a nexus could not be made to support this claim. As with the October 2023 VA examiner, this examiner did not address the intermediary step of obesity to OSA.

To that end, the Board finds the July 2023 private physician's medical opinion and the October 2023 and March 2024 VA medical opinions to be of little probative value. In rendering an opinion, the private clinician's conclusion was inconsistent with the objective medical evidence, and the VA medical opinions did not address whether the service-connected disabilities caused obesity that caused OSA.

Although neither the private nor the two VA medical opinions are probative of the issue, a remand for an additional medical opinion is unnecessary to determine whether the service-connected disabilities caused the Veteran's obesity, which in turn led to OSA, as the competent medical evidence does not support a finding that the Veteran is obese.

As to obesity, the private and VA treatment records were reviewed as it relates to the Veteran's. As noted by the private physician, the Veteran's BMI was 26.2. Private treatment records reflect a similar BMI, 27.12, in February 2024, and VA treatment records reflect a range of BMI from 25 to 27 during the period on appeal. There are no medical records that indicate the Veteran's BMI was 30 or higher; instead, the medical evidence indicates the Veteran is overweight.

Importantly, the medical literature of record, case law, and VA memorandum on the issue of obesity as an intermediary step specifically address obesity, not weight gain or being overweight, as an intermediary step to OSA. As the medical evidence establishes that the Veteran is not obese, the medical evidence does not support secondary service connection with obesity as an intermediary step.

The Board has considered the Veteran's lay statements that the current OSA was caused by obesity caused by his service-connected disabilities. While he is competent to report symptoms as this requires only personal knowledge as it comes through the senses, he is not competent to offer an opinion as to the etiology of the current disorder due to the medical complexity of the matters involved. 

Such competent evidence concerning the nature and extent of the Veteran's OSA has been provided by the medical personnel who examined him during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations. Those findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disorder is evaluated. 

The VA medical professional 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 Veteran's 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' 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