SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, a Navy Veteran who served from October 1985 to October 2005, appealed the denial of service connection for obstructive sleep apnea (OSA) as secondary to a service-connected lumbar strain, with obesity as an intermediate step. The Board reviewed the evidence, noting the Veteran's service-connected lumbar strain and current OSA diagnosis. An initial VA examination in April 2024 was found inadequate because it failed to address aggravation and obesity as an intermediate step, stating only that OSA was less likely than not related to lumbar strain and that risk factors for OSA did not include lumbar strain. The Veteran submitted lay statements detailing sleep problems, inability to exercise, and significant weight gain since service. Crucially, the Veteran also provided a private medical opinion from Dr. Z.M., which linked the service-connected lumbar strain to obesity through pain, reduced motivation, and overeating, and then linked obesity to OSA, citing supporting medical literature. The Board found this private opinion probative due to its accurate medical history and clear, supported conclusions. Although a second VA examination was also inadequate regarding secondary service connection, the Board found the evidence regarding the lumbar strain causing obesity, and obesity causing OSA, to be in approximate balance. Applying the benefit of the doubt, the Board granted service connection for OSA as secondary to the service-connected lumbar strain, with obesity as an intermediate step.

Rationale

Service-connected lumbar strain established.; Current diagnosis of OSA established.; Private medical opinion linked lumbar strain to obesity, and obesity to OSA.; Veteran's lay statements supported weight gain and inability to exercise.; Evidence found in approximate balance regarding secondary connection via obesity.; Benefit of the doubt applied to grant the claim.

Full Decision Text

Citation Nr: A26012624
Decision Date: 02/11/26	Archive Date: 02/11/26

DOCKET NO. 250211-520460
DATE: February 11, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea (OSA) as secondary to lumbar strain, with obesity as an intermediate step, is granted.

FINDING OF FACT

The Veteran's OSA is proximately due to her service-connected lumbar strain, with obesity as an intermediate step.

CONCLUSION OF LAW

The criteria for entitlement to service connection for OSA as secondary to service-connected lumbar strain is met. 38 U.S.C. §§ 1110, 1131, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310(a).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the Navy from October 1985 to October 2005. 

In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

Service connection for OSA. 

Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence between the two. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 

Pertinent to this claim, although obesity by itself is not a disability for which compensation may be awarded, it may constitute an "intermediate step" in demonstrating service connection on a secondary basis for another condition. VA Gen. Coun. Prec. 1-2017 (2017); See also Marcelino v. Shulkin, 29 Vet. App. 155, 158 (2018). Although the VA General Counsel opinion on obesity addresses only causation, the Board must consider aggravation in this context when the theory is explicitly raised by the Veteran or is reasonably raised by the record. Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020).

Initially, the Board finds at the time of the April 2024 rating decision the Veteran was serviced connected for lumbar strain. See April 2024 Rating Decision - Code sheet. Additionally, the Board notes that the Veteran has a current diagnosis of OSA. See April 2024 Rating Decision. Thus, the first and second elements of secondary service connection are met. Accordingly, the question before the Board is whether there is a nexus between the Veteran's OSA and her lumbar strain.

VA obtained a medical opinion in April 2024. The examiner found that the Veteran's OSA is less likely than not proximately due to the result of her lumbar strain. The examiner reasoned that the Veteran's service treatment records were silent for relevant findings. The examiner stated "[r]isk factors for sleep apnea include obesity, advancing age, smoking, and certain medical conditions such as diabetes, hypothyroidism, stroke, and heart failure. There is no medical evidence available that provides any indication of a relationship between the development of obstructive sleep apnea and a muscle strain in the lumbar region (lower back)." See April 2024 VA Examination. 

The examiner did not address aggravation. Accordingly, this examination is inadequate. See El-Amin v. Shinseki, 26. Vet. App. 136, 138 (2013) (In secondary service connection claims, a medical opinion is inadequate if it does not address both causation and aggravation of the nonservice-connected condition).

The Veteran stated that her lumbar strain keeps her from exercising. Additionally, she stated that she experiences sleep problems. The Veteran also stated that she weighed 130 pounds when she entered the Navy, 180 pounds when she separated from the Navy, and that she currently weighs 231 pounds. See February 2024 VA Form 21-4138 Statement In Support of Claim. 

The Veteran provided a private medical opinion from Dr. Z.M. Dr. Z.M. that it is at least as likely as not that the Veteran's obesity is due
 136, 138 (2013) (In secondary service connection claims, a medical opinion is inadequate if it does not address both causation and aggravation of the nonservice-connected condition).

The Veteran stated that her lumbar strain keeps her from exercising. Additionally, she stated that she experiences sleep problems. The Veteran also stated that she weighed 130 pounds when she entered the Navy, 180 pounds when she separated from the Navy, and that she currently weighs 231 pounds. See February 2024 VA Form 21-4138 Statement In Support of Claim. 

The Veteran provided a private medical opinion from Dr. Z.M. Dr. Z.M. that it is at least as likely as not that the Veteran's obesity is due to her service-connected lumbar strain and that her obesity has caused OSA. Dr. Z.M. stated that the Veteran's service-connected disability can lead to pain, painful motion, sleep disturbances, diminished motivation, and comfort overeating which can lead to diminished activity with less caloric expenditure, which leads to and/or promotes weight gain and obesity. Dr. Z.M. cited medical literature which states obesity causes OSA. The Board finds this opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

VA obtained a second medical opinion in April 2024. The examiner provided a negative nexus opinion after determining that the Veteran's OSA was not directly related to her toxic exposure risk activities. However, the Veteran contends that her OSA condition was caused or aggravated by his service-connected lumbar strain, to include obesity. The second April 2024 VA examiner did not address secondary-service connection. As such, the VA examiner's nexus opinion is not relevant to the issue at hand. 

Initially, the Board notes that VA has not obtained an adequate opinion regarding secondary service connection as the April 2024 opinion does not address aggravation nor obesity as an intermediate step. However, the Board notes that the April 2024 found obesity to be a risk factor of OSA. Even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (if it is merely lacking in detail, then it may be given some weight based upon the amount of information and analysis it contains). Furthermore, the Veteran submitted a private nexus statement that concluded her service-connected lumbar strain caused her obesity and her obesity caused her OSA. The private opinion is further supported by the Veteran's statements regarding her inability to exercise, sleep problems, and weight gain. 

In sum, the Board finds that the competent and probative evidence is in approximate balance that the Veteran's lumbar strain caused her obesity. Furthermore, the Board finds that obesity was a substantial factor in the Veteran's OSA. For the reasons above, the evidence is at least evenly balanced as to whether the Veteran's OSA is caused by her service-connected lumbar strain, with obesity as an intermediate step. Thus, entitlement to service connection for OSA is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

 

Cory M. Picton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Welch, Joshua H.

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.