SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, an Army Veteran who served from February 1993 to November 1993, appeals the May 2022 rating decision regarding service connection for obstructive sleep apnea (OSA). The Veteran's primary theory is that OSA is secondary to his service-connected disabilities, specifically tinnitus and bilateral upper extremity radiculopathy, which he claims led to weight gain and obesity. The Board noted the Veteran's current diagnosis of OSA and obesity, and that service connection for tinnitus and bilateral upper extremity radiculopathy was already established. The May 2022 VA examination was not considered as the examiner failed to provide an opinion on the causal link between the service-connected conditions, weight gain, and OSA. At a November 2025 hearing, the Veteran credibly testified about weight gain due to service-connected adjustment disorder and orthopedic issues, impacting his eating habits and activity levels. A December 2025 private medical opinion found it at least as likely as not that the Veteran's OSA is causally related to his service-connected tinnitus and radiculopathy, with obesity as an intermediate step, citing medical literature supporting this link. The Board found this private opinion highly probative due to its comprehensive rationale and medical support. Consequently, service connection for OSA was granted, finding it causally related to the service-connected conditions with obesity as an intermediate step.

Rationale

Veteran credibly testified to weight gain due to service-connected adjustment disorder and orthopedic disabilities.; Private medical opinion found OSA causally related to service-connected tinnitus and radiculopathy with obesity as intermediate step.; Private opinion was well-supported by medical literature and provided adequate rationale.

Full Decision Text

Citation Nr: A26019184
Decision Date: 03/04/26	Archive Date: 03/04/26

DOCKET NO. 220524-246594
DATE: March 4, 2026

ORDER

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

FINDING OF FACT

The Veteran's OSA is causally related to his service-connected bilateral upper extremity radiculopathy and tinnitus. 

CONCLUSION OF LAW

The criteria for service connection for sleep apnea have been met.  38 U.S.C. §§ 1110, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from February to November 1993. 

The rating decision on appeal was issued in May 2022 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

On the May 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  

The Veteran testified at a Board hearing held before the undersigned Veterans Law Judge in November 2025. 

Therefore, the Board may only consider the evidence of record at the time of the November 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for sleep apnea.

The Veteran contends that OSA is secondary to a service-connected disability.  See December 2025, Third party correspondence; March 2022, VA Form 21-526EZ.

Service connection may be established for disability that is proximately due to or the result of a service-connected disability.  38 C.F.R. § 3.310(a).  Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown.  38 C.F.R. § 3.310; El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995).

Service connection on a secondary basis is warranted for any incremental increase in disability, regardless of its permanence.  See Ward v. Wilkie, 31 Vet. App. 233 (2019).  Secondary service connection may be granted where a non-service-connected disability would have been less severe but for a service-connected disability.  Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection). 

Although obesity is not a condition for which service connection may be granted, obesity may qualify as an "intermediate step" between a service-connected disability and another current disability.  See VAOPGCPREC 1-2017; see also Garner v. Tran, 33 Vet. App. 241 (2021); Walsh v. Wilkie, 32 Vet. App. 300 (2020).  In a secondary service connection claim, a theory of obesity as an intermediate step is raised when there is some evidence in the record which draws an association or suggests a relationship between the veteran's obesity, or weight gain resulting in obesity, and a service-connected condition.  Garner v. Tran, 33 Vet. App. 241 (2021).  

The AOJ favorably found the evidence shows the Veteran has a current disability,
 step" between a service-connected disability and another current disability.  See VAOPGCPREC 1-2017; see also Garner v. Tran, 33 Vet. App. 241 (2021); Walsh v. Wilkie, 32 Vet. App. 300 (2020).  In a secondary service connection claim, a theory of obesity as an intermediate step is raised when there is some evidence in the record which draws an association or suggests a relationship between the veteran's obesity, or weight gain resulting in obesity, and a service-connected condition.  Garner v. Tran, 33 Vet. App. 241 (2021).  

The AOJ favorably found the evidence shows the Veteran has a current disability, diagnosed OSA.  See May 2022, Rating decision. 

The Board notes the Veteran has a current diagnosis of obesity.  See April 2022, VA treatment record.  Service connection is also in effect for tinnitus and bilateral upper extremity radiculopathy.  The critical question in this case is the etiology of the diagnosed OSA. 

The Board is required to consider theories of entitlement to benefits that are either raised by the claimant or reasonably raised by the record.  Lynch v. Wilkie, 30 Vet. App. 296, 304 (2018).  In this case, the Veteran's primary theory of entitlement is that due to his service-connected disabilities, he experienced weight gain and obesity, and this caused his obstructive sleep apnea.  

The Veteran was afforded a VA examination in May 2022 but the examiner did not provide an opinion addressing whether the Veteran's OSA was caused or aggravated by his service-connected tinnitus and bilateral upper extremity radiculopathy, to include chronic radicular pain, and/or whether any of his service-connected disabilities caused him to be obese.  Hence, the Board will not address the May 2022 VA examination and opinion hereafter. 

At the November 2025 Board hearing, the Veteran credibly testified that he gained weight due to his service-connected adjustment disorder and orthopedic disabilities, which include his knees, back, and cervical spine.  The Veteran explained that his physical disabilities prevent him from performing physical tasks and mental health symptoms, to include anxiety, impacts his eating habits. He further stated that he uses a Continuous Positive Airway Pressure (CPAP) machine and OSA was diagnosed in 2019 or 2020.  See November 2025, Hearing transcript.

In December 2025, a private medical opinion was received stating that it is at least as likely as not that the Veteran's OSA is causally related to his service-connected tinnitus and bilateral upper extremity radiculopathy, manifested by chronic radicular pain, sleep impairment, weight gain, and obesity.  Specifically, the private examiner conducted a record review and explained that the Veteran's service-connected tinnitus and bilateral upper extremity radiculopathy, to include chronic radicular pain, causes sleep deprivation which modifies appetite-regulated hormones and increases caloric intake.  Sleep deprivation, in turn, reduces activity level in the cortical regions of the brain and causes a progressive food desired which leads to overeating, weight gain, and obesity.  Thus, based on review of the Veteran's medical history and his diagnosed obesity, the private examiner opined it is at least as likely as not that the Veteran's obesity is the direct result of impaired sleep due to service-connected tinnitus and chronic radicular pain due to service-connected bilateral upper extremity radiculopathy.  

The private examiner further stated that obesity is a major risk factor associated with OSA.  The private examiner noted that it is well documented in medical literature that OSA is associated with excessive weight gain and obesity.  After discussing several medical journals, to include reports indicating cervical spine disabilities, depression, and tinnitus tend to aggravate OSA, the private examiner opined that it is at least as likely as not that the Veteran's OSA is the direct result of his obesity and OSA was at least as likely as not aggravated by his service-connected tinnitus, cervical spine disability, and depression/adjustment disorder.  See December 2025, Private treatment record.

After a review of the evidence of record, the Board finds the evidence is persuasively supports finding service connection for OSA.  In reaching this finding, the Board accords high probative weight to the December 2015 private medical opinion as it considered the Veteran's relevant medical history, the opinions provided were well supported by medical literature, and included adequate rationales that linked the Veteran's diagnosed obesity to service-connected disabilities and established a direct causal connection between Veteran's obesity and OSA.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The Board finds that
 and depression/adjustment disorder.  See December 2025, Private treatment record.

After a review of the evidence of record, the Board finds the evidence is persuasively supports finding service connection for OSA.  In reaching this finding, the Board accords high probative weight to the December 2015 private medical opinion as it considered the Veteran's relevant medical history, the opinions provided were well supported by medical literature, and included adequate rationales that linked the Veteran's diagnosed obesity to service-connected disabilities and established a direct causal connection between Veteran's obesity and OSA.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The Board finds that the relevant evidence of record overwhelmingly supports the conclusion that the Veteran's OSA is causally related to his service-connected tinnitus and bilateral upper extremity radiculopathy with obesity serving as an intermediate step.  

Therefore, service connection for OSA is warranted.  See 38 C.F.R. § 3.310(a).  

 

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Straughn, Shavonne

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.