SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, an Army Veteran who served from December 1977 to October 1995, appeals the denial of service connection for obstructive sleep apnea (OSA). The Veteran contends his OSA began during service, citing his wife's observations of snoring and breathing pauses, and his own reports of trouble sleeping. However, the Board found the evidence weighed against a service connection. While the Veteran's service treatment records noted trouble sleeping and breathing in 1984 and 1986, no diagnosis of OSA was made, and the Veteran reported no sleep issues on a 1991 examination, being deemed fit for retention. The first diagnosis of OSA occurred in June 2012, approximately 17 years post-service. Multiple VA examinations were conducted following Board remands. The January 2018 examiner initially opined OSA was not incurred in service, attributing it to obesity. Subsequent opinions in April 2022, November 2022, April 2023, and September 2023, while addressing lay evidence and earlier complaints, consistently found OSA less likely than not related to service, citing the lack of contemporaneous diagnosis, the significant time lapse post-service, and the likely onset due to post-service weight gain. A February 2024 opinion from a different examiner reiterated that OSA was less likely than not incurred in or caused by service, attributing the condition to morbid obesity post-service and noting the lack of clinical findings during service consistent with OSA. The Board assigned significant probative value to these VA opinions, finding the Veteran's lay assertions outweighed by the medical evidence and the lack of contemporaneous service treatment records documenting OSA symptoms. The Board denied service connection for obstructive sleep apnea.

Rationale

Evidence weighs against finding OSA began during service or is related to in-service event/disease.; Lack of contemporaneous service treatment records documenting OSA symptoms.; Significant time lapse between service and post-service diagnosis.; VA medical opinions found OSA less likely than not related to service, attributing onset to post-service morbid obesity.

Full Decision Text

Citation Nr: 25012189
Decision Date: 09/26/25	Archive Date: 09/26/25

DOCKET NO. 18-16 678
DATE: September 26, 2025

ORDER

Service connection for obstructive sleep apnea is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that obstructive sleep apnea began during active service, or is otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active military service in the United States Army from December 1977 to October 1995.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision issued by the Agency of Original Jurisdiction (AOJ).

In October 2021, the Veteran testified at a Board hearing via videoconference before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record.

This matter was previously before the Board in March 2022, September 2022, March 2023, and most recently in December 2023 where it was remanded for additional evidentiary development. 

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Issue: Entitlement to service connection for obstructive sleep apnea.

In May 2014, the Veteran filed his original claim seeking service connection for obstructive sleep apnea, which was denied by rating decision of January 2015, the decision on appeal.  

The Veteran contends his sleep apnea is caused by service and that his symptoms of sleep apnea began during service.   At his October 2021 hearing, the Veteran testified that during service his wife observed excessive snoring, he stopped breathing while sleeping and falling asleep while driving.  The Veteran further stated he had trouble sleeping during service. See Hearing Transcript at 4.   

While the?record?shows?a current disability diagnosed obstructive sleep apnea, the Board notes that a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the claimed disability. 

As for direct basis, the Board concludes that the evidence weighs against finding that the claimed disability began during service or is otherwise related to an in-service injury, event, or disease.  

The Veteran's service treatment records show an April 1984 visit for trouble breathing at night, and a report of "frequent trouble sleeping" on his April 1985 periodic Report of Medical History.  The examining physician at the time indicated "no medication needed" and no diagnosis was noted. The Veteran had normal clinical findings on periodic examination. See Report of Medical History and Report of Medical Examination dated April 1985.   

Another October 1986 Report of Medical History the Veteran reported "frequent trouble sleeping" described as, "normally two or three times a night, I will wake up in the middle of the night. I can sleep no longer than 4 to 5 hours continuously during the night".  See Report of Medical History dated October 1986.  However, on examination, the Veteran had normal clinical findings and no diagnosis indicated by the examining physician. See Report of Medical Examination dated April 1985.   

Notably, the Veteran denied any trouble sleeping on October 1991 Report of Medical History, and had normal clinical findings on examination. He was determined "qualified for retention". See Report of Medical Examination dated October 1991. 

Post-service, the first medical diagnosis of obstructive sleep apnea was in June 2012, approximately 17 years after discharge from military service.  The private report submitted by the Veteran does not reflect any symptoms of sleep apnea manifested at an earlier occasion or that sleep apnea was found related to service.  Furthermore, there is no medical opinion from the Veteran's treating physician as to etiology. See Polysomnography Study from Piedmont Sleep Center dated June 2012, received October 2014. 

In conjunction with his claim,
 October 1991 Report of Medical History, and had normal clinical findings on examination. He was determined "qualified for retention". See Report of Medical Examination dated October 1991. 

Post-service, the first medical diagnosis of obstructive sleep apnea was in June 2012, approximately 17 years after discharge from military service.  The private report submitted by the Veteran does not reflect any symptoms of sleep apnea manifested at an earlier occasion or that sleep apnea was found related to service.  Furthermore, there is no medical opinion from the Veteran's treating physician as to etiology. See Polysomnography Study from Piedmont Sleep Center dated June 2012, received October 2014. 

In conjunction with his claim, the record shows the Veteran was afforded a VA examination for sleep apnea in January 2018.  The examiner recorded the Veteran's report of having ongoing symptoms for the past 25 years. He first sought medical care for symptoms in 2011 and underwent a sleep study.  After thorough review of the claims and examination, the VA examiner opined that the veteran's obstructive sleep apnea was not incurred in miliary service.  In the rationale, the examiner indicated "sleep apnea is due to obesity." The examiner added that the Veteran's service treatment records were reviewed in totality, with consideration of symptoms reported on annual and periodic physical exams which noted "frequent trouble sleeping."  The examiner observed the Veteran did not see a military physician any time to report symptoms consistent with OSA.  Rather, in the years 1995 and 1996, veteran's weight was 172 and 177 with BMI about 25, an ideal body weight. The examiner added that the physician documented "no medication needed" and none was prescribed.  Further, post-military discharge, the examiner pointed out that the veteran provided no medical records to support a claim of a chronic sleep disorder.  The private records provided are limited to the sleep study in 2012 and is inadequate to support his claim.  See VA Medical Opinion dated January 2018.  

In March 2022, the Board remanded the matter finding the January 2018 examiner did not discuss earlier complaints of sleep trouble during service in 1984.  

In compliance with the March 2022 remand, the Veteran was afforded a VA examination and medical opinion obtained in April 2022.  Based on thorough review of the claims file and examination of the Veteran, the VA examiner opined that the veteran's obstructive sleep apnea was less likely than not incurred in or caused by in-service injury, event, or illness.  In the rationale, the examiner indicated the Veteran's service treatment records are silent for OSA diagnosis during active duty. Post discharge, he was diagnosed with OSA per sleep study on 6/8/2012.  The examiner added, this is more than 10 years after discharge and no longer considered proximate to his military service. See VA Medical Opinion dated April 2022.  

In September 2022, the Board remanded the matter as the April 2022 VA opinion did not discuss the lay evidence identified in the prior remand.  

In compliance with the September 2022 remand, an Addendum Opinion was rendered in November 2022 by the same examiner.  The examiner added that there is once again no evidence or documentation to relate the current diagnosis of OSA to the Veteran's military service and reiterated that the April 2022 opinion remained the same. See VA Addendum dated November 2022.  

However, in March 2023, the Board found the November 2022 addendum did not sufficiently address the relevant lay evidence and found another remand necessary. 

In April 2023, the same examiner provided an Addendum stating the medical opinion previously rendered remains the same.  In response to the request for clarification, the examiner indicated service treatment records and medical records were reviewed and noted no new clinical related information.  The examiner noted consideration of April 1984 complaint of cough, April 1985 treatment, October 1986 treatment, October 1991 complete physical exam. No complaint of sleep related or breathing disorder. The examiner noted normal clinical evaluation. No further notation for chronic sleep disorder or cardiopulmonary pathology until his discharged from military in October 1995.  The examiner added the Veteran was diagnosed with OSA per sleep study in June 2012, which is more than 25 years after the trouble breathing complaint in 1984.  "There is no question of the current diagnosis for OSA which he has since 2012 sleep study.... The pathology onset is expected to have started during active duty or onset within the period proximate to service both of which he does not meet."  The examiner noted that "OSA results from recurrent obstruction of the pharyngeal airway during sleep
 No complaint of sleep related or breathing disorder. The examiner noted normal clinical evaluation. No further notation for chronic sleep disorder or cardiopulmonary pathology until his discharged from military in October 1995.  The examiner added the Veteran was diagnosed with OSA per sleep study in June 2012, which is more than 25 years after the trouble breathing complaint in 1984.  "There is no question of the current diagnosis for OSA which he has since 2012 sleep study.... The pathology onset is expected to have started during active duty or onset within the period proximate to service both of which he does not meet."  The examiner noted that "OSA results from recurrent obstruction of the pharyngeal airway during sleep with resultant hypoxemia to apnea. Hence, it would have not been clinically feasible to go unnoticed for that length of time (greater than 25 years) for the actual diagnosis without treatment (sleep device CPAP) as it did with this gentleman." See VA Addendum dated April 2023.  

In September 2023, the examiner was asked for another clarification and to consider the service treatment records of April 1984, April 1985, and October 1986.  In September 2023, the same examiner responded that the medical opinions previously rendered (April 2022, November 2022, and April 2023) remain the same. See VA Addendum dated September 2023.  

In December 2023, the Board remanded for an adequate opinion from a different clinician finding the examiner again failed to consider the relevant evidence as requested. 

In February 2024, a VA Medical Opinion was obtained from a different medical professional.  After thorough review of the Veteran's electronic claims file and multiple Board remand instructions, the examiner rendered a comprehensive medical opinion addressing the pertinent evidence of record.  The examiner opined that it is less likely than not that the Veteran's OSA manifested during service or is related to service.  First, in response to request for consideration of the Veteran's service treatment records, the examiner addressed the April 1984 visit documents diagnosis of bronchitis, which clearly can produce trouble breathing, trouble sleeping, and sleeping no longer than 4-5 hours are not symptoms of OSA. Symptoms of impaired sleep, fatigue, and sleepy during the day are symptoms of insomnia, or other sleep disorder, not related to OSA. See VA Medical Opinion dated February 2024.   

Next, as to the Veteran's February 2015, May 2018 and May 2022 contention that his weight gain during service, 170 pounds at entrance to service and around 195 at separation from service supported OSA manifested during service, the examiner responded that Veteran "increased 25 pounds in 18 years, what is the normal trend for a man between the ages 20-40. Veteran increased 35 more pounds from 1995-2015 (20 years, but at this age weight stabilizes in a man)."  In 1995, on discharge from service, the Veteran was overweight but not obese. In 2015, at the time of the diagnosis, the examiner pointed out the Veteran was morbidly obese (BMI 35).  Meaning, "increase of weight during service unlikely causes OSA, however the severity of the weight, making him morbid obese, is likely the cause of his OSA, that most likely had onset after separation." Id.  

Finally, the examiner addressed the lay statements of record February 2015 NOD and October 2021 hearing testimony that during service his wife observed snoring, stopped breathing, and falling asleep while driving. Additionally, the examiner was asked to consider the May 2022 lay statement from the Veteran's daughter recalling around 1990 to 1992, her mother witnessed the Veteran falling asleep while driving several occasions and asked her to watch him while driving.  In response, the examiner added that although sleeping while driving could be a sign of OSA, Veteran clearly stated in his service treatment records that he woke up many times at night and did not sleep more than 5 hours.  The examiner stated that "this lack of sleep (not from OSA, but from another sleep disorder, which explained above)" cam be another explanation for falling asleep while driving.  The examiner added, snoring is not caused only by OSA. Id.  

Here, the Board assigns significant probative value to the six January 2018, April 2022, November 2022, April 2023, September 2023, and February 2024 VA medical opinions of record as the examiners considered the pertinent evidence of record and provided a rationale, relying on and citing to the records reviewed.  Further, the VA medical opinions were based on a comprehensive review of the Veteran's claims file, consideration of lay evidence of
  The examiner stated that "this lack of sleep (not from OSA, but from another sleep disorder, which explained above)" cam be another explanation for falling asleep while driving.  The examiner added, snoring is not caused only by OSA. Id.  

Here, the Board assigns significant probative value to the six January 2018, April 2022, November 2022, April 2023, September 2023, and February 2024 VA medical opinions of record as the examiners considered the pertinent evidence of record and provided a rationale, relying on and citing to the records reviewed.  Further, the VA medical opinions were based on a comprehensive review of the Veteran's claims file, consideration of lay evidence of record, and provide well-grounded rationale to support the examiners' conclusions. Moreover, the examiners offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. ?See Nieves-Rodriguez v. Peake,?22?Vet. App.?295?(2008).  Accordingly, the Board finds great probative value in the January 2018, April 2022, November 2022, April 2023, September 2023, and February 2024 VA medical opinions.? 

As to the Veteran's assertions of having onset of symptoms since service, while competent are not credible and outweighed by other probative evidence of record.  Here, the record shows an extended period after service without any manifestations of the claimed disability. As noted by the examiners, post-service treatment records do not document findings of chronic sleep disability.  The Veteran reported sleep apnea symptoms but was not diagnosed until 2012, approximately 17 years after separation from active military service. See Buchanan v. Nicholson,?451 F.3d 1331, 1337?(Fed. Cir. 2006) (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining?credibility?of lay evidence, but the Board cannot determine that lay evidence lacks?credibility?merely because it is unaccompanied by contemporaneous medical evidence); see also Maxon v. Gober,?230 F.3d 1330, 1333?(Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). 

Lastly, the Board observes that the Veteran, as a layperson, is not competent to independently opine as to the specific etiology of a claimed disability as such requires medical expertise and the ability to interpret diagnostic medical testing.? Accordingly, the Board assigns more weight to the medical evidence of record, including the January 2018, April 2022, November 2022, April 2023, September 2023, and February 2024 VA medical opinions. ?Critically, there are no contrary medical opinions of record. 

Based on the foregoing reasons, the Board finds that service connection for obstructive sleep apnea is not warranted.? In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence of record persuasively weighs against the claim, that doctrine is not applicable. See 38?U.S.C. §?5107(b); 38?C.F.R. §?3.102; Lynch v. McDonough, 999 F.3d at 1391.? Accordingly, the claim must be denied. 

 

 

KELLI A. KORDICH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S.A., 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 or interpretations of general applicability. 38 C.F.R. § 20.1303.