SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, who served in the U.S. Navy from January 2014 to October 2018, appeals the denial of service connection for sleep apnea. The Board reviewed the evidence submitted by the veteran, including a March 2023 Notice of Disagreement and subsequent evidence received within 90 days. The AOJ had previously found a current diagnosis of mild obstructive sleep apnea and a qualifying in-service event, specifically a complaint of sleep trouble during an exit examination in August 2018, noting irregular sleeping problems and hard breathing. The Board considered two medical opinions regarding the nexus between the veteran's current sleep apnea and his service. A May 2022 opinion found it at least as likely as not that the sleep apnea was related to service, citing the in-service complaint. An August 2022 opinion from the same clinician found it less likely than not, stating a lack of objective evidence during service and attributing the in-service complaint to insomnia. The Board found the first opinion more probative due to its consideration of lay statements and the close proximity of the post-service diagnosis. Resolving doubt in the veteran's favor, the Board found a nexus established. Therefore, service connection for sleep apnea was granted.

Rationale

Current diagnosis of mild obstructive sleep apnea found.; In-service complaint of irregular sleeping problems and hard breathing noted.; Conflicting medical opinions regarding nexus; Board found first opinion more probative.; Benefit of the doubt resolved in veteran's favor.

Full Decision Text

Citation Nr: A25061223
Decision Date: 07/17/25	Archive Date: 07/17/25

DOCKET NO. 230308-329546
DATE: July 17, 2025

ORDER

Entitlement to service connection for sleep apnea is granted.

FINDING OF FACT

The Veteran's sleep apnea is reasonably shown to have begun in service and persisted since.

CONCLUSION OF LAW

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

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Navy from January 2014 to October 2018. 

In the March 8, 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the August 2022 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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. 

Service Connection

Service connection may be established for disability due to disease or injury that was incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R.        § 3.303. To establish service connection for a claimed disability, there must be evidence of: (i) a present claimed disability; (ii) incurrence or aggravation of a disease or injury in service; (iii) and a causal relationship between the present disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R.  § 3.303(a).

Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson.  38 C.F.R. § 3.159 (a)(2).  Competent medical evidence is necessary where the determinative question requires medical knowledge.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises.  Competent medical evidence may also include statements contained in authoritative writing, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a)(1). 

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.            § 5107(b); 38 C.F.R. § 3.102.

Entitlement to service connection for sleep apnea.

As to the first element of service connection, the Board is bound by favorable findings. Here, in August 2022, the AOJ has found that the Veteran has a current diagnosis of mild obstructive sleep apnea. Thus, the first element of service connection is met. See Shedden, supra
 § 3.159 (a)(1). 

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.            § 5107(b); 38 C.F.R. § 3.102.

Entitlement to service connection for sleep apnea.

As to the first element of service connection, the Board is bound by favorable findings. Here, in August 2022, the AOJ has found that the Veteran has a current diagnosis of mild obstructive sleep apnea. Thus, the first element of service connection is met. See Shedden, supra. 

As to the second element of service connection, the Board is bound by favorable findings. Here, in August 2022, the AOJ found that the Veteran had a qualifying event, injury, or disease in service and that the Veteran's service treatment records demonstrate a complaint for sleep trouble during exit examination in August 2018. Thus, the second element of service connection is met. See Shedden, supra. 

As to the final element of service connection, a nexus, the evidence is in support of a finding that the Veteran's current sleep apnea is related to his in-service report of sleep trouble in-service, specifically as the Veteran reported "very irregular sleeping problems, hard breathing." 

A May 2022 medical opinion in which the clinician opined that it was at least as likely as not that the Veteran's sleep apnea was related to the Veteran's service. In supporting rationale, the clinician stated that the Veteran's "medical records shows that during separation on 08/02/2018, veteran reports irregular sleeping problems and hard breathing. The claimed sleep apnea is at least as likely as not incurred in or caused by sleep issues during service." 

An August 2022 medical opinion (by the same clinician who provided the May 2022 medical opinion) is against the Veteran's claim. The clinician states there is no objective evidence to support the diagnosis and treatment of obstructive sleep apnea during service. The clinician noted the Veteran reported insomnia during service due to ship schedule cleanser during the exit examination in August 2018 and that "the claimed OSA is less likely than not incurred in or caused by the sleep issues during service." 

The Board finds that the persuasive value of the first opinion is slightly diminished given the in-service sleep complaint being attributed to insomnia, but it retains probative value given its consideration of the Veteran's lay statements of ongoing sleep and breathing problems coupled with a diagnosis of sleep apnea rendered only four years after separation from service. The Board finds the August 2022 opinion to be of less probative value given its minimal rationale and lack of consideration of the Veteran's lay statements. Resolving reasonably doubt in favor of the Veteran, the Board finds a nexus is established. Thus, the final element of service connection is met. See Shedden, supra. 

Service connection for sleep apnea is warranted. The appeal is granted.

 

 

Michael Sobiecki

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Staskowski, Nichole

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.