SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

H. SEESEL · 2026 · Case ID: A26020764

DENIED

Summary

The veteran, who served in the United States Army from August 1967 to July 1970, including service in Vietnam, appeals the denial of service connection for sleep apnea (OSA) and a compensable evaluation for hypertension. The Board reviewed evidence of record up to May and June 2025, as the case was advanced on the docket and the veteran elected Direct Review. The veteran claimed OSA secondary to herbicide exposure in Vietnam or as secondary to hypertension, and sought a compensable rating for hypertension due to daily medication since 2019. The Board denied service connection for OSA, finding that while the veteran had OSA diagnosed in 2021 and conceded herbicide exposure, the evidence did not establish that OSA began during service or was related to service or hypertension. Multiple VA medical opinions from March, April, and September 2024/2025 concluded that OSA is not at least as likely as not related to herbicide exposure or hypertension, citing lack of medical literature supporting such a nexus and noting OSA is due to anatomical changes not caused by toxic exposure. The Board denied a compensable rating for hypertension, finding the veteran's blood pressure readings, even while on medication, did not meet the criteria for a 10 percent rating under Diagnostic Code 7101, specifically lacking a history of diastolic pressure predominantly 100 or more.

Rationale

Current diagnosis of OSA; No nexus to herbicide exposure; No nexus to hypertension; VA opinions found OSA not related to TERA/AO exposure; OSA not presumed for toxic exposures; OSA due to anatomical changes, not toxic exposure; Medical literature does not support nexus; No nexus to hypertension; Hypertension does not cause OSA; OSA not related to service

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260205-620380

Full Decision Text

Citation Nr: A26020764
Decision Date: 03/09/26 Archive Date: 03/09/26

DOCKET NO. 260205-620380
DATE: March 9, 2026

ORDER

Service connection for sleep apnea is denied.

A compensable evaluation of hypertension is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that obstructive sleep apnea (OSA) began during active service or is secondary to service-connected hypertension or was caused by exposure to herbicide agents to include Agent Orange exposure in Vietnam.

2. During the entire appeal period, the Veteran's has required continuous medication to control his hypertension; however, the Veteran does not have a history of diastolic pressure predominantly 100 or more.

CONCLUSIONS OF LAW

1. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for a compensable evaluation of hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active United States Army service from August 1967 to July 1970, to include service in Vietnam. The Veteran's decorations include the National Defense Service Medal, the Republic of Vietnam Campaign Medal with 60 devices, the Vietnam Service Medal with 4 Bars, and the Bronze Star.

This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. §20.900(c).

VA in September 2022 Memo conceded exposure to herbicides based on the Veteran's duty or visitation (boots on ground) in the Republic of Vietnam.

The rating decision on appeal was issued in November 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In August 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of May 2025 (HTN) and June 2025 (OSA) decisions. In November 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior May and June 2025 decisions.

In February 2026 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 May 2025 (HTN) and June 2025 (OSA) agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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[s], 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 will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation during active service of a preexisting injury or disease. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043.

To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability.
disease. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043.

Competent medical evidence is 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 include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. 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 lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau, 492 F.3d 1372.

If a Veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of § 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of § 3.307(d) are also satisfied: AL amyloidosis, chloracne or other acneform disease consistent with chloracne, Type 2 diabetes, Hodgkin's disease, hypertension, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease, all chronic B-cell leukemias, multiple myeloma, non-Hodgkin's lymphoma, Parkinson's disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft-tissue sarcoma, bladder cancer, hypothyroidism and Parkinsonism. 38 C.F.R. § 3.309(e).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is "nearly equal" or in approximate balance, with the Veteran prevailing in either event, or whether most of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776.

1. Service connection for sleep apnea is denied.

The Veteran contends that sleep apnea is related to service due to herbicide exposure in Vietnam or as secondary to service-connected hypertension.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of obstructive sleep apnea, and evidence shows that exposure to Agent Orange in Vietnam occurred, and hypertension is presumptively service connected, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of obstructive sleep apnea began during service or is otherwise related to an in-service injury, event, or disease or his service-connected hypertension.

March 2024 VA Sleep Apnea examination shows the Veteran was not diagnosed with obstructive sleep apnea (OSA) until July 2021,
the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

March 2024 VA Sleep Apnea examination shows the Veteran was not diagnosed with obstructive sleep apnea (OSA) until July 2021, 5 decades after separation from service. While the Veteran is competent to report having experienced symptoms of difficulty sleeping since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of obstructive sleep apnea. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4.

After being diagnosed with OSA and prescribed CPAP in 2021, the Veteran first claimed OSA service connection as secondary to chronic obstructive pulmonary disease (COPD) in September 2023. The RO denied service connection for COPD in April and October 2022. In September 2023, the Veteran claimed COPD service connection again and claimed OSA as secondary to COPD, explaining that he first had OSA symptoms when he first had COPD symptoms. The Veteran first claimed COPD in July 2021 due to Agent Orange exposure. In November 2023, the Veteran claimed hypertension due to Agent Orange (AO) exposure and OSA as secondary to HTN. The RO granted service connection for HTN in February 2024 as presumptively caused by AO exposure during Vietnam service.

In March 2024, the RO got a VA sleep apnea medical examination and opinion as to whether OSA is due to AO exposure in Vietnam. At the VA examination, the Veteran reported having been diagnosed with sleep apnea a few years earlier in July 2021 after a VA sleep study where he was prescribed CPAP. A VA examiner opined in April 2024 that the Veteran's OSA is less likely than not due to conceded exposure to TERA. The examiner explained that OSA is not a condition that is caused by exposure to herbicide agent conceded by November 2023 VA memo. The examiner explained that OSA is due to specific anatomical changes in the upper respiratory track. The examiner further noted that these changes do not happen due to toxic exposure and OSA is not a presumed condition for such an exposure. These exposures are not known to cause OSA.

Risk factors for OSA do not include such an exposure. Peer reviewed medical literature does not support such a nexus.

Another similar opinion was added to the file in April 2025 by a different medical examiner. This examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity (TERA), after considering the total potential exposure through all applicable military deployments of the Veteran and

the synergistic, combined effect of all toxic exposure risk activities of

the Veteran. As rationale the examiner explained that the Veteran had a diagnostic sleep study in 7-12-2021 for obstructive sleep apnea (OSA). The toxin, Agent Orange, this Veteran was exposed to in active duty does not cause or provide

nexus for obstructive sleep apnea. Agent Orange herbicide exposure is

conceded since service in the Republic of Vietnam 1968-1970. Obstructive

Sleep apnea is not established by presumption according to the Agent

orange act 1991. The examiner stated that according to UpToDate 2024 reference: OSA is large airway collapse during sleep. The large airways are at the level of the supraglottic, glottis, subglottic, and trachea. These airways are surrounded by boney enclosures of mandible, maxilla, skull base and cervical spine. Presumptive conditions for the toxic exposures from Agent Orange (Herbicide Agent - 2,3,7,8 - tetrachlorodibenzodioxin (TCDD), do not collapse these large airways. Medical literature does not report this toxin as a cause or contributor to OSA.

A third nexus opinion was added to the file in September 2024, which opined that OSA is less likely than not due to HTN. As rationale, the September 202
at the level of the supraglottic, glottis, subglottic, and trachea. These airways are surrounded by boney enclosures of mandible, maxilla, skull base and cervical spine. Presumptive conditions for the toxic exposures from Agent Orange (Herbicide Agent - 2,3,7,8 - tetrachlorodibenzodioxin (TCDD), do not collapse these large airways. Medical literature does not report this toxin as a cause or contributor to OSA.

A third nexus opinion was added to the file in September 2024, which opined that OSA is less likely than not due to HTN. As rationale, the September 2024 examiner said a nexus is not supported by peer reviewed medical literature. The examiner acknowledge that an article from the Mayo Clinic indicates an association between HTN and OSA but clarified that this article says that OSA can induce HTN, but the reverse is not true. The examiner explained that OSA is due to specific anatomical changes in the upper respiratory track. The examiner noted that these changes do not happen due to hypertension and risk factors for OSA do not include HTN.

Taken together, the several VA opinions of record establish that the Veteran's OSA is not at least as likely as not related to an in-service injury, event, or disease, including exposure to Agent Orange, or service-connected HTN. The March 2024 and April 2025 VA examiners opined that the Veteran's OSA was not at least as likely as not related to TERA including exposure to AO, while the September 2024 VA examiner opined that the Veteran's OSA was not at least as likely as not related to service-connected HTN. The combined rationale was that OSA is not related to service. The examiners' combined opinion is 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.

The Veteran believes the claimed OSA is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is beyond the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 28. Consequently, the Board gives more probative weight to the VA medical opinions of record which opine against OSA service connection.

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58. However, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505. In such a case, the Veteran's level of disability from the time the increased rating claim was filed is at issue. Francisco, 7 Vet. App. 55; Hart,
be avoided. 38 C.F.R. § 4.14.

If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126. See AB v. Brown, 6 Vet. App. 35 (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded).

2. A compensable evaluation of hypertension is denied.

The Veteran is seeking a compensable rating because he has been on daily medication since 2019 to control his hypertension.

Hypertension is rated pursuant to 38?C.F.R. §?4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

For the reasons that follow, the Veteran's hypertension has not more nearly approximated the criteria corresponding to a 10 percent rating.

Review of medical records in the Veteran's claims file shows he started taking chlorthalidone daily prescription in 2019 and his doctor advised him to check his blood pressure daily to achieve target systolic blood pressure between 100-130 and diastolic pressure between 65-80.

BP readings taken prior to starting blood pressure medication as noted in CAPR October 2019 show diastolic readings less than 100, but higher than the target 65-80. BP 152/96, 138/88, 146/88, 135/88, 154/92, 131/85, 124/86, 140/87. These diastolic readings, while higher than the target, do not meet the criteria for 10 percent rating under DC 7101, of predominantly 100 or more. These diastolic pressure readings are predominantly in the upper 80's.

May 2025 VA hypertension examination reported the following BP readings: 112/72, 110/66, 114/64 (05/06/2025), with diastolic pressure readings well below 100.

A 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.

In the instant case, the Veteran is taking medication for control of his blood pressure since 2019; however, he does not have a history of diastolic pressure predominantly 100 or more at any time as documented by medical records in the claims file.

Blood pressure (BP) noted on entrance examination report in July 1967 is 120/60 and at exit examination is 120/60. These readings indicate the Veteran had normal BP prior to, during, and at exit from military service. His diastolic reading was 60 at both entrance and exit exams, which is significantly lower than 100 required for 10 percent evaluation.

Other BP readings in the claims file include 128/89, 135/85 (10/11/2019); 141/91 (4/12/2019); 145/82 (10/18/2018); 150/98 (3/21/2018); 143/88 (10/18/2017); 148/89; 147/88; 140/90; 138
60 and at exit examination is 120/60. These readings indicate the Veteran had normal BP prior to, during, and at exit from military service. His diastolic reading was 60 at both entrance and exit exams, which is significantly lower than 100 required for 10 percent evaluation.

Other BP readings in the claims file include 128/89, 135/85 (10/11/2019); 141/91 (4/12/2019); 145/82 (10/18/2018); 150/98 (3/21/2018); 143/88 (10/18/2017); 148/89; 147/88; 140/90; 138/79; 156/96 (12/11/2021). A November 2019 VA outpatient record appears to report the Veteran's measurement of his BP readings since visit on October 24, 2019, and lists the following: 10/25 - 148, 83, 70; 10/26 - 140, 86, 78; 10/27 - 144, 87, 90; 10/28 - 127, 84, 71; 10/29 - 124, 85, 83; 10/30 - 122, 82, 76; 10/31 - 122, 76, 92; 11/01 - 131, 85, 78; 11/05 - 123, 80, 81; 11/15 - 132, 80, 81; 11/17 - 114, 77, 85; 11/19 - 124, 85, 74. VA outpatient treatment records also note BP 128/89; 135/85; BP 141/91 (04/12/2019). Other BP readings found in medical records include 145/82 (10/18/2018); 120/70; BP 150/98 (03/21/2018); 120/70; BP 143/88 (10/18/2017); BP 111/72 (10/18/2016); BP 124/80 (10/26/2015); BP 120/80; BP 104/78; BP 110/80 (03/13/1998); BP 128/70 (01/16/1998); BP 128/70 (10/02/1997). Diastolic blood pressure readings are predominantly in the 80s, with a high of 98, which is less than the required 100 for a compensable rating under DC 7101.

The Veteran's hypertension requires continuous medication for control, but the Veteran does not have a history of diastolic pressure predominantly 100 or more. The Veteran's contention that his hypertension requires continuous medication is undebated; however, the second requirement for a compensable 10 percent rating, a history of diastolic pressure predominantly 100 or more, is not found.

Accordingly, the Veteran's hypertension did not manifest in diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. Also, the Veteran did not have a history of diastolic pressure predominantly 100 or more and require continuous medication for control. There is no reasonable doubt to be resolved. The Veteran's hypertension does not more nearly approximate the criteria corresponding to a 10 percent rating.

As the criteria for a 10 percent rating under DC 7101 are not met, a noncompensable rating is warranted. See 38 C.F.R. § 4.31.

H. SEESEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Black

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.

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