SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, who served in the United States Army from June 1998 to November 2004, appeals the denial of service connection for left hip, right hip, and lumbar spine conditions, while also seeking service connection for sleep apnea, neck disability, and tinnitus. The Board found favorable findings for current sleep apnea, neck disability, and tinnitus, and also for the in-service onset of these conditions, granting service connection for all three. For sleep apnea, the Board relied on the veteran's testimony about symptoms during service and statements from a fellow soldier and his spouse, resolving doubt in the veteran's favor. For the neck disability, the Board considered the veteran's testimony about in-service injuries and consistent complaints, along with his spouse's statement, and granted service connection. For tinnitus, despite a VA examiner's unfavorable opinion, the Board found the veteran's testimony credible regarding its onset during service and noise exposures, resolving doubt in his favor to grant service connection. For the hip and lumbar spine conditions, the veteran claimed they were secondary to his service-connected knee disabilities. The Board found favorable findings for current hip and lumbar spine conditions and the primary knee disability. However, a VA examiner opined that the hip and lumbar spine conditions were less likely than not related to service-connected knee disabilities, citing a lack of medical literature and insufficient evidence. The Board found the veteran's lay testimony regarding the nexus to be lacking probative value, assigning low probative value to general medical articles submitted after the hearing. Consequently, service connection for the left hip, right hip, and lumbar spine conditions was denied.

Rationale

Favorable finding of current sleep apnea by AOJ; Veteran testimony regarding symptoms during service; Fellow soldier statement corroborating snoring and breathing issues; Spouse statement detailing symptoms; Resolving reasonable doubt in veteran's favor for in-service onset

Full Decision Text

Citation Nr: A26022508
Decision Date: 03/12/26	Archive Date: 03/12/26

DOCKET NO. 210129-136630
DATE: March 12, 2026

ORDER

Entitlement to service connection for sleep apnea is granted.

Entitlement to service connection for a neck disability is granted.

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for a left hip condition is denied.

Entitlement to service connection for a right hip condition is denied.

Entitlement to service connection for a lumbar spine condition is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his sleep apnea began during active service.

2. Resolving reasonable doubt in the Veteran's favor, his neck disability began during active service.

3. Resolving reasonable doubt in the Veteran's favor, his tinnitus began during active service.

4. The Veteran's left hip condition is not secondary to his service-connected knee disabilities and is not otherwise related to an in-service injury or disease.

5. The Veteran's right hip condition is not secondary to his service-connected knee disabilities and is not otherwise related to an in-service injury or disease.

6. The Veteran's lumbar spine condition is not secondary to his service-connected knee disabilities and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

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

2. The criteria for entitlement to service connection for a neck disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for a left hip condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for entitlement to service connection for a right hip condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for entitlement to service connection for a lumbar spine condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 1998 to November 2004.

This matter comes before the Board of Veterans' Appeals (Board) from July and November 2020 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO) under the modernized review system, or Appeals Modernization Act (AMA).

In March 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for a cervical strain, tinnitus, a left hip condition, a right hip condition, and a lumbar spine condition most recently addressed in November 2015 and January 2017 rating decisions. In July 2020, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received with regards to the claims of entitlement to service connection for a left hip condition, a right hip condition, and a lumbar spine condition and denied the claim based on the evidence of record at the time of that decision. The AOJ found that new and relevant evidence had not been received with regards to the claims of entitlement to service connection for a cervical strain and tinnitus. However, the AOJ readjudicated the Veteran's claims on the merits. The Board concludes there was an implicit finding of new and relevant evidence. Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

In the January 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 27, 2024.

Therefore, the Board may only consider the evidence of record at the time of the July and November 2020 agency of original jurisdiction (AOJ
 of entitlement to service connection for a cervical strain and tinnitus. However, the AOJ readjudicated the Veteran's claims on the merits. The Board concludes there was an implicit finding of new and relevant evidence. Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

In the January 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 27, 2024.

Therefore, the Board may only consider the evidence of record at the time of the July and November 2020 agency of original jurisdiction (AOJ) decisions 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 claims, 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 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 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

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. When a Veteran seeks benefits and the evidence is in relative equipoise, the Veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

1. Entitlement to service connection for sleep apnea is granted.

The Veteran seeks service connection for sleep apnea.

In the November 2020 rating decision, the AOJ made the favorable finding that the Veteran has a current sleep apnea disability. The Board is bound by this favorable finding.

Therefore, the remaining questions before the Board are whether there was in-service incurrence or aggravation of the disease or injury and whether there was a causal relationship between the current disability and the in-service disease or injury.

Service treatment records show no complaint, treatment, or diagnosis related to a sleep condition. See Service Treatment Records.

The Veteran attended a Board
 F.4th 776, 781-82 (Fed. Cir. 2021).

1. Entitlement to service connection for sleep apnea is granted.

The Veteran seeks service connection for sleep apnea.

In the November 2020 rating decision, the AOJ made the favorable finding that the Veteran has a current sleep apnea disability. The Board is bound by this favorable finding.

Therefore, the remaining questions before the Board are whether there was in-service incurrence or aggravation of the disease or injury and whether there was a causal relationship between the current disability and the in-service disease or injury.

Service treatment records show no complaint, treatment, or diagnosis related to a sleep condition. See Service Treatment Records.

The Veteran attended a Board hearing in June 2024. The Veteran stated that he was told by his fellow soldiers that he was keeping them awake with his snoring, and he did not get good sleep while he was on active duty. He additionally stated that he was a healthy weight when his symptoms began. The Veteran testified that he mentioned his sleep issues to medical while on active duty, but they were brushed off and he was told to try to get better sleep. See June 2024 Hearing Transcript.

The Veteran submitted a statement from a soldier he was stationed with in the Army. He said that he shared a tent with the Veteran. He personally witnessed the Veteran snoring loudly and taking huge gulps of air. See Statement of R.G.

The Veteran submitted a statement from his spouse, who is a registered nurse. She stated that the Veteran has symptoms such as loud snoring, episodes of breathing cessation followed by sounds of choking with occasional gasping for air, and restless sleep that causes him to toss and turn throughout the night with daytime sleepiness. See Statement of L.G.

Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's sleep apnea began during active service. Specifically, the Veteran has consistently stated that his symptoms began during active service. Therefore, resolving any reasonable doubt in favor of the Veteran, service connection for sleep apnea is warranted, and this appeal is granted.

2. Entitlement to service connection for a neck disability is granted.

The Veteran seeks service connection for a cervical strain.

In the July 2020 rating decision, the AOJ made the favorable finding that the event, injury, or disease had its onset during service. The Board is bound by this favorable finding.

Therefore, the Board must first determine if the Veteran has a current disability.

The requirement of a current disability is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21?Vet. App.?319, 321 (2007).

Medical treatment records show that the Veteran had a diagnosis of cervicalgia on July 6, 2020. See VA Medical Center Records. Therefore, the Board finds that the Veteran has a current disability.

Service treatment records show that the Veteran complained of neck pain multiple times while in service; specifically, he was seen for neck pain in October 1999, December 2000, and February 2001. He was diagnosed with a cervical strain in December 2000. See Service Treatment Records.

The Veteran attended a Board hearing in June 2024. The Veteran stated that he injured his neck while playing sports in service. He stated that carrying heavy rucksacks, rucking, and jumping down from vehicles also led to his chronic neck pain. The Veteran noted that there have not been any intervening injuries, and he self-treated his pain with heat and over-the-counter medication. See June 2024 Hearing Transcript.

The Veteran submitted a statement from his spouse, who is a registered nurse. She stated that the Veteran has been bothered with neck pain since his time in the military. See Statement of L.G.

Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's neck disability began during active service. Specifically, the Veteran has consistently stated that his symptoms began during active service, and he was seen multiple times in service for neck pain. Therefore, resolving any reasonable doubt in favor of the Veteran, service connection for a neck disability is warranted, and this appeal is granted.

3. Entitlement to service connection for tinnitus is granted.

The Veteran seeks service connection for tinnitus. 

In the July 2020 rating decision, the AOJ made the favorable finding that the Veteran has a current tinnitus disability. The Board is bound by this favorable finding.

Therefore, the remaining questions before the Board are whether there was in-service incurrence or aggravation of the disease or injury and whether there was a causal relationship between the current disability and the in-service disease or injury.

The Veteran was provided a VA examination in January 2017. The Veteran reported that his tinnitus began within the last few months.
 doubt in favor of the Veteran, service connection for a neck disability is warranted, and this appeal is granted.

3. Entitlement to service connection for tinnitus is granted.

The Veteran seeks service connection for tinnitus. 

In the July 2020 rating decision, the AOJ made the favorable finding that the Veteran has a current tinnitus disability. The Board is bound by this favorable finding.

Therefore, the remaining questions before the Board are whether there was in-service incurrence or aggravation of the disease or injury and whether there was a causal relationship between the current disability and the in-service disease or injury.

The Veteran was provided a VA examination in January 2017. The Veteran reported that his tinnitus began within the last few months. The examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure because there were no reports of tinnitus during military service, hearing sensitivity was within normal limits during service, and the reported onset of tinnitus was within the past few months. See January 2017 Disability Benefits Questionnaire.

The Veteran attended a Board hearing in June 2024. The Veteran stated that he had multiple hazardous noise exposures in service. Specifically, he shot M-16s and .50 caliber weapons, he flew in helicopters, and he drove a fuel truck. He stated that he refueled running aircraft on the flightline as part of his duties. He stated that he was incorrect when he told the examiner that his tinnitus began a few months prior and that it had begun during service. He stated the examiner did not ask him any specifics about his noise exposure during service. See June 2024 Hearing Transcript. Because tinnitus is wholly lay observable, the Veteran is competent to report its onset and continuous nature. Charles v. Principi, 16 Vet. App. 370 (2002).

Based on the foregoing, the Board finds that the competent and credible evidence is at least in approximate balance that the Veteran's tinnitus had its onset in service and has been continuous since. Therefore, resolving any reasonable doubt in favor of the Veteran, service connection for tinnitus is warranted, and this appeal is granted.

4. Entitlement to service connection for a left hip condition is denied.

5. Entitlement to service connection for a right hip condition is denied.

The Veteran seeks service connection for left and right hip disabilities that he contends are due to his service-connected bilateral knee disability. See June 2024 Hearing Transcript.

There have been no allegations of relationship to military service on a direct basis, so the Board shall proceed to a discussion only on the issue of secondary service connection.

In the July 2020 rating decision, the AOJ made the favorable findings that the Veteran has current left and right hip disabilities and that the claimed primary disability is service connected. The Board is bound by these favorable findings.

Therefore, the remaining question before the Board is whether the Veteran's current disabilities were caused by or aggravated by his service-connected disability.

The Veteran was provided a VA examination in July 2020. He asserted that his hip condition was due to his knee disability. The Veteran was diagnosed with bilateral hip strain. The examiner opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner stated that, while the Veteran asserted that his flat feet put pressure on knees and hips, there was no sufficient medical literature to support the claim. Additionally, there was no medical evidence to support that the Veteran's knee condition caused his hip condition. See July 2020 Disability Benefits Questionnaires 1, 2, 3, 4, and 5.

At the June 2024 Board hearing, the Veteran stated that he believed medical literature clearly shows that gait disturbances caused by lower extremity disabilities result in excessive force through the hips. He argued, through his representative, that he believed that the VA examiner's opinion was inadequate because there is literature that suggests a connection between the claimed disabilities and the service-connected disabilities. Additionally, he stated that medical records show that he has issues with ambulation due to his right knee disability. See June 2024 Hearing Transcript. However, the Veteran submitted medical literature after the VA examination. An examination is not inadequate because of evidence or argument submitted after the examination. Therefore, the Board finds that the examination was adequate.

The Veteran submitted medical articles after his Board hearing. However, these articles are general in nature and not to this specific Veteran. Therefore, the Board assigns these articles low probative value. See Correspondence.

The only evidence suggesting a nexus between the Veteran's left and right hip disabilities and service is the statement from the Veteran himself. The Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-310 (2007). However, he is not competent
 However, the Veteran submitted medical literature after the VA examination. An examination is not inadequate because of evidence or argument submitted after the examination. Therefore, the Board finds that the examination was adequate.

The Veteran submitted medical articles after his Board hearing. However, these articles are general in nature and not to this specific Veteran. Therefore, the Board assigns these articles low probative value. See Correspondence.

The only evidence suggesting a nexus between the Veteran's left and right hip disabilities and service is the statement from the Veteran himself. The Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-310 (2007). However, he is not competent to diagnose such disability or render a nexus, as it requires specialized medical knowledge and specific testing. See 38 C.F.R. § 3.159 (stating that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Therefore, the Veteran's statements regarding the nexus between his left and right hip disabilities and his service are lacking in probative value.

For the reasons provided above, the Board finds the probative evidence of record persuasively weighs against finding the Veteran's left and right hip disabilities began during active service or are otherwise related to an in-service event, injury, or disease, including as secondary to his service-connected disabilities. Accordingly, entitlement to service connection for left and right hip disabilities is not warranted, and the appeals are denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

6. Entitlement to service connection for a lumbar spine condition is denied.

The Veteran seeks service connection for a lumbar spine condition that he contends is due to his service-connected bilateral knee disability. See June 2024 Hearing Transcript.

There have been no allegations of relationship to military service on a direct basis, so the Board shall proceed to a discussion only on the issue of secondary service connection.

In the July 2020 rating decision, the AOJ made the favorable findings that the Veteran has a current disability and that the claimed primary disability is service connected. The Board is bound by these favorable findings.

Therefore, the remaining question before the Board is whether the Veteran's current disability was caused by or aggravated by his service-connected disability.

The Veteran was provided a VA examination in July 2020. The Veteran stated that his primary care physician told him he had flat feet when he reported his back pain. He was diagnosed with a lumbosacral strain. The examiner opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition because there was no sufficient literature to support the claim that the lower back disability was a result of the Veteran's left or right knee patellofemoral pain syndrome. See July 202 Disability Benefits Questionnaires 1, 2, and 3.

At the June 2024 Board hearing, the Veteran stated that he believed medical literature clearly shows that gait disturbances caused by lower extremity disabilities result in excessive force through the hips. He argued, through his representative, that he believed that the VA examiner's opinion was inadequate because there is literature that suggests a connection between the claimed disabilities and the service-connected disabilities. Additionally, he stated that medical records show that he has issues with ambulation due to his right knee disability. See June 2024 Hearing Transcript. However, the Veteran submitted medical literature after the VA examination. An examination is not inadequate because of evidence or argument submitted after the examination. Therefore, the Board finds that the examination was adequate.

The Veteran submitted medical articles after his Board hearing. However, these articles are general in nature and not to this specific Veteran. Therefore, the Board assigns these articles low probative value. See Correspondence.

The only evidence suggesting a nexus between the Veteran's lumbar spine condition and service is the statement from the Veteran himself. The Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-310 (2007). However, he is not competent to diagnose such disability or render a nexus, as it requires specialized medical knowledge and specific testing. See 38 C.F.R. § 3.159 (stating that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Therefore, the Veteran's statements regarding the nexus between his lumbar spine condition and his service are lacking in probative value.

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?

For the reasons provided above, the Board finds the probative evidence of record persuasively weighs against finding the Veteran
 See Barr v. Nicholson, 21 Vet. App. 303, 308-310 (2007). However, he is not competent to diagnose such disability or render a nexus, as it requires specialized medical knowledge and specific testing. See 38 C.F.R. § 3.159 (stating that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Therefore, the Veteran's statements regarding the nexus between his lumbar spine condition and his service are lacking in probative value.

(Continued on the next page)

?

For the reasons provided above, the Board finds the probative evidence of record persuasively weighs against finding the Veteran's lumbar spine condition began during active service or is otherwise related to an in-service event, injury, or disease, including as secondary to his service-connected disabilities. Accordingly, entitlement to service connection for a lumbar spine condition is not warranted, and the appeal is denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ho, Ashley M.

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.