FANCONI ANEMIA

Summary

The Veteran served on active duty from March 1996 to December 1996. He appeals the denial of service connection for Fanconi anemia, sleep apnea, and related complications, including leukemia, thrombocytopenia, bone marrow transplant with acquired agranulocytosis, hepatocarcinoma, and cirrhosis of the liver. The Veteran's Fanconi anemia, a congenital genetic disorder, was diagnosed after service. He claims his in-service exposures and stressors aggravated this condition, leading to his subsequent diagnoses. The Board denied service connection for Fanconi anemia, citing its congenital nature and the lack of aggravation by service. For leukemia, thrombocytopenia, bone marrow transplant, acquired agranulocytosis, hepatocarcinoma, and cirrhosis of the liver, the Board found the evidence in equipoise. While the VA examiner opined these conditions were less likely than not related to service, citing a lack of presumptive regulations and medical literature, a private physician provided a detailed opinion linking the Veteran's Fanconi anemia and subsequent cancers to in-service exposures like fuel fumes and solvents, which likely accelerated the disease progression. The Board found the private opinion more probative due to its detailed rationale and the VA examiner's conclusory statements, thus tipping the scales in favor of the Veteran. Service connection for sleep apnea was denied, as the Board found no pre-decisional duty to provide an examination, and the evidence persuasively weighed against a service connection, lacking a competent medical opinion linking it to service.

Rationale

Fanconi anemia is a congenital defect.; Congenital defects are not considered diseases or injuries for VA purposes.; Service connection is not available for congenital defects, even on aggravation basis.

Full Decision Text

Citation Nr: A26027879
Decision Date: 03/27/26	Archive Date: 03/27/26

DOCKET NO. 240627-450881
DATE: March 27, 2026

ORDER

Service connection for Fanconi anemia is denied.

Service connection for leukemia is granted.

Service connection for thrombocytopenia is granted.

Service connection for a bone marrow transplant and acquired agranulocytosis is granted.

Service connection for hepatocarcinoma is granted.

Service connection for cirrhosis of the liver is granted.

Service connection for sleep apnea is denied.

FINDINGS OF FACT

1.  The Veteran's Fanconi anemia is a congenital defect.

2.  The Veteran's in-service toxic exposures contributed to his development of leukemia.

3.  The Veteran's in-service toxic exposures contributed to his development of thrombocytopenia.

4.  The Veteran's in-service toxic exposures contributed to his development of acquired agranulocytosis and need for bone marrow transplants.

5.  The Veteran's in-service toxic exposures contributed to his development of hepatocarcinoma.

6.  The Veteran's in-service toxic exposures contributed to his development of cirrhosis of the liver.

7.  The Veteran's sleep apnea is not related to service.

CONCLUSIONS OF LAW

1.  The criteria for service connection for Fanconi anemia are not met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 4.9 (2025).

2.  The criteria for service connection for leukemia are met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2025).

3.  The criteria for service connection for thrombocytopenia are met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2025).

4.  The criteria for service connection for a bone marrow transplant and acquired agranulocytosis are met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2025).

5.  The criteria for service connection for hepatocarcinoma are met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2025).

6.  The criteria for service connection for cirrhosis of the liver are met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2025).

7.  The criteria for service connection for sleep apnea are not met.  38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1996 to December 1996.

This appeal is before the Board of Veterans' Appeals (Board) from November 2023 and May 2024 rating decisions of the agency of original jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO).

In his June 2024 notice of disagreement, the Veteran elected the Hearing docket.  In December 2025, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge via videoconference.  A transcript is included in the claims file.  Therefore, the Board may only consider the evidence of record at the time of each applicable AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the December 2025 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
conference.  A transcript is included in the claims file.  Therefore, the Board may only consider the evidence of record at the time of each applicable AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the December 2025 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.  The precise evidence window for each issue will be discussed below.

The Veteran submitted evidence outside the windows described above.  If he would like VA to consider any evidence that was submitted that the Board could not consider, he 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, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a supplemental claim are included with this decision. 

The Board notes that the Veteran appointed his representative in July 2025, more than 90 days after submission of his June 2024 notice of disagreement.  The Board will not accept a change in representation more than 90 days following receipt of a notice of disagreement, except when an appellant demonstrates on motion that there was good cause for the delay.  In the absence of such a showing, the change in representation will only apply to subsequent actions before the AOJ.  38 C.F.R. § 20.1304(b).  While no motion was made in this instance, the Board finds that good cause was evident in the record.  Specifically, the Veteran was unrepresented prior to this appointment, and his then-upcoming December 2025 hearing constituted good cause to have representation.  Moreover, the Board allowed the attorney to provide representation at the hearing.  As such, in the best interest of the Veteran, the Board finds the July 2025 appointment to be valid and will proceed to adjudicate this appeal.

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, 1131; 38 C.F.R. § 3.303(a).  Service connection requires:  (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).  Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Service connection may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury."  See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).  For "aggravation of non-service-connected disabilities" it is enough to show that a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

Congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation and therefore do not constitute disabilities for VA compensation purposes.  See 38 C.F.R. §§ 3.303(c), 4.9.  Such disabilities may not be considered aggravated by service, but service connection is available for separate disabilities superimposed over congenital or developmental defects if related to service.  See Johnson v. Shinseki, 23 Vet. App. 344, 347-48 (2010) ); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995).  

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied.  38 U
(c), 4.9.  Such disabilities may not be considered aggravated by service, but service connection is available for separate disabilities superimposed over congenital or developmental defects if related to service.  See Johnson v. Shinseki, 23 Vet. App. 344, 347-48 (2010) ); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995).  

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

1. Entitlement to service connection for Fanconi anemia

2. Entitlement to service connection for leukemia

3. Entitlement to service connection for thrombocytopenia

4. Entitlement to service connection for a bone marrow transplant and acquired agranulocytosis

5. Entitlement to service connection for hepatocarcinoma

6. Entitlement to service connection for cirrhosis of the liver

The Veteran claims service connection for Fanconi anemia, leukemia, thrombocytopenia, a bone marrow transplant with acquired agranulocytosis, hepatocarcinoma, and cirrhosis of the liver.

Service connection for Fanconi anemia was initially denied in a September 2022 rating decision.  In January 2023, he requested Higher-Level Review (HLR) of this denial.  In February 2023, the AOJ issued a HLR decision which considered the evidence of record at the time of the prior decision.  In April 2023, he submitted a new claim of service connection for aplastic anemia, thrombocytopenia, and leukemia.  The AOJ declined to accept the claim for aplastic anemia, informing him in an April 2023 letter that this claim had been deemed a claim to readjudicate the denial of service connection for Fanconi anemia, and as such he was instructed to submit a supplemental claim.  Service connection for thrombocytopenia and leukemia was initially denied in a June 2023 rating decision.  In September 2023 he submitted a supplemental claim for Fanconi anemia, thrombocytopenia, and leukemia.  The claims were denied in a November 2023 rating decision, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision.  

The Veteran's June 2024 notice of disagreement identified the initial September 2022 and June 2023 denials as the decisions on appeal.  While the notice of disagreement is untimely as to the initial denial, the Board broadly construes an intent to appeal the most recent adjudication of the issues initially denied in September 2022 and June 2023.  The Board thus finds timely appeals of the November 2023 rating decision.  The November 2023 rating decision found that new and relevant evidence had been received to readjudicate this claim.  This is a favorable finding by the AOJ, and the Board will proceed to the address the claim on the merits.  See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c). 

Service connection for a bone marrow transplant with acquired agranulocytosis, hepatocarcinoma, and cirrhosis of the liver was initially denied in the May 2024 rating decision on appeal.  The claim of service connection for a bone marrow transplant, however, is inextricably intertwined with the Veteran's claims for leukemia, thrombocytopenia, and Fanconi anemia.  All of these claims are about related complications of the same disability that require the Board to make the same factual determination.  As such, the Board construes the Veteran's January 2024 fully developed claim of service connection for a bone marrow transplant to be a supplemental claim of service connection for leukemia, thrombocytopenia, and Fanconi anemia that was denied in the May 2024 rating decision.  See Chisholm v. Collins, 38 Vet. App. 140, 150 (2025).  Therefore, with respect to these issues, the Board may consider the evidence of record at the time of the May 2024 AOJ decision on appeal, as
, and Fanconi anemia.  All of these claims are about related complications of the same disability that require the Board to make the same factual determination.  As such, the Board construes the Veteran's January 2024 fully developed claim of service connection for a bone marrow transplant to be a supplemental claim of service connection for leukemia, thrombocytopenia, and Fanconi anemia that was denied in the May 2024 rating decision.  See Chisholm v. Collins, 38 Vet. App. 140, 150 (2025).  Therefore, with respect to these issues, the Board may consider the evidence of record at the time of the May 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the December 2025 hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  

Service treatment records do not reflect any symptoms of or treatment for the claimed disabilities, and the Veteran does not contend that they arose in service.

Private treatment records reflect that in August 2018 the Veteran was admitted to the hospital with severe abdominal pain and diarrhea.  He was initially diagnosed with acute gastroenteritis.  He reported that he had a history of chronic pancytopenia, first diagnosed as a young child.  Specifically, he had undergone bone marrow biopsies at the ages of 12 and 22, both of which came back as nondiagnostic but ruled out leukemia at those times.  In August 2018, he was found to have a worsening platelet count.  An initial bone marrow biopsy was a poor study and nondiagnostic.  He was referred to oncology in September 2018.  A second bone marrow biopsy showed leukemia, specifically myelodysplastic syndrome (MDS).  He began treatment.  In March 2020 he was diagnosed with aplastic anemia, specifically Fanconi anemia, a hereditary condition leading to a much higher risk of cancer.  He underwent a bone marrow transplant in September 2020.  In January 2021 he began chemotherapy.  His oncologist advised him that he was at risk for bleeding due to his condition and/or his treatment and began treating him for chemotherapy induced thrombocytopenia.  In March 2021 his oncologist diagnosed acute myeloid leukemia in remission.  In May 2021 he was diagnosed with chemotherapy-induced neutropenia.  In March 2022, he underwent additional chemotherapy.  In April 2022, he underwent another bone marrow transplant.  In May 2022 his white blood cell count dropped, and he returned for further treatment.

VA treatment records reflect that at a May 2022 primary care initial consultation, the Veteran reported being diagnosed with Fanconi anemia three years prior, after which he underwent a bone marrow transplant in September 2020.

In his August 2022 initial claim, the Veteran contended that his Fanconi anemia was worsened due to service.  He stated that it was a congenital syndrome he was born with but was not aware he had until later on.  He stated that the condition prevented his DNA from repairing itself, and as such intense and strenuous activity caused bone marrow failure, resulting in acute myeloid leukemia and myelodysplastic syndrome.

In his April 2023 initial claim of service connection for thrombocytopenia and leukemia, the Veteran contended that these disabilities as well as aplastic anemia were the result of in-service stress and chemical and substance exposure.

Private treatment records reflect that in May 2023, while being monitored for his leukemia, the Veteran reported abdominal distention and bloating.  It resolved in June 2023, but he reported it again in July 2023.  An MRI showed hepatocellular carcinoma.  In August 2023 he began radiation treatment.

The Veteran underwent a VA examination in February 2024.  He was diagnosed with myelodysplastic syndrome status post bone marrow transplant, hepatocellular carcinoma, and cirrhosis of the liver.  The examiner initially opined that the disabilities were at least as likely related to his exposure to burn pits.  In April 2024, VA informed the examiner that the Veteran was not exposed to burn pits in service and requested an addendum opinion.  The examiner opined that the disabilities were less likely than not related to his exposure to dust, fuel fumes, solvents, and waste as an aircraft metals technology specialist.  This opinion was based on the rationale that there was no presumptive relationship to such exposures, and causation was not supported by current medical literature.

In an undated letter received by VA in January 2024, the Veteran's primary care physician opined that the Veteran's bone
rhosis of the liver.  The examiner initially opined that the disabilities were at least as likely related to his exposure to burn pits.  In April 2024, VA informed the examiner that the Veteran was not exposed to burn pits in service and requested an addendum opinion.  The examiner opined that the disabilities were less likely than not related to his exposure to dust, fuel fumes, solvents, and waste as an aircraft metals technology specialist.  This opinion was based on the rationale that there was no presumptive relationship to such exposures, and causation was not supported by current medical literature.

In an undated letter received by VA in January 2024, the Veteran's primary care physician opined that the Veteran's bone marrow failure, liver cancer, and leukemia were more likely than not related to service.  This opinion was based on the rationale that his Fanconi syndrome, a genetic disease that he was born with, resulted in an impaired response to correct and limit DNA damage.  As such, his body did not recover from intense exercise, long periods of deployment, lack of adequate rest, and exposure to certain chemicals.

At his December 2025 hearing, the Veteran described his medical history.  His representative argued that the VA examiner's opinion was inadequate.  Specifically, the representative contended that the examiner used boilerplate language to state that the disability was not presumptive and therefore was not related to toxic exposures.  The representative argued that there is no need to ask an examiner whether a disability is presumptively related to an exposure (which is, of course, a legal question and not a medical question), and as such the examiner must offer a more detailed rationale.

The Veteran submitted a December 2025 evaluation by a private physician based on review of the record.  The physician stated that the Veteran was born with a largely asymptomatic case of congenital Fanconi anemia, which eluded diagnosis throughout his childhood and until many years after service when it became severely symptomatic and contributed to the onset of myelodysplastic syndrome and subsequently to hepatocellular carcinoma.  The physician opined that the natural history of his Fanconi anemia was significantly aggravated beyond its natural progression as a result of his military service as an aircraft metals technology specialist, including as a result of exposure to fuel fumes and solvents.  The physician further opined that these exposures as likely as not resulted in an earlier and more severe onset of myelodysplastic syndrome, hepatocellular carcinoma, and their resultant complications.  This opinion was based on the rationale that fuel fumes and solvents are likely to contain chemicals such as benzene, toluene, and xylene which metabolize to reactive intermediates, generating DNA adducts and lesions.  The exposure overloads the pathways already impaired by Fanconi anemia, accelerating unrepaired damage accumulation and increasing the risk of earlier and more severe resultant disease and complications, such as the Veteran's myelodysplastic syndrome, hepatocellular carcinoma, and associated complications.

In December 2025, the Veteran submitted two September 2025 statements from private physicians, specifically the Director of Bone Marrow Transplantation and Immune Deficiency at Cincinnati Children's Hospital and the Principal Investigator of the Fanconi Anemia Cancer Screening Study at the National Institute of Health.  Both physicians stated that Fanconi anemia inherently reduces physiologic reserve and predisposes patients to cancer, bone marrow failure, and organ dysfunction.  Under sustained physical and environmental stress such as those common in military service, these risks are reasonably expected to manifest earlier and with greater severity than in the general population.

In December 2025, the Veteran also submitted a September 2025 statement by a physician and professor who directs the International Fanconi Anemia Registry.  The physician explained that while Fanconi anemia is a hereditary disease, it is clear that environmental exposures, high inflammatory states, and physical stressors accelerate organ dysfunction and cancers in its patients.  The physician continued to state that the physical and environmental demands typical of military service, including prolonged exertion, recurrent infections, environmental toxin exposures, and high stress, are likely to accelerate or exacerbate complications in Fanconi anemia patients.  Sustained exertion can worsen cytopenias and result in myelodysplastic syndrome, and exposure to infection or toxins can compound DNA damage leading to liver damage, dysfunction, and malignancy.

The Board finds that the Veteran's Fanconi anemia is a congenital defect, and as such service connection is not available.  38 C.F.R. §§ 3.303(c), 4.9.  The medical evidence and the Veteran's statements are consistent in establishing that the disability is by definition genetic and has been present since his birth.  Thus, while service connection is available for those disabilities for which service and Fanconi anemia are both
 accelerate or exacerbate complications in Fanconi anemia patients.  Sustained exertion can worsen cytopenias and result in myelodysplastic syndrome, and exposure to infection or toxins can compound DNA damage leading to liver damage, dysfunction, and malignancy.

The Board finds that the Veteran's Fanconi anemia is a congenital defect, and as such service connection is not available.  38 C.F.R. §§ 3.303(c), 4.9.  The medical evidence and the Veteran's statements are consistent in establishing that the disability is by definition genetic and has been present since his birth.  Thus, while service connection is available for those disabilities for which service and Fanconi anemia are both contributing factors, service connection is not available for Fanconi anemia itself, even on the basis of aggravation.  See Johnson v. Shinseki, 23 Vet. App. 344, 347-48 (2010).  Service connection for Fanconi anemia is therefore denied.

The Board further finds that the evidence is at least in equipoise as to whether the Veteran's leukemia and hepatocarcinoma, along with their associated conditions of thrombocytopenia, bone marrow transplant with agranulocytosis, and cirrhosis of the liver, are related to service.  The VA examiner's opinions are based on boilerplate rationales, providing the unnecessary legal advice that there is no presumptive regulation applicable to the Veteran's exposures, and stating that there is no medical literature to support a relationship with no further explanation.  The December 2025 private evaluation, in contrast, offered a detailed account of how the Veteran's cancers and associated complications were caused by his Fanconi anemia as catalyzed and hastened by his in-service exposure to exposures and toxins.  There is no probative evidence in the record to contradict this finding beyond the VA examiner's conclusory assertion.  For these reasons, the Board finds that the evidence is at least in equipoise as to whether the Veteran's leukemia and hepatocarcinoma, along with their associated conditions of thrombocytopenia, bone marrow transplant with agranulocytosis, and cirrhosis of the liver, are related to service.  Service connection is therefore denied.

7. Entitlement to service connection for sleep apnea

The Veteran claims service connection for sleep apnea.

Service connection for sleep apnea was initially denied in a June 2023 rating decision.  The Veteran submitted a supplemental claim in September 2023 seeking readjudication of this claim.  The claim was again denied in a November 2023 rating decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  His June 2024 notice of disagreement identified the initial June 2023 denial as the decision on appeal.  While the notice of disagreement is untimely as to the initial denial, the Board broadly construes an intent to appeal the most recent adjudication of the issue initially denied in June 2023.  The Board thus finds a timely appeal of the November 2023 rating decision.  Therefore, with respect to sleep apnea, the Board may only consider the evidence of record at the time of the November 2023 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the December 2025 hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  The November 2023 rating decision found that new and relevant evidence had been received to readjudicate this claim.  This is a favorable finding by the AOJ, and the Board will proceed to the address the claim on the merits.  See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c).

Service treatment records do not reflect any symptoms of or treatment for sleep apnea.

In his April 2023 initial claim of service connection, the Veteran stated that his partner notices that he often stops breathing during sleep, gasping for air.  He stated that he wakes up with dry mouth and a headache and has severe insomnia with difficulty falling or staying asleep.  He reported excessive daytime tiredness that had been an issue since service that had worsened over the years.

VA treatment records reflect that in June 2023 the Veteran's psychologist noted his reports that his wife had noted snoring and witnessed apneas.  He had had an in-clinic sleep study scheduled previously but had missed his appointments due to his leukemia treatment.  He was provided a home sleep study.  In September 2025 (as evidenced by a record submitted after the Veteran's December 2025 hearing), a sleep study showed evidence of mild obstructive sleep apnea
 during sleep, gasping for air.  He stated that he wakes up with dry mouth and a headache and has severe insomnia with difficulty falling or staying asleep.  He reported excessive daytime tiredness that had been an issue since service that had worsened over the years.

VA treatment records reflect that in June 2023 the Veteran's psychologist noted his reports that his wife had noted snoring and witnessed apneas.  He had had an in-clinic sleep study scheduled previously but had missed his appointments due to his leukemia treatment.  He was provided a home sleep study.  In September 2025 (as evidenced by a record submitted after the Veteran's December 2025 hearing), a sleep study showed evidence of mild obstructive sleep apnea.

At his December 2025 hearing, the Veteran stated that his wife brought his sleep apnea to his attention when they got married in 2000.  He attributed his symptoms to his lack of sleep and exhaustion in service.

In a December 2025 statement, the Veteran's wife reported that since their September 2000 marriage, he exhibited chronic sleep problems including loud and persistent snoring with periods where he would stop breathing followed by gasping or choking.  These symptoms were continuous and ongoing throughout their marriage until he was diagnosed with sleep apnea.

As an initial matter, the Board finds that there was no pre-decisional duty to provide the Veteran with a VA examination.  Specifically, at the time of the rating decision on appeal there was no evidence that the Veteran had been diagnosed with sleep apnea.  McLendon v. Nicholson, 20?Vet. App.?79, 81 (2006); see 38?U.S.C. §?5103A(d)(2); 38?C.F.R. §?3.159(c)(4)(i).  VA treatment records show a diagnosis of mild sleep apnea in September 2025, after the appeal was initiated.  For these reasons, the Board finds that the evidence of record at the time of the decision on appeal did not establish a current disability, and as such there was no pre-decisional duty to provide the Veteran with a VA examination. Remand for an examination is thus not warranted. 

The Board finds that the evidence persuasively weighs against a finding that the Veteran's sleep apnea is related to service.  While the Veteran and his wife are competent to report his snoring and individual incidents of apnea, they are not competent to determine whether these symptoms arose in service or are related to his in-service sleep schedule.  The evidence does not establish that they have the medical training or experience to relate his condition to his active service, which is a medically complex determination requiring training.  There is no competent medical opinion in the record relating his current apnea to his lack of sleep and exhaustion in service.  For these reasons, the Borad finds that the evidence persuasively weighs against a finding that the Veteran's sleep apnea is related to service, and service connection is therefore denied.

 

 

Rebecca N. Poulson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Gallagher, 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.