SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

CORY M. PICTON · 2026 · Case ID: A26034800

DENIED

Summary

The Veteran, a Navy veteran who served from June 1974 to October 1995, appeals the denial of service connection for obstructive sleep apnea, bradycardia, and high cholesterol (dyslipidemia). The Board denied service connection for obstructive sleep apnea, finding that while the Veteran has a current diagnosis, the evidence persuasively weighs against an in-service onset or relation, citing silent service treatment records and the Veteran's own reports denying sleep issues. A January 2024 VA examiner opined the condition was less likely than not related to service or toxic exposures, a conclusion the Board found most probative. For bradycardia, the Board denied service connection, concluding the Veteran does not have a current diagnosis, despite a March 2020 VA report noting it while on metoprolol. The VA examiner in January 2025 found no current bradycardia, a conclusion the Board found more persuasive than the Veteran's lay assertions. Service connection for high cholesterol (dyslipidemia) was denied because the Board determined that, while present, it is not considered a "disability" for VA compensation purposes as it does not demonstrate an impairment of earning capacity. The Board found no evidence that dyslipidemia caused another disease or injury. The Veteran's claims were denied based on the preponderance of the evidence.

Rationale

Service treatment records silent regarding sleep issues; Veteran denied frequent trouble sleeping in service and post-service; January 2024 VA examiner opined less likely than not related to service/TERAs

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251217-615006

Full Decision Text

Citation Nr: A26034800
Decision Date: 04/15/26 Archive Date: 04/15/26

DOCKET NO. 251217-615006
DATE: April 15, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea is denied.

Entitlement to service connection for bradycardia is denied.

Entitlement to service connection for high cholesterol (claimed as dyslipidemia) is denied.

FINDINGS OF FACT

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

2. The evidence of record persuasively weighs against finding that the Veteran has had bradycardia at any time during or approximate to the pendency of the claim.

3. High cholesterol and dyslipidemia are laboratory findings and do not alone constitute a disability for Department of the Veterans Affairs (VA) compensation purposes; the evidence of record persuasively weighs against finding that the Veteran has had a medically diagnosed disability manifested by high cholesterol and/or dyslipidemia at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for entitlement to 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 entitlement to service connection for bradycardia have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for high cholesterol (claimed as dyslipidemia) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303; 61 Fed. Reg. 20440, 20445 (May 7, 1996).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from June 1974 to October 1995. For his meritorious service, the Veteran was awarded (among other decorations) a Navy Commendation Medal, Southwest Asia Service Medal, Navy Achievement Medal, and Sea Service Deployment Ribbon

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In his December 2025 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 January 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his 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. Claims for Service Connection

Service Connection Claims

Service connection may be established 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. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service
atology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).

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).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presumptive service connection for Persian Gulf War veterans. Presumptive conditions under 38 C.F.R. § 3.317(a) and (b) may now manifest to any degree at any time. There is no longer a requirement for chronic disability to manifest to a degree of 10 percent or more prior to December 31, 2026. The end date is no longer applicable and will be removed in a forthcoming regulation.

Additionally, the PACT Act expanded the definition of a Persian Gulf veteran to include those who served in the countries of Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan, along with those who served in the Southwest Asia theater of operations as defined in 38 C.F.R. § 3.317(e).

Finally, pursuant to the PACT Act, exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf; the Arabian Sea; or the Red Sea will be presumed BPOT exposed, as will any veteran who, on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; or Uzbekistan. 38 U.S.C. § 1119; VBA Letter 20-22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed related to service for veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

A December 2022 VA Toxic Exposure Risk Activity (TERA) memorandum confirmed that the Veteran is considered to have presumptive toxic exposure under 38 U.S.C. § 1119. Thus, his BPOT exposure is presumed. 38 U.S.C. § 1119.

Medical evidence is generally required to establish a medical diagnosis or to address questions of medical causation; lay assertions of medical status do not constitute competent medical evidence for these purposes. Lay assertions, however, may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see Buchanan v. Nicholson,
BPOT exposure is presumed. 38 U.S.C. § 1119.

1. Entitlement to service connection for obstructive sleep apnea.

The Board concludes that, while the Veteran has a current diagnosis of obstructive sleep apnea, the persuasive evidence of record weighs against finding that this condition began during service or is otherwise related to an in-service injury, event, or disease, including due to inservice TERAs.

The Veteran's service treatment records are silent as to any complaints of or treatment for snoring, fatigue, or any sleep disorder during service. The Veteran's August 1995 separation examination was silent as to any complaints of or diagnosis of a sleep disorder. On a medical history report, completed by the Veteran pursuant to his separation examination, he denied having frequent trouble sleeping. He again denied having a history of frequent trouble sleeping on an October 1995 medical history report.

A February 2020 VA treatment report noted that the Veteran had a history of sleep apnea, and that he was using a CPAP machine. A March 2021 VA treatment report noted that the Veteran was unable to locate any of his prior sleep study results prior to the February 2020 test.

An April 2024 private treatment report noted the Veteran's history of unspecified sleep apnea, April 3, 2015.

In August 2024, the Veteran filed his current claim seeking entitlement to service connection for sleep apnea.

In January 2024, the Veteran underwent a VA examination for sleep apnea. The examination report noted a diagnosis of obstructive sleep apnea. The Veteran reported an onset of this condition in the early 2000s, and that he has used a CPAP machine since that time. The January 2024 VA examiner opined that the Veteran's obstructive sleep apnea was less likely than not related to his military service. The VA examiner further opined that this condition was less likely than not caused by his inservice TERAs after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran.

In support of this opinion, the VA examiner noted that obstructive sleep apnea is a condition in which the upper airway collapses during sleep, leading to snoring, breathing pauses, and interrupted sleep. The VA examiner noted that there was no sleep apnea shown during the Veteran's military service. The VA examiner noted that the risk of obstructive sleep apnea was higher with weight gain, aging, being male, and anatomic features like having a large tongue, tonsils, or a narrow airway. The VA examiner also noted there is no medical evidence to support an association between obstructive sleep apnea and the Veteran's inservice TERAs. Therefore, the Veteran's obstructive sleep apnea was less likely than not caused by his inservice TERAs.

While the Veteran is competent to report having experienced symptoms such as snoring and trouble sleeping both during and since his military service, he has not reported having an ongoing sleep problem since his military service. Moreover, his service treatment reports indicate that he repeatedly denied having any history of frequent trouble sleeping.

The Veteran is also not competent to provide a diagnosis in this case or determine that any symptoms he was experiencing during service were manifestations of sleep apnea. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing and knowledge of medical pathology. Therefore, it is outside the competence of the Veteran in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011).

Based upon a longitudinal review of the evidence of record, the Board concludes that the evidence of record persuasively weighs against finding that the Veteran's obstructive sleep apnea began during active service or
this case or determine that any symptoms he was experiencing during service were manifestations of sleep apnea. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing and knowledge of medical pathology. Therefore, it is outside the competence of the Veteran in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011).

Based upon a longitudinal review of the evidence of record, the Board concludes that the evidence of record persuasively weighs against finding that the Veteran's obstructive sleep apnea began during active service or is otherwise related to an in-service injury or disease, including inservice TERAs. The Veteran's inservice and post service treatment records are completely silent as to any complaints of or treatment for sleep problems or sleep apnea for several years after his separation from military service. The Veteran reported the onset of this condition in the early 2000s. Available treatment records do not reference sleep apnea for two decades after the Veteran's separation from service. Finally, the January 2025 VA examiner opined that this condition was less likely than not related to the Veteran's military service, including his inservice TERAs. In rendering this opinion, the VA examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner physically examined the Veteran and also supported the opinion provided with a sufficient rationale. Accordingly, this opinion is deemed to be the most probative evidence of record.

The persuasive evidence of record is against the Veteran's claim seeking service connection for obstructive sleep apnea; the evidence is not in approximate balance, and the benefit of the doubt rule is inapplicable. Thus, the claim of entitlement to service connection for obstructive sleep apnea is denied.

2. Entitlement to service connection for severe bradycardia is denied.

The Veteran contends that he has bradycardia related to his military service.

Bradycardia is a slow heartbeat. Pritchett v. Derwinski, 2 Vet. App. 116, 117 (1992).

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 the Veteran does not have a current diagnosis of bradycardia and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

A March 2020 VA treatment report noted that the Veteran was diagnosed with bradycardia, while on metoprolol. No subsequent treatment for or diagnoses of bradycardia are indicated.

In April 2024, the Veteran filed his present claim seeking entitlement to service connection for bradycardia.

In January 2025, the Veteran underwent a VA examination for heart conditions. Following a review of the Veteran's claims file, consideration of the Veteran's contentions, and physical examination of the Veteran, the report concluded with diagnoses of atherosclerotic cardiovascular disease and atrial fibrillation.

The VA examiner noted the Veteran's history of bradycardia in the past, but also concluded that the Veteran had no current diagnosis of bradycardia. In rendering this opinion, the examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner physically examined the Veteran and also supported the opinion provided with a sufficient rationale.

The RO's January 2025 rating decision granted service connection at an initial evaluation of 100 percent for atherosclerotic cardiovascular disease to include atrial fibrillation.

While the Veteran believes there is a current diagnosis of bradycardia, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence.

The persuasive evidence of record is against the Veteran's claim; the evidence is not in approximate balance, and the benefit of the doubt rule is inapplicable. Thus, entitlement to service connection for bradycardia is denied.

3. Service connection for high cholesterol (claimed as dyslipidemia).

The Veteran contends that his dyslipidemia was caused by or incurred in service.

Dyslip
of bradycardia, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence.

3. Service connection for high cholesterol (claimed as dyslipidemia).

The Veteran contends that his dyslipidemia was caused by or incurred in service.

Dyslipidemia is a metabolic disorder characterized by abnormally high or low levels of lipids or lipoproteins in the blood. Dyslipidemia, National Institutes of Health, Medline Plus Medical Encyclopedia (accessed April 2026).

While the record reflects that the Veteran has dyslipidemia, these findings are not a "disability" for the purposes of awarding VA disability benefits. 38 U.S.C. § 1701 (1); Allen v. Brown, 7 Vet. App. 439, 444-45 (1995) (applying definition of disability in section 1701(1) to statutes describing "eligibility for disability compensation for service-connected disabilities").

The clinical record does not show, and the Veteran has not claimed that his dyslipidemia is a symptom of a specific disability. Elevated cholesterol or an abnormal lipids level represents laboratory findings. Hyperlipidemia, dyslipidemia, or high cholesterol is not a disability for which VA disability compensation may be granted. 61 Fed. Reg. 20440, 20445 (May 7, 1996). Therefore, service connection for high cholesterol (claimed as dyslipidemia) must be denied.

VA post service treatment records show that the Veteran has high cholesterol and dyslipidemia. While it may reflect a possible underlying disability, there is no showing of a current medically diagnosed disability manifested by high cholesterol. The term "disability" as used for VA purposes refers to impairment of earning capacity. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). There is no evidence of record suggesting the Veteran's high cholesterol and/or dyslipidemia readings cause any impairment of earning capacity.

Statements by the Veteran to the effect that he has high cholesterol do not constitute competent evidence of a current disability productive of impairment in earning capacity.

In this case, there is no evidence of record suggesting that dyslipidemia, on its own, has caused any impairment of earning capacity or other disease or injury for which service connection may be granted. As such, lacking a current disability, service connection may not be granted. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. Accordingly, service connection for dyslipidemia is denied.

In the absence of a current medically diagnosed disability manifested by high cholesterol and/or dyslipidemias, there is no basis for service connection. As the persuasive evidence of record is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49.

Cory M. Picton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Yates, William 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.

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