SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, who served from August 1973 to August 1977, May 1979 to June 1980, and January 2005 to April 2005, appealed the denial of service connection for sleep apnea as secondary to tinnitus. The Agency of Original Jurisdiction (AOJ) had previously found the Veteran to have a current diagnosis of sleep apnea. The Veteran is also service-connected for tinnitus. The Board reviewed a December 2024 VA examination opinion, which found the sleep apnea less likely than not related to tinnitus, citing a lack of known pathophysiological connection but referencing a study showing higher sleep disturbances in tinnitus patients. However, the Board found this opinion inadequate due to an incomplete explanation of the study's relevance. The Board then considered a July 2025 private medical opinion, which found the sleep apnea at least as likely as not secondary to tinnitus. The private examiner linked tinnitus to REM disruption and pharyngeal muscle paralysis, contributing to sleep apnea. The Board found this private opinion highly probative due to its thoroughness and adequate rationale, establishing the necessary nexus. Consequently, service connection for sleep apnea as secondary to tinnitus was granted.

Rationale

Current diagnosis of sleep apnea established; Service-connected for tinnitus; Private opinion found sleep apnea secondary to tinnitus; Private opinion linked tinnitus to REM disruption and pharyngeal muscle paralysis; Private opinion found highly probative due to thoroughness and rationale

Full Decision Text

Citation Nr: A26037804
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 250731-567949
DATE: April 22, 2026

ORDER

Entitlement to service connection for sleep apnea as secondary to tinnitus is granted.

FINDING OF FACT

The Veteran's sleep apnea is proximately due to, or the result of his service-connected tinnitus.

CONCLUSION OF LAW

The criteria for entitlement to service connection for sleep apnea have been met. 38 U.S.C. §§?1110,?1131,?5103, 5103A,?5107;?38 C.F.R. §§ 3.102, 3.159, 3.303, 3.110.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from August 1973 to August 1977, from May 1979 to June 1980, and from January 2005 to April 2005.

The Appeals Modernization Act (AMA) creates a new framework for Veterans dissatisfied with Department of Veterans Affairs' (VA) decision on their claim to seek review. The AMA became effective on February 19, 2019. 38 C.F.R. §?3.2400(a)(1). The AMA applies to all?initial?decisions issued after February 19, 2019.? 

The present matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025?rating decision?issued by VA Agency of Original Jurisdiction (AOJ).?Accordingly, this?decision?is?subject to the AMA.? 

The Veteran's claims for entitlement to service connection for sleep apnea?was denied in an April 2025 rating decision.? 

Next, the Veteran?timely?appealed the?April 2025?rating decision to the?Board in?a?July 2025, VA Form 10182, Notice of Disagreement.?Based on the Veteran's?selection?of the evidence docket, the Board can only consider evidence received up to the date of the rating decision on appeal and evidence received within 90 days of receipt of the VA Form 10182 Notice of Disagreement. 38 C.F.R. § 20.303.?? 

Service Connection 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  

To establish a right to compensation for a present disability, a Veteran must show: (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-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in a denial of service connection. Service connection may also be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 

Service?connection?may alternatively be?established?on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be?established?for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree)?over and above the degree of disability existing prior to the aggravation.?See?38?C.F.R. § 3.310(b);?Allen v. Brown, 8?Vet. App.?374 (1995).??????? 

In order to?prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence?establishing?a connection between the service-connected disability and the current disability.?See Wallin v. West, 11?Vet. App.?509, 512 (1998);?see also?Allen,?supra.??????? 

Service connection must be considered on the basis of the places, types, and circumstances of a Veteran's service as shown by his
 § 3.310(b);?Allen v. Brown, 8?Vet. App.?374 (1995).??????? 

In order to?prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence?establishing?a connection between the service-connected disability and the current disability.?See Wallin v. West, 11?Vet. App.?509, 512 (1998);?see also?Allen,?supra.??????? 

Service connection must be considered on the basis of the places, types, and circumstances of a Veteran's service as shown by his or her service records, the official history of each organization in which he or she served, his or her medical records, and all pertinent medical and lay evidence. See 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); and see Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).  

The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau, 492 F.3d at 1377; Buchanan, 451 F.3d at 1337 ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence").  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 

Entitlement to service connection for sleep apnea as secondary to tinnitus

The Veteran seeks service connection for his sleep apnea as secondary to his service-connected tinnitus. Because the Board is issuing a grant based on this theory of entitlement, it is not necessary for the Board to address other theories of entitlement. 

As to evidence of a current disability, the AOJ made a favorable finding in the April 2025 rating decision that the Veteran has a disability based on a diagnosis of sleep apnea. The Board is bound by this finding. 38?C.F.R. 3.104(c).?As such, the Board finds that?a current disability is?established?for sleep apnea. 

With respect to evidence of a service-connected disability, the Veteran is service connected for tinnitus. Thus, the second element of secondary service connection is satisfied. 

Regarding a nexus between the service-connected disability of tinnitus and the current disability of a sleep apnea, the Veteran was afforded a VA examination in December 2024, and the examination indicated a diagnosis of central sleep apnea. In the December 2024 VA opinion, the examiner opined that the Veteran's sleep apnea was less likely than not proximately due to, or the result of, tinnitus. As rationale, the examiner stated that there is no known pathophysiological relationship between the tinnitus causing sleep apnea. Conversely, the examiner discussed a study which assessed the prevalence and severity of sleep disturbance in chronic tinnitus patients. Included in the study were 80 military personnel with tinnitus, and sleep disturbances were found to be higher than those of normal controls in 77 percent of patients. However, the rationale does not fully explain the study and how it does or does not correlate to the Veteran's claim. As such, the Board is not able to make a fully informed decision from this evidence, and the December 2024 opinion is inadequate for this reason. Accordingly, the Board affords the December 2024 VA opinion no probative weight. 

The Board acknowledges the July 2025 private opinion, included with the Veteran's appellate brief, in which the examiner opined that the Veteran's sleep apnea was at least as likely as not secondary to his tinnitus. As rationale, the private examiner stated that most of the hypopneas during sleep were seen during REM sleep, and soon after, the Veteran demonstrated frequent central apneas. Additionally, the examiner explained that tinnitus is associated with REM disruption, which leads to a more sustained and deepened state of paralysis of the tongue. Furthermore, the examiner stated that sleep apnea can develop only when there is both narrowing of the airway and failure
, the Board affords the December 2024 VA opinion no probative weight. 

The Board acknowledges the July 2025 private opinion, included with the Veteran's appellate brief, in which the examiner opined that the Veteran's sleep apnea was at least as likely as not secondary to his tinnitus. As rationale, the private examiner stated that most of the hypopneas during sleep were seen during REM sleep, and soon after, the Veteran demonstrated frequent central apneas. Additionally, the examiner explained that tinnitus is associated with REM disruption, which leads to a more sustained and deepened state of paralysis of the tongue. Furthermore, the examiner stated that sleep apnea can develop only when there is both narrowing of the airway and failure of the pharyngeal muscles and the tongue to maintain airway patency during sleep. In formation of the opinion, the examiner considered the Veteran's medical history, military history, and the Veteran's statements. The opinion is thorough, and the conclusion is supported by adequate rationale. As such, the Board finds the July 2025 private opinion highly probative. 

Given that no adequate VA opinion exists, the most probative evidence of a nexus between the Veteran's sleep apnea and tinnitus is the July 2025 private opinion. Thus, the Board finds that a nexus is established. 

Accordingly, service connection for the Veteran's sleep apnea as secondary to tinnitus is warranted, and the claim is granted. 

 

 

GAYLE STROMMEN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jeffreys, J.

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.