SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, an Air Force veteran who served from June 1976 to February 1997, including service in Portugal, appeals the denial of service connection for obstructive sleep apnea (OSA) on a secondary basis. The veteran claimed entitlement to service connection for OSA as secondary to his service-connected degenerative changes of the lumbar spine. The Board reviewed multiple VA medical opinions. A December 2024 VA opinion found OSA likely aggravated by the lumbar spine disability, reasoning that low back pain could worsen sleep quality and, consequently, OSA symptoms. This opinion was found to be more probative than an August 2022 VA opinion, which stated medical literature does not support a link between lumbar spine degenerative changes and OSA aggravation and did not address the specific effects of the veteran's low back pain on his sleep. The Board found the December 2024 opinion contained clear rationale and applied the benefit of the doubt, granting service connection for OSA as secondary to the lumbar spine condition. The veteran's service information included the National Defense Service Medal and Meritorious Service Medal.

Rationale

Favorable VA opinion from December 2024 found OSA likely aggravated by lumbar spine disability.; Reasoning: Pain from lumbar spine may lead to poor sleep quality, worsening OSA.; This opinion was found more probative than an August 2022 VA opinion that did not address low back pain's effect on sleep quality.

Full Decision Text

Citation Nr: A26038153
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 250421-539512
DATE: April 23, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea (OSA), as secondary to the service-connected disability of degenerative changes of the lumbar spine, is granted.

FINDING OF FACT

The appellant's OSA is aggravated by his service-connected lumbar spine disability. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for OSA, as secondary to the service-connected disability of degenerative changes of the lumbar spine, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The appellant served on active duty in the United States Air Force from June 1976 to February 1997, including in Portugal. He is the recipient of the National Defense Service Medal, the Meritorious Service Medal, and other commendations. 

Procedural History 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision issued by the Department of Veterans Affairs (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ). VA timely received the appellant's April 2025 notice of disagreement (NOD), via VA Form 10182, with the March 2025 rating decision. The appellant selected the Board's Direct Review docket.

Applicable Evidentiary Window 

As the appellant selected Direct Review, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issue(s) on appeal. See 38 C.F.R. §§ 20.300(a), 301. The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the NOD (VA Form 10182). 38 C.F.R. § 20.301. The appellant has not filed such a request. If additional evidence was submitted after the AOJ decision, the Board will not consider it. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant may file a supplemental claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023).

Entitlement to service connection for OSA, as secondary to the service-connected disability of degenerative changes of the lumbar spine, is granted. 

The appellant maintains he is entitled to service connection for OSA on a secondary basis. There are multiple theories of entitlement, including secondary aggravation via his service-connected lumbar spine disability. See e.g., Brief in Support of NOD, April 21, 2025. After careful review, the Board finds that service connection is warranted. 

Applicable Law 

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; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). 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). The United States Court of Appeals for the Federal Circuit clarified the standard for secondary service connection in Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023
 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). The United States Court of Appeals for the Federal Circuit clarified the standard for secondary service connection in Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023), finding that 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. Id. 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.

Analysis 

In November 2024, the Board remanded the appellant's OSA claim to the AOJ for correction of a pre-decisional duty to assist error. Following that remand, the AOJ obtained multiple VA medical opinions on the nature and etiology of the appellant's OSA, including a favorable opinion regarding secondary aggravation. See VA Sleep Apnea Examination Report & Medical Opinions, December 5, 2024. The favorable December 2024 VA opinion indicated that the currently diagnosed OSA is likely aggravated by his service-connected lumbar spine disability. Essentially, the VA clinician reasoned that pain from the lumbar spine disability may lead to poor sleep quality, which in turn leads to worsening of OSA symptoms. Id. 

On the other hand, the record also contains an unfavorable August 2022 VA medical opinion, which indicated that the OSA is not likely aggravated by the lumbar spine disability. See VA Medical Opinion, August 8, 2022. According to that opinion, medical literature "does not support degenerative changes of the lumbar spine as being causative of or having the potential to aggravate sleep apnea." Id. Notably, unlike the December 2024 VA opinion, this opinion did not address the specific effects of the appellant's low back pain on his sleep quality. 

The probative value of a medical opinion comes from "the factually accurate, fully articulated, sound reasoning" for its conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the favorable December 2024 VA opinion contains clear medical rationale in support of the conclusion that the appellant's OSA would be less severe but for his service-connected low back pain. See Spicer, 61 F.4th at 1364. This opinion carries at least as much probative weight as the unfavorable August 2022 VA opinion, which did not discuss the appellant's low back symptoms, his OSA symptoms, or the relationship between the two. 

Accordingly, resolving any reasonable doubt in his favor, the Board finds that the appellant's OSA is aggravated by his service-connected lumbar spine disability. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021). Entitlement to service connection is granted.  

 

K.A. KENNERLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D.Z. Wall, 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.