SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, who served from July 1982 to July 1986, appeals the denial of service connection for sleep apnea. The veteran sought service connection for sleep apnea as secondary to his service-connected tinnitus, alleging that the tinnitus caused or aggravated the sleep apnea. The veteran submitted private medical opinions suggesting a link between tinnitus and sleep disturbance, and potentially sleep apnea in tinnitus sufferers, but these opinions were afforded little weight by the Board. The Board found the opinions conflated the standards for causation and aggravation and suggested age and obesity were more likely causes of the sleep apnea. The Board also considered VA treatment records noting morbid obesity as a cause for sleep apnea and VA medical opinions stating that tinnitus does not negatively impact or cause sleep apnea. The Board found these VA opinions more probative, concluding that the weight of the evidence showed the sleep apnea was unrelated to service or tinnitus. Therefore, the Board denied service connection for sleep apnea.

Rationale

Private opinions afforded little weight due to conflation of causation/aggravation standards and suggestion of age/obesity as causes.; VA treatment records noted morbid obesity as a cause for sleep apnea.; VA examiner opined tinnitus does not negatively impact or cause sleep apnea.

Full Decision Text

Citation Nr: A26038978
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 260102-619725
DATE: April 27, 2026

ORDER

Entitlement to service connection for sleep apnea is denied.

FINDING OF FACT

The Veteran's obstructive sleep apnea is not due to his in-service TERAs and is not caused or aggravated by his service-connected tinnitus.

CONCLUSION OF LAW

The criteria for service connection for sleep apnea have not been 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 Veteran served on active duty from July 1982 to July 1986. 

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. However, no evidence has been added to the file since that decision. 

Finally, VA regulations provide that, "[u]pon request, a claimant is entitled to a hearing on any issue involved in a claim...before VA issues notice of a decision on an initial or supplemental claim." 38 C.F.R. § 3.103(d)(1). In November 2022, VA amended VA Form 21-526EZ and in May 2024 VA amended VA Form 20-0995 to inform claimants of the right to a hearing at any time during the claims process. The initial claim in this appeal was filed on VA Form 20-0995 after it was amended; therefore, the Veteran received the requisite notice.

The Veteran seeks service connection for sleep apnea as secondary to his service-connected tinnitus. 

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). Also, service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

The evidence shows the Veteran was diagnosed with obstructive sleep apnea in February 2015. Because the Veteran has not alleged, and the evidence does not raise, that his condition began in service, the question for the Board is whether his sleep apnea is related to his toxic exposure risk activities (TERAs) in service or was caused or aggravated by his service-connected tinnitus. 

In August 2021, and again in September 2024, the Veteran submitted a private nexus opinion in which a medical provider opined that the Veteran's tinnitus caused and/or aggravated his sleep apnea. Citing a study, the provider stated that "sleep disturbance is a common and frequent complaint reported by tinnitus sufferers." It is unclear from the opinion whether the study participants had sleep apnea, and sleep disturbance is not the same thing as sleep apnea. Notably, the provider stated that the "self-rated severity of the tinnitus was greater in subjects with higher sleep disturbance scores," suggesting that tinnitus was impacted by sleep disturbance, rather than the reverse. The provider also wrote that "organic sleep disorders might be sizeable in a tinnitus population because these patients tend to be older increasing the likelihood of a sleep-related breathing disorder." This weighs against a causal relationship between the Veteran's tinnitus and sleep apnea, and instead suggests that the causal factor is old age. 

The medical provider cited a 2017 study that "investigated the association between [obstructive sleep apnea] and chronic tinnitus" and ultimately opined that "our sleeping quality [] affects the many reason[s] that our body cannot eliminate tinnitus, is what we suspect." Again, this suggests that tinnitus is impacted by sleep quality, not that sleep apnea is caused or aggravated by tinnitus. Finally, the provider stated that the prevalence of sleep disorders in patients with tinnitus varies from 25 percent to 77 percent
 be older increasing the likelihood of a sleep-related breathing disorder." This weighs against a causal relationship between the Veteran's tinnitus and sleep apnea, and instead suggests that the causal factor is old age. 

The medical provider cited a 2017 study that "investigated the association between [obstructive sleep apnea] and chronic tinnitus" and ultimately opined that "our sleeping quality [] affects the many reason[s] that our body cannot eliminate tinnitus, is what we suspect." Again, this suggests that tinnitus is impacted by sleep quality, not that sleep apnea is caused or aggravated by tinnitus. Finally, the provider stated that the prevalence of sleep disorders in patients with tinnitus varies from 25 percent to 77 percent; while this shows correlation, this does not demonstrate causation. Based on these reasons, the Board afforded little weight to this medical opinion. 

The probative weight is further undermined by the examiner's opinion that the Veteran's "obstructive sleep apnea is at least as likely as not, proximately due to or aggravated by his service connected tinnitus." Whether a secondary condition is due to a primary condition or aggravated by a primary condition are two separate issues based on two distinct questions. A condition may not be both the cause or the origin of the condition and the factor that aggravates an already existing condition. Thus, the Board finds that the opinion is inadequate to the extent it conflates the standards for secondary service connection.

The Board finds that the weight of the probative evidence instead shows that the Veteran's sleep apnea is unrelated to his TERAs and tinnitus. A September 2015 VA treatment record states that the "Veteran is currently diagnosed with morbid obesity which has resulted in sleep apnea and joint pain." In March 2025, a VA examiner opined that the Veteran's obstructive sleep apnea is less likely than not related to his in-service TERAs, to include asbestos exposure. The examiner's rationale noted that obstructive sleep apnea is due to obstruction of the upper airway during sleep and asbestos exposure "typically affects the lower airways and thus the pathophysiology of asbestos exposure is different than that for [obstructive sleep apnea.]" The examiner opined that the Veteran's condition was more likely related to his risk factors of morbid obesity and regular alcohol use because they both relax the soft tissues of the upper airway which potentially obstruct the upper airway during sleep. 

Regarding the secondary service connection claim, a different VA examiner opined that tinnitus does not affect or cause narrowing or closure of the oral pharynx during sleep such that it would negatively impact or cause sleep apnea. While the examiner did not specifically use the word "aggravation," the Board finds that this opinion adequately addresses both secondary service connection theories as the examiner noted that tinnitus does not "affect" or "impact" obstructive sleep apnea. Collectively, the Board finds that these medical opinions are highly probative as they address the Veteran's contentions, provide adequate rationales to support their conclusions, and include alternative etiologies for the Veteran's sleep apnea. 

Consequently, the Board gives more probative weight to the VA treatment records and VA medical opinions. After weighing the evidence, the Board finds that the persuasive evidence is against service connection for sleep apnea due to his in-service TERAs or secondary to his service-connected tinnitus. Accordingly, the claim for service connection is denied. 

 

 

MICHELLE L. KANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Lavan

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.