SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran, who served in the Army from April 1968 to November 1969 and again from March 1976 to September 1996, appeals the denial of service connection for obstructive sleep apnea. The veteran contended that his military duties, which involved interrupted sleep patterns and rotating shifts, contributed to his condition. He also reported experiencing symptoms like snoring and daytime drowsiness since the 1980s, corroborated by his children and a fellow servicemember. While the veteran's service treatment records did not document obstructive sleep apnea, a July 1986 record noted sleep trouble related to anxiety. The Board found the AOJ's favorable findings regarding toxic exposure risk activity (TERA) and the current diagnosis of obstructive sleep apnea to be binding. A February 2025 VA examination provided a negative opinion, stating the condition was less likely than not related to service due to a lack of chronicity and the presence of post-service risk factors like obesity. However, the Board found this opinion inadequate as it did not fully address the specific facts of the case. A March 2026 private medical opinion from L.B., MPAS, PA-C, found it at least as likely as not that the obstructive sleep apnea began during service, citing the lay statements, service treatment records, and medical literature, and concluding that the reported symptoms indicated an onset during service despite later risk factors. The Board found this private opinion probative and, resolving reasonable doubt in the veteran's favor, granted service connection for obstructive sleep apnea.

Rationale

Private medical opinion found condition at least as likely as not related to service.; VA examination opinion was inadequate as it did not fully address specific facts.; Lay statements from family and fellow servicemember corroborated in-service symptoms.; Resolving reasonable doubt in favor of the Veteran.

Full Decision Text

Citation Nr: A26039226
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260410-647766
DATE: April 28, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea is granted.

FINDING OF FACT

The Veteran has been shown to have obstructive sleep apnea that is related to his military service.

CONCLUSION OF LAW

Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for obstructive sleep apnea have been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1968 to November 1969 and from March 1976 to September 1996.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2025 rating decision.

The Veteran filed a VA Form 10182 in April 2026 and elected the evidence submission docket.  Therefore, the Board may only consider the evidence of record at the time of the May 2025 agency of original jurisdiction (AOJ) decision, as well as any evidence submitted by the Veteran or his representative with or within 90 days from receipt of the VA Form 10182.  If evidence was submitted either (1) during the time period after the AOJ issued that decision 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.  Nevertheless, this decision represents a full grant of the benefit sought on appeal.

In addition, the Veteran waived his right to switch dockets under 38 C.F.R. § 20.202(c)(2) through his representative's notation on the VA Form 10182 and an accompanying written statement to the VA Form 10182. See Williams v. McDonough, 37 Vet. App. 305 (2024).  His representative also submitted a written statement later that same month indicating that the Veteran waived the remainder of the 90-day evidence submission period.  Therefore, the Board may proceed with adjudication of the case at this time.  

Law and Analysis

Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, air, or space service. 38 U.S.C. §§ 1110, 1131.  That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease.  Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303.

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits.  VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is entitled to service connection for obstructive sleep apnea.

The Veteran has made multiple contentions as to how his obstructive sleep apnea may be related to his military service, including that his duties throughout his service resulted in interrupted sleep patterns; that he had in-service symptoms that were later confirmed to be early manifestations of the now diagnosed disorder; and that he had in-service exposures.  See, e.g., written statements from January 2025 and April 2026; April 2026 appellate brief.  During the February 2025 VA examination, the Veteran recalled that he was diagnosed a couple years prior, but he reported that he had been snoring for many years, which necessitated that he sleep in a separate bedroom from his spouse. See also June 2024 private treatment record (reported married to spouse for 48 years prior to her passing away about four years prior).  His adult children and a fellow servicemember friend also provided written statements in which they recalled the Veteran having potentially relevant
 symptoms that were later confirmed to be early manifestations of the now diagnosed disorder; and that he had in-service exposures.  See, e.g., written statements from January 2025 and April 2026; April 2026 appellate brief.  During the February 2025 VA examination, the Veteran recalled that he was diagnosed a couple years prior, but he reported that he had been snoring for many years, which necessitated that he sleep in a separate bedroom from his spouse. See also June 2024 private treatment record (reported married to spouse for 48 years prior to her passing away about four years prior).  His adult children and a fellow servicemember friend also provided written statements in which they recalled the Veteran having potentially relevant symptomatology as early as the 1980s, including frequent and loud snoring and daytime drowsiness, which his children found particularly noticeable given the daily energy (self-described "chaos" and "running amok") that was generated from their family with five young children at that time.  The fellow servicemember further noted that he was constantly on rotating shifts that broke up any normal sleep patterns.  See written statements received in January 2025 and April 2026.

The Veteran's service treatment records do not document any complaints, treatment, or diagnosis of obstructive sleep apnea.  A July 1986 service treatment record shows that he reported trouble sleeping in the context of requesting a mental health counseling appointment for feelings of anxiety.  The resulting mental health evaluation report reflects that the symptomatology was associated with life circumstances by the military treatment provider at that time.

The AOJ made favorable findings that the Veteran participated in a toxic exposure risk activity (TERA) through his presumed herbicide agent exposure (a qualifying in-service event) and a current diagnosis of obstructive sleep apnea.  Those favorable findings are binding on the Board. 38 U.S.C. § 5104(b)(4), 5104A; 38 C.F.R. § 20.801(a).  The record also supports those determinations.  See, e.g., notation of foreign service in service personnel records; February 2025 VA examination report (based on review of results of January 2024 private sleep study).

The February 2025 VA examiner provided a negative medical opinion as to a relationship between the Veteran's TERA and also determined that the disorder was less likely than not otherwise incurred in or caused by the claimed in-service injury, event, or illness.  In so finding, she indicated that the fact that the Veteran did not have a sleep study done until 2024 resulted in a lack of chronicity during service or after service to suggest a causal relationship between his service and the current diagnosis.  She further indicated that there were various risk factors that could lead to the development of obstructive sleep apnea without clearly addressing the specific facts and circumstances of this case.  Thus, the February 2025 VA examiner's medical opinion is not adequate to decide the case by itself.  See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding medical opinion based upon incomplete or inaccurate factual premise has no probative value); Swann v. Brown, 5 Vet. App. 229, 233 (1993); Black v. Brown, 5 Vet. App. 177, 180 (1993) (an opinion based on an inaccurate (or unsubstantiated) factual premise has limited, if any, probative value); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning).

Nevertheless, the Board notes that Veteran, his children, and his friend are competent to report their recollections as to the history of the Veteran's observable symptomatology.  There is also no reason to doubt their statements in this regard other than the lack of contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).  The Veteran's performance reports in the service personnel records also support his description of the nature of his in-service duties.

Moreover, in a March 2026 private medical opinion, L.B. (initials used to protect privacy), MPAS and PA-C, determined that, after review of the pertinent records, the Veteran's medical history, and medical literature, it was at least as likely as not that the Veteran's obstructive sleep apnea began while he was serving in the United States Army.  In rendering her opinion, she detailed the content of the lay statements discussed above, as well as the July 1986 service treatment record and post-service private treatment records.  L.B. stated that the reported symptomatology supported a finding that the Veteran displayed
's performance reports in the service personnel records also support his description of the nature of his in-service duties.

Moreover, in a March 2026 private medical opinion, L.B. (initials used to protect privacy), MPAS and PA-C, determined that, after review of the pertinent records, the Veteran's medical history, and medical literature, it was at least as likely as not that the Veteran's obstructive sleep apnea began while he was serving in the United States Army.  In rendering her opinion, she detailed the content of the lay statements discussed above, as well as the July 1986 service treatment record and post-service private treatment records.  L.B. stated that the reported symptomatology supported a finding that the Veteran displayed the initial symptoms of obstructive sleep apnea while in service and that the condition had worsened over time, which was consistent with the natural progression and development of obstructive sleep apnea.  She also cited to medical literature.

In addition, L.B. observed that the Veteran did have additional post-service risk factors for sleep apnea, including a history of obesity and drinking, which was documented in private treatment records.  However, she explained that he was still at a stable weight when he started demonstrating signs of sleep disordered breathing during service.  Thus, given the nature of his in-service symptoms, she confirmed her opinion as to the onset of the disorder in this case despite the above risk factors.  

The Board finds that L.B.'s medical opinion is entitled to probative weight because it addresses the central medical issues in the case and is based on an analysis of the evidence and current medical understanding. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (an examination is not rendered inadequate where the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion") and Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record).

Based on the foregoing and resolving any reasonable doubt in favor of the Veteran, the Board concludes that service connection for obstructive sleep apnea is warranted.

 

 

J.W. ZISSIMOS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Postek, 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.