SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

C.B. IWANOWSKI · 2026 · Case ID: A26039417

DENIED

Summary

The Veteran, who served in the United States Air Force from July 1975 to April 1977, appeals the denial of service connection for four conditions: sleep apnea, diabetes mellitus, emphysema, and prostate cancer. The Board reviewed the evidence of record at the time of the agency of original jurisdiction's December 2024 supplemental claim decision, as the Veteran elected the Direct Review docket. The Veteran submitted a VA Form 20-0995 in April 2023, requesting readjudication for sleep apnea, and stated in an August 2024 lay statement that his sleep apnea symptoms began during service. However, service treatment records were silent for sleep apnea complaints or diagnosis, and post-service records showed no history of sleep apnea diagnosis or treatment until a May 2024 consultation. For diabetes, emphysema, and prostate cancer, service treatment records were also silent or did not indicate in-service issues. The Board noted that while the Veteran has current diagnoses for these conditions, the evidence persuasively weighed against a finding that they began during service or were related to an in-service event. The Board also noted that the agency of original jurisdiction determined the Veteran had not experienced a toxic exposure risk activity (TERA) during service, and no favorable findings regarding TERA were binding on the Board. The Board concluded that the evidence was persuasively against each claim, and the benefit-of-the-doubt doctrine was not applicable. Service connection for all four conditions was denied.

Rationale

No in-service event, injury, or disease established; No indication of nexus to service; Evidence persuasively weighs against claim

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251128-629518

Full Decision Text

Citation Nr: A26039417
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 251128-629518
DATE: April 28, 2026

ORDER

Service connection for sleep apnea is denied.

Service connection for diabetes is denied.

Service connection for emphysema is denied.

Service connection for prostate cancer is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that 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 diabetes mellitus began during active service or is otherwise related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that emphysema began during active service or is otherwise related to an in-service injury or disease.

4. The evidence of record persuasively weighs against finding that prostate cancer began during active service or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for emphysema are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Air Force from July 1975 to April 1977.

The rating decision on appeal was issued in December 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

Additionally in April 2023, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of sleep apnea most recently addressed in a December 2022 rating decision. In December 2024, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

In the November 2025 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 December 2024 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes the Veteran's Correspondence received December 14, 2024, requesting the removal of Robert Gordon as his attorney representative. This representation has been removed from VA systems and the Veteran proceeds pro se.

Service Connection

1. Service connection for sleep apnea

The Veteran seeks service connection for sleep apnea.

Service Connection

1. Service connection for sleep apnea

The Veteran seeks service connection for sleep apnea.

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 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 RO conducted development to determine whether the Veteran had experienced a toxic exposure risk activity (TERA) during active service. In an August 2024 memorandum, the RO determined that the Veteran had not experienced a TERA during service.

The Veteran reports in an August 2024 statement that his sleep apnea symptoms started during service. He reports that he never sleeps longer than a few hours, and that his symptoms have been this way since 1976 on active duty. Service treatment records are silent for complaints or diagnosis of sleep apnea. The Veteran denied frequent trouble sleeping at his October 1976 report of medical history.

Post-service treatment records reflect that in January 2013, the Veteran reported poor sleep. However, treatment providers specifically noted that there was no history of sleep apnea diagnosis or treatment. A later May 2024 consultation reflected positive diagnoses for sleep apnea.

The Board concludes that, while the Veteran has a diagnosis of sleep apnea, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. In the rating decision, in-service toxic exposure risk activities were not conceded. It follows that there are no favorable findings binding the Board in this regard. The Board finds at this time that a TERA during service has not been established for the Veteran.

The Board acknowledges that the Veteran reports that his sleep apnea symptoms onset during service. A VA medical examination has not been obtained addressing the claimed disability. VA's duty to assist includes providing a medical examination when necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology).

While a medical examination has not been obtained regarding the nature and etiology of sleep apnea, the Board finds the record does not establish an indication that the sleep apnea is related to any event or disease in service. A mere conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require an examination under McLendon. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (rejecting appellant's argument that his "conclusory generalized statement that his service illness caused his present medical problems was enough to entitle him to a medical examination under the standard of 38 U.S.C. § 5103A(d)(2)(B)."). Accordingly, even the low threshold under McLendon has not been met here and VA's duty to provide a VA examination is not triggered. See 38 U.S.C. §
mere conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require an examination under McLendon. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (rejecting appellant's argument that his "conclusory generalized statement that his service illness caused his present medical problems was enough to entitle him to a medical examination under the standard of 38 U.S.C. § 5103A(d)(2)(B)."). Accordingly, even the low threshold under McLendon has not been met here and VA's duty to provide a VA examination is not triggered. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159 (c), 3.326; McLendon, 20 Vet. App. 79.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for sleep apnea is not warranted. The claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Service connection for diabetes

The Veteran seeks service connection for diabetes.

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.

STRs are silent for high blood sugar or diabetes. VA treatment records show a current diagnosis of diabetes.

The RO conducted development to determine whether the Veteran had experienced a TERA during active service. In an August 2024 memorandum, the RO determined that the Veteran had not experienced a TERA during service.

The Board concludes that, while the Veteran has a diagnosis of diabetes mellitus, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. In the rating decision, in-service toxic exposure risk activities were not conceded. It follows that there are no favorable findings binding the Board in this regard. The Board finds at this time that a TERA during service has not been established for the Veteran.

While the Veteran believes the claimed diabetes mellitus is related to active service, the Board reiterates that the evidence of record persuasively weighs against findings that a TERA occurred.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for diabetes mellitus is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

3. Service connection for emphysema

The Veteran seeks service connection for emphysema.

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 STRs demonstrate seasonal hay fever but are silent for emphysema. VA treatment records show a diagnosis of emphysema which was a favorable finding in the rating decision on appeal.

The RO conducted development to determine whether the Veteran had experienced a toxic exposure risk activity (TERA) during active service. In an August 2024 memorandum, the RO determined
the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

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 STRs demonstrate seasonal hay fever but are silent for emphysema. VA treatment records show a diagnosis of emphysema which was a favorable finding in the rating decision on appeal.

The Board concludes that, while the Veteran has a diagnosis of emphysema, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. In the rating decision, in-service toxic exposure risk activities were not conceded. It follows that there are no favorable findings binding the Board in this regard. The Board finds at this time that a TERA during service has not been established for the Veteran.

While the Veteran believes the claimed emphysema is related to active service, the Board reiterates that the evidence of record persuasively weighs against findings that a TERA occurred. As such, the in-service and nexus elements have not been met in this case.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for emphysema is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

4. Service connection for prostate cancer

The Veteran seeks service connection for prostate cancer.

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 STRs are silent for prostate problems. VA treatment records show the Veteran taking Tamsulosin for the prostate, hypertrophy of the prostate, and prostate cancer. See February 2024 CAPRI.

The Board concludes that, while the Veteran has a diagnosis of prostate cancer, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. In the rating decision, in-service toxic exposure risk activities were not conceded. It follows that there are no favorable findings binding the Board in this regard. The Board finds at this time that a TERA during service has not been established for the Veteran. As such, the in-service element has not been met in this appeal and there can be no nexus to service.

While the Veteran believes the claimed prostate cancer is related to active service, the Board reiterates that the evidence of record persuasively weighs against findings that a TERA occurred. As such, the in-service and nexus elements have not been met in this case.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for prostate cancer is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

C.B. Iwanowski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D. Lauritzen

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.
.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for prostate cancer is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

C.B. Iwanowski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D. Lauritzen

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