SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The veteran served from September 2014 to December 2014 and again from March 2018 to July 2021, with additional Reserve/National Guard service. The veteran appealed the denial of service connection for sleep apnea, alleging it was secondary to his service-connected acquired psychiatric disorder. The Board reviewed the evidence, including a VA examination from April 2025 and a private medical assessment from February 2026. The VA examiner concluded that the veteran's musculoskeletal conditions led to reduced mobility and obesity, which indirectly contributed to his sleep apnea, finding this causal chain medically reasonable and supported by literature. The private medical assessment, citing medical literature, determined a connection between the veteran's acquired psychiatric disorder and sleep apnea, noting that anxiety and stress can lead to upper airway obstruction causing obstructive sleep apnea (OSA). This assessment concluded it was at least as likely as not that the sleep apnea developed secondary to the acquired psychiatric disorder. The Board found both the VA and private opinions to be probative and supported by evidence and rationale. Weighing the evidence in favor of the veteran, the Board found the sleep apnea to be secondary to his service-connected conditions and granted service connection.

Rationale

Service-connected acquired psychiatric disorder; Musculoskeletal conditions led to reduced mobility and obesity; Obesity indirectly contributed to sleep apnea; Anxiety associated with fragmented REM sleep; Medical literature supports link between anxiety and sleep apnea

Full Decision Text

Citation Nr: A26039973
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 260219-644934
DATE: April 29, 2026

ORDER

Entitlement to service connection for sleep apnea is granted.

FINDING OF FACT

The evidence of record indicates that the Veteran's sleep apnea was caused by his service-connected musculoskeletal and acquired psychiatric disorders.

CONCLUSION OF LAW

The criteria for service connection for sleep apnea as secondary to service-connected disabilities are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 2014 to December 2014 and March 2018 to July 2021, with additional service in the Reserve and/or National Guard.

This appeal is before the Board of Veterans' Appeals (Board) from a May 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office.

In the February 19, 2026, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran 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 on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal 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.

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 claim, 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 has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); see Williams v. McDonough, 37 Vet. App. 305 (2024). Although the period to change dockets per 38 C.F.R. § 20.202(c)(2) has not elapsed, the Board notes that the Veteran submitted evidence with or within 90 days of his evidence submission docket appeal election. See 38 CFR 20.202(c)(2) ("Requests to modify a Notice of Disagreement will not be granted if the appellant has submitted evidence or testimony as described in §§ 20.302 and 20.303."). Additionally, the issue on appeal is being granted in full. As such, the Board will proceed with adjudicating the appeal.

Service Connection for Sleep Apnea is Granted

The Veteran seeks entitlement to service connection for sleep apnea which he alleges was caused by his service-connected acquired psychiatric disorder. See April 2026 Private Medical Assessment.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury, shown by evidence
 (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury, shown by evidence of (1) a current disability 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); Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability"). The but-for causation standard in a secondary service-connected case is not limited to a single cause and effect, but rather contemplates multi-causal links. Id.

Obesity may act as an "intermediate step" between a service-connected disability and another current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a).  See VAOPGCPREC 1-2017; See Walsh v. Wilkie, 32 Vet. App. 300, 304 (2020).  If competent and credible evidence establishes that: (1) a service-connected disability caused or aggravated the Veteran's obesity, (2) obesity was a substantial factor in causing the claimed disability, and (3) the claimed disability would not have occurred but for the obesity, then the claimed disability may be service-connected on a secondary basis.  Id.

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where 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; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

In this case, the April 2025 VA examination determined the Veteran has a diagnosis of sleep apnea and the evidence reflects he is service-connected for an acquired psychiatric disorder. See August 2024 Rating Decision. Therefore, the first two requirements of a secondary service connection claim are met. See Spicer, 61 F.4th at 1364. All that remains to be resolved is whether the medical evidence of record establishes a link between the Veteran's service-connected disabilities and his sleep apnea.

Here, the Board remanded the Veteran's claim in April 2025 to acquire a VA medical opinion to determine if the Veteran's service-connected disabilities caused the Veteran to develop obesity and if that obesity operated as an intermediate step in the development of his sleep apnea. 

In April 2025, three VA medical opinions were associated with the claims file. The third medical opinion addressed conflicting evidence. The examiner noted that musculoskeletal issues can have a significant impact on sleep quality and overall functional impairment. Chronic musculoskeletal pain can disrupt sleep architecture, leading to increased sleep fragmentation and reduced sleep efficiency, which can exacerbate the patient's overall functional impairment.  The VA examiner also addressed the limitations of the Veteran's service-connected musculoskeletal disabilities in detail. The examiner concluded that based on the available evidence, it is medically reasonable to conclude that the veteran's musculoskeletal conditions, which resulted in decreased mobility and subsequent obesity, indirectly contributed to the development of his obstructive sleep apnea. The causal chain of events, from musculoskeletal conditions to reduced mobility, obesity, and ultimately sleep apnea, is supported by the medical literature and the veteran's clinical history. The Board affords this opinion significant probative value as it is supported by the evidence of record, medical literature, and sound medical rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

In February 2026, the Veteran submitted a private medical assessment which included a detailed review of his medical history and the claims file. Citing medical literature, the medical professional determined there was a connection between sleep apnea and the Veteran's acquired psychiatric
 development of his obstructive sleep apnea. The causal chain of events, from musculoskeletal conditions to reduced mobility, obesity, and ultimately sleep apnea, is supported by the medical literature and the veteran's clinical history. The Board affords this opinion significant probative value as it is supported by the evidence of record, medical literature, and sound medical rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

In February 2026, the Veteran submitted a private medical assessment which included a detailed review of his medical history and the claims file. Citing medical literature, the medical professional determined there was a connection between sleep apnea and the Veteran's acquired psychiatric disorder. Specifically, medical literature indicates veterans with diagnosed anxiety, such as the Veteran, experienced increased rates of sleep apnea. Moreover, that "anxiety and stress are associated with a fragmented pattern of REM sleep. Abnormalities of REM sleep cause hypotonia of the muscles in the upper airway, which creates a functional obstruction of the upper airways, resulting in OSA." The physician then cited six other pieces of medical literature indicating a medical connection exists between the Veteran's acquired psychiatric disorder and his sleep apnea and further indicating they are comorbid conditions. Ultimately, the medical professional determined that "it is at least as likely as not that [the Veteran's] diagnosis of [sleep apnea] developed secondary to his service-connected" acquired psychiatric disorder. The Board affords this opinion significant probative value as it is supported by the evidence of record, medical literature, and sound medical rationale. See Nieves-Rodriguez, 22 Vet. App. at 304.

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Accordingly, the Board finds the probative evidence of record weighs in favor of finding that the Veteran's sleep apnea is secondary to his service-connected conditions. 38 U.S.C. § 5107; See Lynch, 21 F.4th at 776.  Therefore, the claim is granted.

 

 

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Masters, Tyler

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.