SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, who served from October 1990 to October 1993, February 2009 to January 2010, and April 2010 to May 2010, appeals the February 2021 rating decision denying service connection for obstructive sleep apnea (OSA). The Veteran claimed OSA was secondary to his service-connected PTSD with persistent depressive disorder and insomnia. The Board reviewed the evidence of record as of the AOJ decision date, noting the Veteran withdrew his hearing request. The evidence included a January 2022 private treatment record diagnosing OSA and a May 2025 private medical opinion. This private opinion opined that the Veteran's OSA is at least as likely as not due to his service-connected PTSD, citing literature supporting a higher incidence of OSA in Veterans with PTSD and explaining how PTSD symptoms may increase sleep fragmentation. The Board found this opinion well-reasoned and substantially probative, noting no conflicting medical opinions. Consequently, the Board found the evidence established that OSA is caused by the service-connected PTSD, granting service connection for OSA on a secondary, causation basis. The Board also noted that no earlier effective date would result from this grant.

Rationale

Current disability (OSA) demonstrated; Service connection for PTSD with persistent depressive disorder and insomnia established; Private medical opinion linked OSA to PTSD based on literature and PTSD symptomology; Private opinion found OSA at least as likely as not due to PTSD; No conflicting medical opinion in record

Full Decision Text

Citation Nr: A26040879
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210909-184146
DATE: April 30, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea (OSA), secondary to service connected posttraumatic stress disorder (PTSD) with persistent depressive disorder and insomnia, on a causation basis, is granted.

FINDING OF FACT

The Veteran's OSA is caused by service connected PTSD.

CONCLUSION OF LAW

The criteria for service connection for OSA, secondary to service-connected PTSD with persistent depressive disorder and insomnia, on a causation basis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1990 to October 1993, from February 2009 to January 2010, and from April 2010 to May 2010.

This case comes to the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On March 20, 2025, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the February 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. 

Obstructive Sleep Apnea

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in the active military, naval, air, or space service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection is also warranted for disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a).

The Veteran contends that his OSA is caused by his service-connected PTSD with persistent depressive disorder and insomnia. For the following reasons, the Board agrees, and service connection for OSA on a secondary, causation basis, is therefore warranted.

In this case, the evidence of record demonstrates a current disability. In May 2025, the Veteran submitted a January 2022 private treatment record noting a diagnosis of obstructive sleep apnea.  Moreover, the Veteran is in receipt of service connection for PTSD with persistent depressive disorder and insomnia.  The first two elements of secondary service connection have therefore been met.

In May 2025, the Veteran submitted a private medical opinion dated in May 2025 in support of his claim. The private physician opined that the Veteran's OSA is at least as likely as not due to his service-connected PTSD. The physician's rationale discussed literature which supports the conclusion that Veterans with PTSD are diagnosed with OSA at rates higher than amongst the general population. The physician indicated that the hyperarousal and hypervigilance symptoms of PTSD may lower the arousal threshold and therefore increase the frequency of sleep fragmentation related to obstructive events.

As the private physician explained the reasons for her conclusions based on an accurate characterization of the evidence, her opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). There is no conflicting medical opinion in the evidence of record.

For the above reasons, the probative evidence reflects that O
 Veterans with PTSD are diagnosed with OSA at rates higher than amongst the general population. The physician indicated that the hyperarousal and hypervigilance symptoms of PTSD may lower the arousal threshold and therefore increase the frequency of sleep fragmentation related to obstructive events.

As the private physician explained the reasons for her conclusions based on an accurate characterization of the evidence, her opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). There is no conflicting medical opinion in the evidence of record.

For the above reasons, the probative evidence reflects that OSA is caused by service-connected PTSD with persistent depressive disorder and insomnia. Thus, service connection for OSA is warranted on a secondary, causation basis. 

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?

As there is no indication that the grant of service connection on a direct or any other basis could result in an earlier effective date, particularly given that the Veteran has been in receipt of service connection for PTSD with persistent depressive disorder and insomnia since September 2011 and the claim for service connection for OSA was filed in May 2020, further discussion is unnecessary.

 

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Walker, 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.