SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

Summary

The Veteran, an Army Veteran who served from October 1971 to October 1975, appeals the denial of service connection for obstructive sleep apnea. The Veteran contends that his service-connected acquired psychiatric disorder, including PTSD and major depressive disorder, caused or worsened his sleep apnea. The Board acknowledged the comorbidity of PTSD and sleep apnea but found the evidence insufficient to establish service connection. The Veteran's service treatment records did not reflect complaints related to sleep apnea. A February 2021 VA examination concluded that the condition was less likely than not proximately due to or the result of the acquired psychiatric disorder, noting the relationship is not completely understood. The Board found this examination adequate. The Veteran submitted a March 2025 private opinion and studies, with the private clinician opining the sleep apnea was at least as likely as not due to PTSD. However, the Board found this opinion inadequate, deeming it speculative and lacking specifics to the Veteran's history, and noted that many cited symptoms were already captured by his psychiatric rating. The Board also found the Veteran, as a layperson, was not competent to make an etiological conclusion. Ultimately, the Board found the evidence weighed against service connection, as a nexus was not established, and the benefit-of-the-doubt doctrine was not applicable due to the lack of approximate balance. Service connection for obstructive sleep apnea was denied.

Rationale

Service treatment records did not reflect complaints related to sleep apnea.; VA examiner opined condition was less likely than not proximately due to or the result of acquired psychiatric disorder.; Private opinion lacked specifics and was deemed speculative by the Board.

Full Decision Text

Citation Nr: A26040923
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210609-164992
DATE: April 30, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea is denied.

FINDING OF FACT

The Veteran's obstructive sleep apnea is not etiologically related to service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for obstructive sleep apnea have not been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from October 1971 to October 1975. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision of a Department of Veterans Affairs (VA) Regional Office.  

In the June 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  On December 17, 2024, the Veteran withdrew the hearing request and requested 90 days to submit additional evidence and argument.  Therefore, the Board may only consider the evidence of record at the time the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his 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[s], considering the new evidence in addition to the evidence previously considered. Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service.  38 U.S.C. § 1110, 1131; 38 C.F.R. §§ 3.303, 3.304.  Service connection may 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(d).

Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999).  Additionally, a showing of continuity of symptoms from separation to the present is a factor to be considered in assessing service connection claims.

In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury.  38 C.F.R. § 3.310.  Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated.  Allen v. Brown, 7 Vet. App. 439 (1995).  When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.  Id.

Entitlement to service connection for obstructive sleep apnea

The Veteran seeks service connection for obstructive sleep apnea contending his service connected acquired psychiatric disorder caused or worsened his condition. After reviewing the evidence of record, the Board finds service connection for obstructive sleep apnea is not warranted.

As an initial matter, the Board recognizes the following favorable findings regarding this claim: A diagnosis of obstructive sleep apnea was confirmed in the February 202
 injury caused by the service-connected condition, should also be compensated.  Allen v. Brown, 7 Vet. App. 439 (1995).  When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.  Id.

Entitlement to service connection for obstructive sleep apnea

The Veteran seeks service connection for obstructive sleep apnea contending his service connected acquired psychiatric disorder caused or worsened his condition. After reviewing the evidence of record, the Board finds service connection for obstructive sleep apnea is not warranted.

As an initial matter, the Board recognizes the following favorable findings regarding this claim: A diagnosis of obstructive sleep apnea was confirmed in the February 2021 VA examination and he is service connected for an acquired psychiatric disorder, including post traumatic disorder (PTSD) and major depressive disorder.   The Board will not disturb these favorable findings.  

The remaining question for the Board is whether his service connected acquired psychiatric disorder caused or worsened his obstructive sleep apnea.  After a review of the evidence, the Board finds service connection for obstructive sleep apnea is not warranted.

The Veteran's service treatment records (STRs) reflect that during an April 1974 routine screening for his assigned duties, the physician noted he has trouble sleeping, but assessed it was non pathologic, and found him qualified for duties requiring precise judgment and unwavering stability.  However, the STRS do not reflect any complaints or symptoms related to difficulties sleeping or specific to obstructive sleep apnea, including subsequent evaluations for his duties in July 1974, October 1974, November 1974, and his September 1975 separation examination, with post-service treatment records reflecting sleep difficulties and reports of a transition to breathing through his mouth due to ongoing allergic rhinitis in 2012, with ongoing complaints of mouth breathing and evidence of swollen nasal turbinates in 2019, and was diagnosed with obstructive sleep apnea in February 2020, many decades after service.  Indeed, the Veteran has not asserted this his current disability began in or continued since service.

The Veteran was afforded a February 2021 VA examination in which the Veteran reported he was referred for a sleep study by his cardiologist in 2020 due to lethargy, frequent waking, and snoring.  The examiner opined that the Veterans obstructive sleep apnea was less likely than not proximately due to or the result his acquired psychiatric disorder.  In providing this opinion, the examiner acknowledged that PTSD and sleep apnea are often comorbid diagnoses.  However, in the examiner's opinion, this does not mean that PTSD necessarily causes sleep apnea.  Rather, the presence of such a relationship is "not completely understood."  

The Board finds the examination adequate and affords it high probative value as the examiner considered the evidence of record, medical literature that supports an association but not a direct relationship between the two conditions, and considered the development of obstructive sleep apnea specific to the Veteran's medical history. 

In an authorized evidence submission window, the Veteran submitted a March 2025 private opinion and articles and a study concerning obstructive sleep apnea and PTSD.

The March 2025 private clinician opined that the Veteran's obstructive sleep apnea is at least as likely as not due to his posttraumatic stress disorder (PTSD), noting that obstructive sleep apnea is characterized by repeated episodes of upper airway occlusion, resulting in brief periods of breathing cessation (apnea) or a significant reduction in airflow (hypopnea) during sleep and specifically noted risk factors for sleep apnea including obesity, narrowed airway, chronic nasal congestion, use of central nervous system depressant medications, older age, male gender, and smoking.  However, the clinician did not explain how upper airway occlusion could be caused or aggravated by PTSD and instead cited literature that makes a statistical association between obstructive sleep apnea and PTSD and supports a correlation/ comorbidity between PTSD and several sleep disorders.  

Furthermore, the opinion lacks specifics to the Veteran's medical history, concludes because many other people have the two conditions a relationship is established, and notes that disturbed sleep may play a role in the pathophysiology of PTSD because treatment of obstructive sleep apnea treatment may improve PTSD symptoms.  Such statements are too speculative for service-connection purposes.  Finally, many of the symptoms addressed in this opinion, such as sleep fragmentation or depravation, insomnia and nightmares are symptoms already captured by the rating he received for his acquired psychiatric symptoms.   As such the Board finds the opinion inadequate and affords it limited probative value.  

The Board has considered March 2025 argument from the Veteran's attorney that the 2021 VA opinion is entirely without merit and is soundly contradicted by medical literature and the additional articles the Veteran
 people have the two conditions a relationship is established, and notes that disturbed sleep may play a role in the pathophysiology of PTSD because treatment of obstructive sleep apnea treatment may improve PTSD symptoms.  Such statements are too speculative for service-connection purposes.  Finally, many of the symptoms addressed in this opinion, such as sleep fragmentation or depravation, insomnia and nightmares are symptoms already captured by the rating he received for his acquired psychiatric symptoms.   As such the Board finds the opinion inadequate and affords it limited probative value.  

The Board has considered March 2025 argument from the Veteran's attorney that the 2021 VA opinion is entirely without merit and is soundly contradicted by medical literature and the additional articles the Veteran submitted.  Specifically, the Veteran's attorney cited statements from studies which address higher risk for Veteran's with PTSD screening for obstructive sleep apnea, increased PTSD symptoms are associated with an increased probability of screening for high risk for sleep apnea, and argues that VA has conceded that sleep apnea is common among people with PTSD. In actuality, both the VA examination and the private opinion cite similar evidence.  However, the Board agrees with the conclusion of the VA examiner that the evidence, which almost entirely discusses potential relationships between sleep apnea and psychiatric symptoms, is too theoretical and speculative for service connection purposes.  

The Board acknowledges the Veteran's own firmly held beliefs that his obstructive sleep apnea is due to his service-connected PTSD.  While lay evidence may be competent on a variety of matters concerning the nature and cause of disability, the etiology of a disorder such as the one currently on appeal is a medical determination and generally must be established by medical findings and opinion  See Jandreau v. Nicholson,?492 F.3d 1372, 1376-77?(Fed. Cir. 2007.  In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of his disability.  

The Board finds that the evidence weighs persuasively against service connection as a nexus is not established. 38 U.S.C. §§ 1110, 1131 38 C.F.R. § 3.310.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  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.

 

 

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Miller, Associate Counsel