Sleep Apnea VA Claim Grants

Findings of Fact (verbatim from decision)

1. The Veteran's sleep apnea not having been satisfactorily disassociated from active duty service, the evidence is in approximate balance for a finding that it is related to such service. 2. The Veteran's GERD not having been satisfactorily disassociated from active duty service, the evidence is in approximate balance for a finding that it is related to such service. 3. The evidence is in approximate balance as to whether the Veteran's Barrett's esophagus was caused by or related to his GERD.

Reasons & Bases (verbatim excerpts from decision)

As will be discussed in detail below, following August 2023 VA medical opinions and a November 2023 Supplemental Statement of the Case (SSOC), the issues of entitlement to service connection for sleep apnea, GERD, and Barrett's esophagus are now once again before the Board for adjudication. […] The Veteran claims entitlement to service connection for sleep apnea. Specifically, he contends that his sleep apnea was at the least caused by his toxic exposures while deployed to the Southwest Asia theater of operations, including Afghanistan. See November 2017 VA Form 9. […] In an August 2023 VA medical opinion, after confirming a current diagnosis, the examiner opined that the Veteran's sleep apnea was less likely than not caused by the indicated TERAs after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. As rationale, the examiner stated that the current medical literature did not discuss toxic exposures as causal relationships for obstructive sleep apnea which was caused by an ongoing functional collapse of the velopharyngeal and/or oropharyngeal (posterior airway) causing an airway obstruction. The examiner included cites to medical articles pertaining to sleep apnea in adults.

Findings of Fact (verbatim from decision)

1. The Department of Veterans Affairs (VA) Regional Office (RO) granted entitlement to service connection for irritable bowel syndrome, a gastrointestinal condition, in a December 2024 rating decision. There was no indication of clear and unmistakable error. 2. The RO also granted entitlement to service connection for OSA in a December 2024 rating decision. There was no indication of clear and unmistakable error. 3. The evidence is in approximate balance that the Veteran's vertigo was caused or aggravated by her service-connected conditions.

Reasons & Bases (verbatim from decision)

The Veteran served honorably on active duty in the United States Army from February 2006 through February 2010, with additional reserve service. She had over 1 year and 5 months of foreign service, including in Afghanistan, and was awarded the Afghanistan Campaign Medal (w/ Campaign Star), Joint Service Commendation Medal, Joint Service Achievement Medal, among others.

Findings of Fact (verbatim from decision)

1. The probative evidence of record is at least in approximate balance as to whether the Veteran's right shoulder disorder onset in-service. 2. The probative evidence of record is at least in approximate balance as to whether the Veteran's OSA is secondary to his service-connected disabilities. 3. The probative evidence of record is at least in approximate balance as to whether the Veteran's kidney disorder is secondary to his service-connected disabilities.

Reasons & Bases (verbatim excerpts from decision)

The Veteran received a VA sleep apnea examination in October 2025, wherein a diagnosis of OSA was confirmed (dated 2012). The Veteran reported that his condition onset in 1969 when he noticed that he was snoring, waking up gasping for air, and a partner informed him that she can see him stop breathing while sleeping. He indicated that his condition has worsened or progressed and his current symptoms were daytime drowsiness, fatigue, snoring, difficulty sleeping, and waking frequently. It was noted that he uses a continuous positive airway pressure (CPAP) machine for treatment. As to functional impact, the Veteran said that he has difficulty concentrating and efficiently completing tasks due to fatigue. In a December 2025 VA opinion, the same examiner determined that the Veteran's claimed OSA is at least as likely as not related to his service-connected PTSD. It was explained that medical literature demonstrates a significant association between PTSD and OSA, noting that sleep disturbances, hyperarousal, sleep fragmentation, nightmares, and altered sleep patterns associated with PTSD can contribute to the development and severity of OSA. The examiner stated that the Veteran's PTSD preceded the onset of OSA and that the current severity of PTSD supports a causal relationship, concluding that the OSA was the direct result of service-connected PTSD and a nexus is established.

Findings of Fact (verbatim from decision)

1. Resolving reasonable doubt in the Veteran's favor, OSA is at least as likely as not related to a service-connected condition, including obesity as an intermediate step. 2. Resolving reasonable doubt in the Veteran's favor, lumbar spine disability is at least as likely as not related to service-connected right ankle condition. 3. Throughout the period on appeal the Veteran had marked right ankle limitation of motion, as he had examinations showing five degrees of dorsiflexion with reduced plantar flexion as well as pain. The Veteran did not have right ankle ankylosis, or its equivalence.

Reasons & Bases (verbatim excerpts from decision)

The Veteran contends that his OSA incurred in service. In the alternative he contends that his sleep apnea is due to weight gain from his service-connected conditions. See Hearing Related dated February 2020. The Veteran's representative stated that the Veteran's sleep condition may also be secondary to psychiatric condition, noting that his weight gain is also related to his depression. See Third Party Correspondence received August 2020. […] He also has a current medical diagnosis of sleep apnea or OSA. See C&P Exam dated February 2024. Therefore, the Board finds that the Veteran meets the first and second elements of the secondary service connection test discussed above. […] However, the examiner then also found that obesity was a risk factor for OSA but not a direct cause. The examiner concluded that the Veteran's OSA was not secondary to the Veteran's service-connected conditions as the Veteran's OSA was more likely due to anatomical structures of the Veteran's pharyngeal airway. The examiner also opined that the Veteran's OSA was not aggravated by his body habitus, but rather by his noncompliance with CPAP therapy. […] While, on its face the medical opinion obtained by the VA in February 2024 did not opine that there was a link or causation between the Veteran's sleep apnea and his service-connected conditions, the opinion's rationale was contradictory.

Findings of Fact (verbatim from decision)

Applying benefit of the doubt, the Veteran's obstructive sleep apnea is secondary to his service-connected diabetes mellitus, type II.