Obstructive sleep apnea, secondary to PTSD
Secondary service connection under 38 CFR § 3.310; PTSD already rated 70%
1. The Veteran is service-connected for posttraumatic stress disorder (PTSD), rated 70 percent disabling. 2. The Veteran has a current diagnosis of obstructive sleep apnea, confirmed by polysomnography, and uses a continuous positive airway pressure (CPAP) device nightly. 3. Resolving reasonable doubt in favor of the Veteran, the Veteran's obstructive sleep apnea is proximately due to or the result of his service-connected PTSD.
The Board has considered the September 2017 private medical opinion from Dr. [redacted], which provides that it is at least as likely as not that the Veteran's obstructive sleep apnea was caused or aggravated by his service-connected PTSD. The physician cites the well-established medical literature linking PTSD hyperarousal, antidepressant medication regimens, and weight gain secondary to reduced physical activity to increased OSA prevalence among combat-exposed Veterans. The Board finds this opinion probative because it was rendered by a physician who reviewed the claims file, the Veteran's VA medical records, and the Veteran's lay statements regarding his symptom progression. Giving the Veteran the benefit of the doubt as required by 38 CFR § 3.102, service connection is warranted.
Citation Nr 18132894 (2018) — granted service connection for OSA secondary to PTSD on a private nexus opinion citing hyperarousal, medication, and weight-gain pathways. Same fact pattern supports [Veteran's] claim under 38 CFR § 3.310.
The nexus opinion does not need to be from a sleep specialist. A PCP or psychiatrist can make this call if they reference the three well-documented pathways (hyperarousal, medication, weight gain) and use the "at least as likely as not" phrasing required by 38 CFR § 3.102.