Citation Nr: 18132206
Decision Date: 09/06/18	Archive Date: 09/06/18

DOCKET NO. 07-28 775
DATE:	September 6, 2018
ORDER
Entitlement to service connection for obstructive sleep apnea, to include on a secondary basis is granted.
FINDING OF FACT
Resolving all doubt in his favor, the Veteran’s obstructive sleep apnea is secondary to his service-connected sinusitis with allergic rhinitis.
CONCLUSION OF LAW
The criteria for service connection for obstructive sleep apnea are met.  38 U.S.C. 1110, 1131, 5107; 38 C.F.R. 3.102, 3.303, 3.310.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from September 1981 to January 1993.  
In May 2015, the Board denied service connection for obstructive sleep apnea.  The Veteran timely appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court), which granted a January 2016 Joint Motion for Remand, vacating the Board’s denial of service connection for obstructive sleep apnea, and remanding the issue for further development.  In July and August 2017, the Board remanded the issue for further development.  In May 2018, the Board sought an advisory medical opinion from the Veterans Health Administration (VHA), which was obtained in July 2018.
The Veteran contends that his obstructive sleep apnea is secondary to his service-connected posttraumatic stress disorder (PTSD) with major depression and anxiety, Meniere’s disease with hearing loss and tinnitus, residuals of pulmonary sarcoidosis with asthma, and sinusitis with allergic rhinitis.
After reviewing the record, the Board concludes that the Veteran has current diagnoses of obstructive sleep apnea secondary to service-connected sinusitis with allergic rhinitis.  38 U.S.C. 1110, 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.310.  Post-service treatment records, including an October 2006 VA sleep study, note a diagnosis of obstructive sleep apnea.  A December 1993 rating decision awarded service connection for a sinus condition with headaches and allergic rhinitis (now characterized as sinusitis with allergic rhinitis). 
In May 2018, the Board requested a VHA advisory medical opinion from a sleep specialist with respect to whether the Veteran’s current obstructive sleep apnea was caused or aggravated by a service-connected disability, to include medication taken for the treatment of that disability.  In July 2018, a VA physician and Fellow of the American College of Chest Physicians, with specialties in Pulmonary, Critical care, and Sleep, reviewed the claims file, considered the differing VA and private medical opinions record, and opined that the Veteran’s current sleep apnea was related to his allergic rhinitis.  The rationale was that “[n]asal swelling and congestion confers an approximately twofold increase in the prevalence of [obstructive sleep apnea] . . . regardless of cause. . . probably related to the increased resistance due to decreased nasal patency or obstruction . . . .” He stated that rhinitis alone is associated with mild sleep apnea.  
In light of the favorable July 2018 VHA advisory medical opinion, which essentially clarifies any conflicting medical opinions in the record, the Board finds the most probative and persuasive medical evidence supports the Veteran’s claim that his obstructive sleep apnea is related to his service-connected sinusitis with allergic rhinitis.  Therefore, service connection for obstructive sleep apnea is granted.
 
A. ISHIZAWAR
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K.R.Fletcher, Counsel 

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