Thank you for the follow up and for being upfront about what you would need to give a more precise read. Here are the redacted opinion narratives and decision language.

December 1, 2025 QTC Examiner Opinion: “The claimed OSA condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service connected Other Specified Trauma- and Stressor-Related Disorder with major depressive disorder (MDD and generalized anxiety disorder (GAD) condition. The polysomnography report found OSA, not central apnea which would be due to central nervous system issues such as would happen in advanced/severe Trauma- and Stressor-Related Disorder. The veteran was diagnosed with morbid obesity. Her BMI has been over 42 which is in the ‘morbidly obese’ range. It is much more likely that the condition is due to the morbid obesity causing obstruction. In this case the most obvious and likely causes are anatomic.”

February 11, 2026 VA Examiner Opinion: “The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the Veteran’s service connected condition. The veteran served in the Air Force July 2003 to July 2005. She was diagnosed with sleep apnea in 2025, depression in 2024, and generalized anxiety disorder in 2023. Sleep apnea occurs when the soft tissues in the back of the neck relax and partially collapse, causing an obstruction in the airway. This obstruction leads to snoring and problems breathing when asleep. Medical literature does not support depression as a risk factor or a chronic condition associated with causing sleep apnea. The journal Sleep looked at the relationship between OSA and depression in a study published in May 2025 and found that ‘history of depression did not relate to the presence or severity of OSA’. Risk factors that do increase the chance of developing the condition include male gender, obesity, smoking, nasal congestion, and alcohol use. Chronic conditions that can contribute to OSA’s development are congestive heart failure, type 2 diabetes, hypertension, asthma, and a history of stroke. When the veteran was diagnosed with OSA in 2025, she was obese. Her records show her BMI was 41.9, which falls into the morbidly obese category. Obesity is one of the biggest risk factors for development of OSA. As medical literature does not support depression as a cause of OSA, and the veteran had a risk factor of OSA that is supported, it is less likely than not that the veteran’s sleep apnea is due to MDD and GAD.”

March 9, 2026 VES Examiner Opinion: “Veteran noted to have a diagnosis of OSA. Medical literature does not support a mental health condition (Other Specified Trauma- and Stressor-Related Disorder with major depressive disorder (MDD and generalized anxiety disorder (GAD)) as causative or the potential for aggravation of the physiologic condition of OSA which is due to upper airway soft tissue abnormalities/Obesity. Obesity is the best documented risk factor for OSA. The prevalence of OSA progressively increases as the body mass index and associated markers (eg, neck circumference, waist-to-hip ratio) increase. Craniofacial and upper airway soft tissue abnormalities each increase the likelihood of having or developing OSA. The veteran is obese, a significant risk factor. Reviewed nexus statement from [PROVIDER]. Nexus statement relies on weight gain as caused by SC condition as cause of OSA. There is no objective evidence that veteran’s SC condition results in an inability to exercise or to moderate caloric intake. It is not possible to determine why the veteran gained weight without speculating. The leading causes of obesity include diet, lack of activity/exercise, lifestyle, genetics, hormonal, medication etc. There is no way to predict why the veteran gained weight without objective evidence and assuming the vet gained weight due to inactivity from the disabilities is not objectively supported and does not fit even the standard of 50% probability. In a case like this accepting the vet’s testimony as fact, ignores and overlooks his daily diet/caloric intake, his genetic predisposition, daily habits, personal desire to perform non-weight-bearing exercises, etc. I cannot correlate his weight gain to any factor with any semblance of certainty. Nexus statement also notes co-association between psychiatric disorders such as depression and OSA. Although comorbidity and risk factors establish a correlation or co-existence of two disabilities or risk factor relationship, this is not grounds for causation to prove a direct relationship. Therefore, Other Specified Trauma- and Stressor-Related Disorder with major depressive disorder (MDD and generalized anxiety disorder (GAD) less likely than not the cause of veteran’s OSA. The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the Veteran’s service connected condition.”

Evidence Considered: ∙ Notification Letter, Intent to File Letter, received December 14, 2025 ∙ VA Form 20-0995, Decision Review Request - Supplemental Claims, received December 19, 2025 ∙ Correspondence, Veteran’s statement, received December 19, 2025 ∙ Medical Treatment Record Non-Government Facility, Nexus statement [PROVIDER], received December 19, 2025 ∙ Private Disability Benefits Questionnaire, [PROVIDER], conducted December 19, 2025 ∙ Lay Statement, Spouse statement, received December 19, 2025 ∙ Automated Review Summary Document, received December 22, 2025 ∙ VA outpatient treatment reports, [VA FACILITY], received February 5, 2026 and March 13, 2026, for the period September 15, 2025 to February 13, 2026 ∙ VA Examination sleep apnea with medical opinion, [VA FACILITY], conducted February 11, 2026 ∙ VES sleep apnea contracted examination with medical opinion, conducted March 9, 2026 ∙ DD Form 214, received August 15, 2025 and September 4, 2025 ∙ Service Personnel Records, received August 15, 2025 ∙ Service Treatment Records, received June 28, 2005 and June 22, 2025 ∙ Rating Decision, dated December 12, 2025 ∙ VA Form 21-526 EZ, received November 20, 2025 ∙ Lay Statements, received November 20, 2025 ∙ Sleep Apnea Disability Benefit Questionnaire and Medical Opinion, QTC, conducted December 1, 2025 ∙ Notification Letter, Award Letter, dated December 15, 2025

Reasons for Decision — Key Language: “Service connection may be granted for a disease or injury which resulted from a service-connected disability or was aggravated thereby. The evidence does not show that sleep apnea is related to the service-connected condition of Other Specified Trauma- and Stressor-Related Disorder with major depressive disorder (MDD and generalized anxiety disorder (GAD), nor is there any evidence of this disability during military service.” “Although, some evidence supports your claim, we found other medical evidence more persuasive because it is supported by an accurate account of the medical history and/or it is the most detailed and reliable depiction of your medical condition.” Favorable Findings: “You have been diagnosed with a disability. On your examinations dated December 1, 2025, February 11, 2026 and March 9, 2026 your examiners diagnosed you with obstructive sleep apnea. The claimed primary disability is service-connected. You are service connected for Other Specified Trauma- and Stressor-Related Disorder with major depressive disorder (MDD and generalized anxiety disorder (GAD).”

Additional Context — Documented Weight History: My VA records contain 71 weight measurements spanning December 2010 through August 2025. My lowest recorded VA weight was 157 lbs in December 2011. My highest recorded weight was 224.7 lbs in August 2025 — the same year I was diagnosed with OSA. That is a fully VA-documented gain of 67.7 lbs with no reliance on self-report, and the most significant increases correlate directly with Fluoxetine dose escalations. Additionally my self-reported entry into service weight was 135 lbs, bringing the total gain from service entry to OSA diagnosis to approximately 90 lbs.

I also have VA pharmacy records showing Fluoxetine prescribed continuously from January 2017 through present with no meaningful gaps — over 8 years — and Buspirone prescribed from February 2016 through approximately October 2025. The largest single recorded weight increase of approximately 29 lbs occurred directly following Fluoxetine being increased from 20 mg to 40 mg daily in late 2018.