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My VSO let me know that my OSA appeal was denied. My original claim was a direct service connection. I read the sleep apnea field manual from Chris Attig and appealed the decision. On appeal I stated the OSA should be secondary to PTSD and sinusitis. I obtained an IMO from Dr Anaise and a DBQ with the at least as likely as not and medically necessary (CPAP) statements from my psychiatrist. My question is on appeal can you submit evidence to make it a secondary condition or does it need to be filed as secondary from the beginning? I haven't received the RAMP appeal denial letter yet. Also is there a section in the 38 CFR regarding secondary conditions with an original direct service connection claim?