Sleep Apnea

Many conditions are believed to be able to cause or result in sleep apnea. Any nasopharyngeal (nose and throat) abnormalities that reduce the openings of the airways “can” lead to an apnea condition. Rhinitis is a common condition that can lead to sleep apnea.

Mental health disorders such as PTSD and depression have clear correlations with increased rates of sleep apnea. While the treatment of the disorder can cause weight gain, depression can also be the result of sleep apnea, as well, due to the lack of sleep and its impact on the mood.

One will always need to find and use the lasted research to help prove the relationship between their service-connected disability and sleep apnea.

I do claims with veterans who have PTSD, by using good research and a nexus might work in other areas too.  You may have to fight these types of claims to the United States Court of Appeals for Veterans Claims. Also, as the regulation is written now, you do not have to be using a CPAP to be rated at 50%. You only need to be using it as per the sleep studies.

You can file a claim sleep apnea on the bases of it being a secondary issue to all your mental health disorders to include the treatment by the medication for the disorder(s). You address what you are taking for your service-connected PTSD, depression and other mental health disorders and so should your doctor in the nexus letter. A claim for veterans’ disability compensation on sleep apnea, secondary to medication taken for the treatment of PTSD and or other mental health disorders, should have all elements completed before you file.

Just like all claims that file for secondary to some other illness, you need to have a nexus letter from a doctor with a good rationale before you even file this claim. That is why you need to use the “Intent to File” form as we addressed in the Guide. You need to have some good research that will be supporting the link between your sleep apnea and the illness that you are saying is causing it or making it worse.

You will need to address everything as you first file the claim to keep that effective date. If you have other rated issues, like fibromyalgia, that can also add to the cause of sleep apnea, you need to have those illnesses included in the claim and the nexus letter.

Gulf War veterans need to understand that sleep apnea is not a presumptive illness to their service under 38 CFR 3.317 and that is a court case upholding this fact.

Read the section in Veteran Information Network’s guide on secondary service connection with the example, “If you have an issue of chronic pain in your legs and not able to walk long and you are on pain and other meds for it”, you add that into the claim too. You would not just add the meds for the PTSD but everything you are rated for when you file.”

There are opportunities to make mistakes in preparing the claim at every step of the process. Take time to get everything done right before you file your claim. Sleep apnea is NOT a presumptive condition, meaning that you as the veteran filing the claim, must meet the normal burden of proof before the VA will consider your claim has merit. You must show that you have sleep apnea, and that it is at least as likely as not that it is service connected on a direct and or secondary bases. This is why you must send in research studies showing the much higher rates of sleep apnea in veterans with PTSD.

If you are claiming sleep apnea as a secondary to your PTSD, you should already be service connected for PTSD. If not, you must organize and word your claim carefully, so it is clear to the rating officer that he/she must first determine your claim for PTSD, and only then consider your sleep apnea. The same thing if you are using depression and fibromyalgia for the sleep apnea. ALWAYS include the treatment and the side effects such as the weight gain.

Many veterans with sleep apnea and PTSD have also gained weight since leaving military service. If this is not addressed in your claim, it will create an opening for the VA to deny your claim. If you have gained weight, then use the information in the next section to bolster your claim, as well as your visits with your personal doctor and your examining doctor.

Many of the sleep apnea claims seeking to be service-connected secondary to mental health, including PTSD, may be denied at the VARO. The first person who rates your claim may not be well educated about this, or they may be allowing pre-conceived notions to interfere with considering the evidence and the law.

One piece of evidence that will help in your claim is having your doctor write a very good nexus letter saying things that are in the study and state: based on the science, “that it is more likely than not (greater than 50%) that VETERAN’S sleep apnea is caused by the weight you gained from his treatment for PTSD and fibromyalgia and that the pain in the fibromyalgia kept him from working out to keep the weight off. “

Remember, since this is a claim for a secondary condition, you are trying to prove the connection between sleep apnea and your service-connected PTSD, not the direct link sleep apnea and your military service. This letter may come from the VA examiner assigned to you after you file a claim. However, such doctors are often hesitant to write such a letter. It is in your best interest to provide this letter from your own doctor when you file the claim. That letter can even provide ‘cover’ for the VA doctor who examines you later, thus helping your claim twice.

The doctor’s examination is critical to your claim. If the doctor who examines you believes ” more likely than not (greater than 50%) ” that your sleep apnea is related to your PTSD (and they

There is a mounting body of evidence that suggests a causative relationship between Traumatic Brain Injury (TBI) and many sleep disorders, including sleep apnea. To prove secondary service-connection, the Veteran will need to service-connect the first condition such as TBI. Have the research showing how it can cause sleep apnea. Then a medical expert report or opinion may be crucial to providing the key linkage in this type of claim. Remember that the TBI is rated under the PTSD so the medication causing the weight gain should not be overlooked when filing. You can file on more than one theory of service connection.

If the claim is denied, do not give up. Work with your VSO or get a claims agent/ lawyer and fight your disagreement and get a higher-level review. If you need to, fight on to the Board of Veterans Appeals too. Do not give up! The VA’s job is to help you, even when an individual or two within the system are not doing that.

Use a VA accredited claims agent, VSO or lawyer when doing your claim. Look up the person BEFROE letting them help you This site list everyone that can help you as per the laws to protect you. By law they are the only one to help you. NEVER PAY anyone upfront; they cannot charge you like that.

OGC – Accreditation Search (va.gov)

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