Can Your Sleep Apnea be Secondary to Your TBI?

Can Your Sleep Apnea be Secondary to Your TBI?

Millions of Veterans receive disability benefits for traumatic brain injuries (TBIs) and sleep apnea. However, some Veterans develop sleep apnea symptoms directly caused or aggravated by their TBIs. If this is the case for you, you might wonder whether your sleep apnea is secondary to your TBI or vice versa.

Let’s break down how the VA rates sleep apnea benefits, how they relate to TBI benefits, and how both benefits ratings can combine for your total benefits award.

What Is Sleep Apnea?

Sleep apnea is a medical condition characterized by difficulty breathing while asleep. A Veteran with sleep apnea regularly awakens while sleeping because their airway is obstructed by their tongue or soft palate tissue or their brain fails to send the correct signals to their lungs and nervous system to continue breathing while they are asleep.

Sleep apnea comes in three types:

  • Obstructive sleep apnea, which occurs when tissue physically obstructs the airway
  • Central sleep apnea, which occurs when the brain doesn’t send the right signals to the nervous system, arresting the breathing process
  • Mixed sleep apnea, which is characterized by symptoms from both of the above types

Left unchecked, sleep apnea can lead to several negative and long-term symptoms, including but not limited to:

  • Chronic fatigue or excessive daytime sleepiness (hypersomnolence)
  • Irritation or moodiness
  • Difficulty concentrating
  • And more

Veterans can develop sleep apnea for any number of reasons. For example, they may develop sleep apnea as a result of PTSD, or they may develop sleep apnea after experiencing a TBI.

Sleep Apnea VA Ratings

The VA provides disability benefits to Veterans who receive a service connection for their sleep apnea symptoms. These ratings are awarded per 38 CFR 4.97-13 Diagnostic Code 6847 under the following percentages:

  • 0% rating for Veterans whose sleep apnea is documented but asymptomatic
  • 30% rating for Veterans whose sleep apnea results in chronic or persistent daytime hypersomnolence
  • 50% rating for Veterans who require the use of a CPAP machine or alternative breathing assistance device
  • 100% rating for Veterans whose sleep apnea requires a tracheostomy or that results in chronic respiratory failure, including carbon dioxide retention

What Is a TBI?

A TBI is a traumatic brain injury. It includes any damage to the brain that results in noticeable symptoms, which can affect a Veteran’s day-to-day life, personality, and more. 

TBIs can lead to a wide range of different physical and mental health symptoms, including but not limited to:

  • Moodiness or irritation, or mood swings
  • Loss of memory
  • Difficulty concentrating
  • Nausea or dizziness
  • Personality changes
  • Headaches or migraines
  • Difficulty sleeping
  • And more

Can Sleep Apnea be Caused by a TBI?

Although sleep apnea sounds very distinct from TBIs, the two conditions are sometimes more related than you may think. Specifically, central sleep apnea — the type of sleep apnea that occurs when the brain doesn’t send the right signals to the nervous system — could be directly caused by a traumatic brain injury, like a concussion or other head injury.

For example, suppose a Veteran who suffers a TBI during their military service. They return home and discover that they now have sleep apnea. Upon examination of their medical records, they discover that they did not showcase any symptoms of central sleep apnea until after they suffered from the original TBI.

That’s because the TBI could have caused some neurological change in the Veteran’s brain, which led to the development of central sleep apnea. So, while sleep apnea is sometimes caused by traumatic brain injuries, this is not always the case.

For example, obstructive sleep apnea is not typically caused or related to a traumatic brain injury. Veterans who wish to prove a connection between their sleep apnea and a service-related TBI must first receive an accurate sleep apnea diagnosis from a licensed and practicing medical professional.

Other Conditions Caused by TBIs

Sleep apnea isn’t the only possible side effect of a traumatic brain injury. Other secondary conditions could develop due to brain damage, such as:

  • Insomnia, which is characterized by difficulty or inability to fall asleep regardless of personal fatigue. Insomnia doesn’t have a specific diagnostic code for the VA rating schedule, but it is rated under the Schedule of Ratings for Mental Disorders and ranges from 10% to 100% based on its severity.
  • Narcolepsy, which is characterized by not being able to control your sleep or wake cycles. For example, you may suddenly fall asleep or experience excessive daytime drowsiness. The VA rates narcolepsy under the Diagnostic Code 8911 for Neurological Conditions and Convulsive Disorders. Ratings range from 10% to 100%, depending on the severity of your symptoms.

It’s possible that you learn that you have developed or aggravated multiple secondary conditions due to one injury or incident after sustaining one TBI. This does not mean your benefits are capped.

Rather, you must get an official opinion from a licensed medical practitioner to see your benefits increase. A medical practitioner can provide the necessary proof of a medical nexus between your service-connected injury and your current mental health or physical problems. 

Secondary Sleep Apnea to TBI

It is possible for you to receive a secondary service connection for your sleep apnea symptoms if you can prove that they are related to or caused by a service-related traumatic brain injury. If successful, you could receive a new disability rating for your secondary sleep apnea, which will be added to your primary disability rating for a new, combined disability rating.

However, secondary disability ratings are not added to your current disability rating in the way you may think. Say that you have a current disability rating of 50% for a traumatic brain injury suffered during your active duty military service. You then apply for a secondary service connection for your sleep apnea symptoms.

You receive a secondary disability benefits rating for your sleep apnea of 30%. The 30% isn’t added to the 50% you already have. Instead, it’s 30% of the current 50%, which is 15%. You add 15% and 50% to get a new combined disability rating of 65%.

Proving a Connection to Your TBI

Of course, proving that your sleep apnea is related to your traumatic brain injury means:

  • Showing an accurate, up-to-date diagnosis of your sleep apnea symptoms and their severity. The diagnosis must be from a licensed medical professional
  • Showing proof that your symptoms began after your service-related TBI occurred
  • Showing further evidence of your sleep apnea symptoms and how they may be affected by your service-related TBI

This requires you to gather doctor’s notes, personal journal entries, and other evidence to support your claim. Knowledgeable Veterans law attorneys can help you put together an airtight application for further disability benefits from the VA.

How Legal Professionals Can Help

Indeed, legal professionals can be invaluable when trying to prove a connection between your sleep apnea and a service-related TBI or other injury. They can:

  • Speak to medical professionals or insurance companies on your behalf
  • Put together the paperwork and evidence necessary for your disability benefits application
  • Walk you through the appeals process if your first application is denied for one reason or another
  • Explain what you’re likely to receive based on your current symptoms and disability rating for a TBI
  • And more

Perhaps most importantly, the right legal team can provide sound legal counsel throughout your benefits application process. You’ve already served your country honorably. Let us serve you and get you the benefits you deserve ASAP.

Contact Berry Law Today

If you have sleep apnea symptoms and a traumatic brain injury, those symptoms could indeed be caused or aggravated by the TBI. If this is the case, you might qualify for a secondary service connection for your sleep apnea and receive a higher combined disability rating as a result.

To make sure this happens quickly, contact Berry Law today. As experienced Veterans law attorneys, we’re well-equipped and ready to assist with your next application for further benefits. We can also help you with the appeals process if your initial claim is overturned, plus make sure that you have the right evidence to secure a favorable ruling. 

Contact us today for a free case evaluation and consultation. 


What Is Sleep Apnea? | NHLBI, NIH

38 CFR § 4.97 – Schedule of ratings – respiratory system. | CFR | US Law | LII / Legal Information Institute

Traumatic Brain Injury / Concussion |

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

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