Sleep apnea is a common occurrence among Veterans. In fact, Veterans are four times more likely than other Americans to develop sleep apnea. Both PTSD (post-traumatic stress disorder) and traumatic brain injuries (TBIs) have been found to increase the chances of a Veteran developing some type of sleep disorder.
Sleep’s great impact on health is well-documented. A sleep disorder can often lead to other health problems, such as a heart attack or stroke, as well as decreased cognitive abilities.
Veterans who regularly have trouble sleeping that is related to their time in the military should file a claim for the VA benefits that they have earned with their service.
At the Berry Law Firm, our experienced VA benefits attorneys represent Veterans throughout the United States. We are committed to providing quality and effective legal representation to the men and women who have served our country and put themselves in harm’s way in the line of duty. At the very least, our Veterans are entitled to the benefits and compensation they have been promised.
We’ll Help Add Sleep Apnea to Your VA Disability Rating
Berry Law Firm specializes in Veterans’ disability appeals and can assist you at any VA Regional Office in the United States, and in higher levels of appeal if necessary. Most of our attorneys are military service Veterans, who understand the sacrifices disabled Veterans have made. We can help you have your sleep apnea diagnosis included in your VA disability rating and increase the benefits you receive.
Sleep apnea is considered a VA disability under the Federal Schedule for Rating Disabilities, Code 6847. Ratings range from 100% disability for chronic respiratory failure with carbon dioxide retention to 0% for “documented sleep disorder breathing” without symptoms.
Our Veterans’ benefits lawyers can ensure that your VA disability rating appeal includes the relevant medical evidence required for a successful review and rating change. If necessary, Berry Law can refer you to medical professionals who are familiar with VA disability requirements to ensure that your medical file properly reflects your diagnosis of sleep apnea and its effect on your life.
What is Sleep Apnea?
Sleep apnea is a disorder in which the individual’s breathing repeatedly stops and starts during sleep. It can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. In other cases, a medical condition causes the brain to fail to signal the sleeping body to breathe.
People with sleep apnea sometimes stop breathing hundreds of times during the night and often for a minute or longer. In most cases, the sleeper never realizes that they have stopped breathing because they don’t fully awaken.
But if you wake during the night choking or gasping for air or you regularly snore loudly, you may have sleep apnea. Even without waking, sleep apnea may cause you to feel tired after a full night’s sleep because your brain has had to kick-start your breathing repeatedly during the night. You may awake with a dry mouth or headache because of sleep apnea. Lack of sleep can cause irritability and difficulty paying attention or concentrating.
Eventually, individuals with sleep apnea can experience physical and psychological trauma from repeated nighttime bouts of oxygen deprivation and the stress of repeatedly being jolted into consciousness and/or gasping for air to recover from lack of breathing. Sleep apnea can lead to a variety of physical and mental health problems.
Your doctor may diagnose sleep apnea based on anecdotal evidence of your sleep/sudden waking/choking experience, your medical history, a physical exam, and a sleep study. A definitive diagnosis of sleep apnea requires a sleep study conducted during a visit to a sleep lab, usually overnight, or a home study performed with special equipment.
Sleep apnea may be diagnosed as:
- Obstructive sleep apnea,which occurs when throat muscles relax to block the upper airway. This is the most common form of sleep apnea.
- Central sleep apnea,which occurs because the brain doesn’t send proper signals to the muscles that control breathing.
- Complex sleep apnea syndrome,also called “mixed sleep apnea syndrome” or “treatment-emergent central sleep apnea,” which is a combination of obstructive sleep apnea and central sleep apnea.
Symptoms of Sleep Apnea Magnified by PTSD, TBI
The Sleep Foundation says obstructive sleep apnea (OSA) affects between 17 and 22 percent of the general population. Among individuals with PTSD, that number ranges from 12 to 90 percent. People who have both OSA and PTSD are more likely to have more severe PTSD symptoms.
Sleep disturbances such as sleep apnea are also common following traumatic brain injury (TBI), affecting 30 to 70 percent of TBI patients, according to the National Institutes of Health (NIH).
As many as 12 to 20 percent of Veterans suffer from PTSD, depending on the era of service, according to the VA. Nearly 414,000 TBIs were reported among U.S. service members worldwide between 2000 and late 2019.
Sleep apnea, PTSD, and TBI can form a vicious circle of symptoms in many Veterans. While insomnia or an inability to sleep well because of nightmares, night terrors, restless leg syndrome (RLS), sleep paralysis, or REM behavior disorder are symptoms of PTSD, sleep apnea disturbances in Veterans are often related to neurological or physical injury – such as TBI – suffered during military service, the Sleep Apnea Association of America says.
Meanwhile, the chronic anxiety and/or stress associated with PTSD, TBI, and loss of sleep can lead to lower levels of serotonin, a hormone in the brain that regulates your ability to manage fear and anxiety. Lower levels of serotonin in the system are also known to disrupt sleep.
The NIH says sleep apnea may increase your risk of multiple disorders, such as:
- Atrial fibrillation
- Cancers, such as pancreatic, renal, and skin cancers
- Chronic kidney disease
- Cognitive and behavioral disorders, such as decreases in attention, vigilance, concentration, motor skills, and verbal and visuospatial memory, as well as dementia in older adults.
- Diseases of the heart and blood vessels, such as atherosclerosis, heart attacks, heart failure, difficult-to-control high blood pressure, and stroke
- Eye disorders, such as glaucoma, dry eye, or keratoconus
- Metabolic disorders, including glucose intolerance and type 2 diabetes
- Pregnancy complications, including gestational diabetes and gestational high blood pressure, as well as having a baby with low birth weight
VA Disability Rating for Sleep Apnea
The VA’s rating schedule determines compensation for each level of disability severity. The higher the VA disability rating, the higher the monetary compensation. Factors such as being married or having dependents increase the amount of compensation available.
Within §4.97 Schedule of Ratings—respiratory system of the VA’s Schedule for Rating Disabilities, you can find Diagnostic Code 6847 for Sleep Apnea Syndromes (Obstructive, Central, Mixed). It provides four levels of ratings:
- A 100% disability rating requires “chronic respiratory failure with carbon dioxide retention or cor pulmonale (right-sided heart failure) or requires tracheostomy” (an opening in the neck for a tube into the windpipe)
- A 50% disability rating requires a condition that requires the use of a breathing assistance device, such as continuous positive airway pressure (CPAP) machine
- A 30% disability rating requires “persistent daytime hypersomnolence (sleepiness)”
- A 0% disability rating is granted a Veteran who is “asymptomatic but with documented sleep disorder breathing”
Note that while there is no compensation for a 0% disability rating, it is beneficial to submit evidence of documented sleep disorder breathing so it is in your VA record. You may then be entitled to other benefits, such as VA health care. If your condition worsens, which unfortunately is likely for respiratory issues, our attorneys can help appeal to increase your VA rating and qualify for benefits.
Veterans who cannot work or who require accommodations to perform the essential functions of their jobs because of service-connected disabilities may be eligible for Total Disability Individual Unemployability (TDIU) benefits. TDIU benefits pay disabled Veterans the same monthly compensation as a 100% VA disability rating, even if their physical and/or mental impairments do not provide them with a 100% VA disability rating.
Establishing Your Service Connection to Sleep Apnea
To qualify for VA benefits for sleep apnea, you must be able to demonstrate that:
- You have a diagnosis of sleep apnea based on a sleep study conducted by a qualified medical professional, and
- Your sleep apnea is a result of your military service or was made worse by your military service, or
- Your sleep apnea was caused by or aggravated beyond its natural progression by a primary service-connected injury. This is known as a secondary service connection.
In most cases, Berry Law Firm attorneys have found that Veterans who receive a VA rating for sleep apnea obtain it as a secondary service connection. Above we discussed the findings that post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) cause symptoms that can lead to sleep apnea.
If you are already receiving VA benefits for PTSD or TBI, we can help make sure your sleep apnea diagnosis is a part of your overall VA disability rating.
Potential Causes of Sleep Apnea as a Secondary Service-Connected Disability
As we noted above, central sleep apnea occurs because the brain doesn’t send proper signals to the muscles that control breathing. This can be caused by several neuromuscular conditions, such as stroke and by amyotrophic lateral sclerosis (ALS), which qualifies Veterans for a presumptive 100% disability rating.
There are numerous medical conditions that can cause sleep apnea and which may already be in your VA file as a service-connected disability. They include:
- Other respiratory conditions, ranging from asthma to deviated septum and allergic rhinitis
- Congestive heart failure
- Kidney failure
- High blood pressure
- Type 2 diabetes
- Parkinson’s disease
- Polycystic ovary syndrome
- Hormonal disorders
- Weight gain due to disabling musculoskeletal or mental health condition (such as depression)
- Use of opioid medications, especially long-acting ones such as methadone, which may have been prescribed for a service-connected disability.
For the VA to accept sleep apnea as a secondary service-connected disability, you’ll need to submit records of your diagnosis accompanied by a qualified doctor’s statement as to how and why your sleep apnea is “more likely than not” a secondary disability that occurred because of your primary service-connected disability.
For example, you may be able to show that you did not have sleep apnea prior to the onset of PTSD or that the PTSD aggravated your sleep apnea beyond what would have been expected to be its natural progression. For instance, you may be able to show that you had a documented sleep disorder prior to the onset of PTSD, but now you must sleep with a CPAP machine.
Further, if you have a medical condition caused by sleep apnea – such as asthma, atherosclerosis, atrial fibrillation, or certain cancers, as listed above – that condition could be considered secondary service-connected.
Other Types of Sleep Disorders and Their Symptoms
Sleep disorders can be caused by blunt trauma to the head or psychological and mental disorders. Types of sleep disorders include:
- Insomnia: Sufferers have trouble falling asleep or staying asleep for more than a few hours. This can lead to drowsiness, irritability and a depressed mood.
- Obstructive Sleep Apnea: This condition causes breathing to stop during sleep, either for a few seconds or several minutes. Sleep apnea causes fatigue, slow reflexes and eventually can impact the heart—leading to heart problems such as arrhythmia and cardiac arrest.
- Narcolepsy: Those suffering from this condition are extremely fatigued during daytime hours, no matter how many hours they slept the night before. This disorder causes abrupt daytime unconsciousness and cataplexy, an episodic loss of muscle function ranging from sagging facial muscles to physical collapse.
- Daytime somnolence or excessive daytime sleepiness (EDS): This condition is linked to each of the disorders listed above, but can be diagnosed on its own. Persons with EDS feel very drowsy during the day and often feel compelled to take naps at inappropriate times.
Let a Lawyer from Berry Law Firm Help You
The attorneys of Berry Law Firm are accredited by the VA to represent Veterans filing appeals for monetary VA disability benefits, We have successfully obtained compensation from the VA for thousands of disabled Veterans.
A lawyer from Berry Law Firm can help you file an appeal to upgrade your VA rating at the Regional Office, before the Board of Veterans Appeals, or in the Court of Appeals for Veterans Claims.
If you have a valid diagnosis of sleep apnea that is not already a part of your VA disability rating, Berry Law Firm can work to help you increase your VA disability rating and your monthly compensation, as well as other VA benefits that you and your family receive. Your VA disability rating determines your monthly Veterans’ disability benefit payment.
The rules and regulations governing appeals of VA disability benefits claim decisions are complex and confusing. But our attorneys have decades of experience successfully helping Veterans from across America fight for and win the VA benefits they’ve been promised for their service to our nation. We know how to help you seek the correct disability rating based on your medical issues and the monetary benefit you deserve. We Know the Way Forward.