2 Ways to Service Connect Sleep Apnea.

Sleep Apnea Graphic 2

Let's be clear: Sleep Apnea is a Killer.

There are 3 things that the human body cannot live - or function - without:  Blood/Oxygen, Food/Water and Sleep.

You can lose a kidney, and live a full and complete life.  You can lose your arms and legs and still survive. 

But if your body cannot get sleep, you will die.  In fact, sleep deprivation is a common form of torture, as many of us know all too well. 

That's what Sleep Apnea does - while you are sleeping, you stop breathing.  You cut off oxygen to the brain and blood, and other body systems break down.   If you are lucky, you start breathing again.

Sleep Apnea is no joke, and it is affecting a lot of Veterans.  

There are many conditions that cause sleep apnea - damage to the brain from a TBI (Traumatic Brain Injury), heart conditions, Post-Traumatic Stress, Nerve conditions and disorders - and more - are all conditions that are known to cause sleep apnea.

And Sleep Apnea can be caused by so many conditions - we have one client who was in the best physical shape of his life until he damaged his knees and got a knee replacement while in the military.  He gained a lot of weight because he could no longer exercise, and the sudden weight gain caused his obstructive sleep apnea.   

Other clients have had Traumatic Brain Injuries which interfered with how their Nervous System works, and as a result, have a different kind of Sleep Apnea (oversimplified, where the brain's signals to breathe don't make it through to the lungs).

Despite this,  it seems like the VA Regional Offices and BVA struggle with sleep apnea claims.

Perhaps until they have spent a night with someone that suffers from obstructive sleep apnea, hear the suffocating snoring,  experience the fear that the person will stop breathing altogether, they will continue to not take seriously claims for sleep apnea.

Or perhaps when they realize that Sleep Apnea is going to be as big an issue for our current generation of Veterans as Agent Orange related conditions are to Vietnam Veterans, they will take it seriously. 

No matter, though....

Veterans Are entitled to Service Connect Sleep Apnea.

First, it is important to recognize some of the different types of sleep apnea.

  • "Obstructive sleep apnea" is (over-simplified)  the result of an obstructed airway or physical blockage of the airway during sleep.
  • "Central Sleep Apnea" is (over-simplified) a function of mixed signals from the brain to the breathing muscles.
  • "Complex sleep apnea" is (over-simplified) Obstructive Sleep Apnea that, resists treatment and acts like Central Sleep Apnea (it is sometimes called Treatment Emergent Central Sleep Apnea).

Once you know what type of sleep apnea you are dealing with , this should lend some clarity as to how to service connect the condition. Here are the 2 common ways to service connect Sleep Apnea.

There are other ways, but these are the 2 most common. 

Method #1:  Diagnosis in service.

The easiest way to service connect sleep apnea is to have a diagnosis of the condition in-service and a current diagnosis of the condition.

I've read decisions where the Board seemed to have difficulty with mere symptoms of sleep apnea in service, but seemed to be  persuaded by some combination of medical complaints of sleep disorders in service, obstructed airways, and some related treatment in service.

Continuity of Symptomatology.

Most service medical records do not contain a diagnosis of sleep apnea, but appear to contain references to the symptomatology of sleep apnea or sleep disorders.  If this is the case, then continuity of symptomatology (post-service), as well as chronicity, should be enough to convince the BVA (or the Court of Appeals for Veterans Claims) to service-connect the sleep apnea.  The symptoms of sleep apnea seem to be symptoms that a non-medical "lay" witness can observe and comment on - difficult falling asleep, restless sleep, loud snoring, etc.  Ask your spouse or significant other to write a statement of the symptoms of sleep apnea they observed from the end of your military service until the date of the claim.  In a sleep apnea claim, especially, it is important to have no long breaks of time where there are no symptoms or medical complaints.

Note: Since the decision in Walker v. Shinseki, 708 F.3d 1331 (2013), continuity of symptomatology as a manner of proving service connection is no longer a valid method unless the condition is listed on the list of conditions at 38 CFR 3.303 (b). Sleep apnea is not on this list.

 

Method #2:  Secondary Service Connection (&/or Aggravation).

Sleep apnea can be the result of other disorders or medical conditions.   It can also be incidental to, but not caused by, other medical conditions.

For example, peripheral neuropathy can lead to waking up throughout the night - as does sleep apnea.

Absent a medical expert opinion showing that the neuropathy caused the sleep apnea, the sleep apnea (in that case) may well just be an incidental diagnosis.

Many conditions are believed to cause or result in sleep apnea symptoms.  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.  

PTSD and Depression can be the cause of sleep apnea.  

Depression and dysthmia can be the result of sleep apnea, as well, due to the lack of sleep and its impact on the mood.

Heart Disease is a leading cause of Central Sleep Apnea.

Strokes have been known to cause central sleep apnea as well.

There is also a mounting body of evidence that suggests a causative relationship between Traumatic Brain Injury (TBI) and many sleep disorders, including sleep apnea.

Of course, to prove secondary service-connection, the Veteran will need to prove, or service-connect, the first condition.

A medical expert report or opinion may be crucial to providing the key linkage in this type of claim.

Once you are service-connected for sleep apnea, the VA will rate your sleep apnea condition using DC 6847.

Where can you Learn More about Service Connection in a VA Disability Claim?

Here are 3 ways to learn more. 

#1: Visit the Veterans Law Blog, where I post every weekday about issues related to VA Disability Claims. Check out our VA Sleep Apnea Guidebook packages by clicking here.

#2: Get my private Weekly Email I send to thousands of Veterans.  One email, once a week - I will teach you my "8 Steps to Improve Your VA Claim", and share several posts from this blog each and every week that will help you learn how to improve your VA Claim or Appeal.

@Sleep Apnea Package Main

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Peter tebbetts says:

I am service connected for chronic sinusitis with a 30% rating. I also have central and obstructive sleep apnea which has been denied service connection. I have tried to connect OSA secondary to chronic sinusitis which has also been denied. I have had cardiomegly X-rays while on active duty. I stated on my retirement physical that I sometimes have trouble sleeping at night. I was diagnosed with OSA 10 years after separation. I did not have a va physical until about 13 years after seperation from service. I am also service connected for chronic bronchitis with a rating of 0 %. Any advice on getting sleep apnea service connected?

Chris Attig says:

Of course, I don’t give legal advice on the Veterans Law Blog. No blog, and no eBook can substitute for legal advice from an accredited VA attorney.

That said, the key here is making the connection from service to diagnosis. A couple things you mention are worth exploring:

Damage to the nasal or breathing passages, like chronic sinusitis or bronchitis, can cause OSA. A medical opinion will be necessary to show these causative connection, and you will want to first service connect the sinusitis, and then argue that the OSA is secondary or argue that the OSA is secondary to the bronchitis. Medical opinions will be CRUCIAL, as these are not “NECESSARY” connections.

Take a look at the Sleep Apnea eBook when it comes out – I think you will find a lot of informaiton that will help you understand better the many different paths and proofs for service connection of Sleep Apnea.

Chris

Cardiomegaly – enlargement of the heart – makes me thing of a damage resulting from a chronic sleep apnea condition. Long term chronic sleep apnea can cuse the heart to work harder, thus causing it to enlarge. However, there are more causes of Cardiomegaly than sleep apnea, so you will want a doctor’s medical opinoino as to whether your Cardiomegaly is related to a chronic sleep breathing disorder, or has some other origin.

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