Here's how to service connect sleep apnea.

Sleep Apnea Graphic 2The short answer is yes.

But 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.

In any event, I don't believe that a VA Claim needs to be as hard as the VA makes them.  

That's one of the unique things about this Veterans Law Blog.

I have analyzed several Board of Veteran Appeals (BVA) decisions, to come up with some sort of theme as to how the BVA grants or denies service connection for 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) some combination of the Central and Obstructive 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 primary ways to service connect Sleep Apnea:

 

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.

 

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.

Do you want to know how the VA views a "Sleep Apnea" claim?
I'm about to Publish an eBook telling YOU how!

We're still a few weeks away from publishing, but  share your name and email with me, and I'll tell you  how to get a Pre-Release Discount!

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