Tip #: Know What The Va Is Looking For
To start, the biggest two factors the VA examiner will immediately look for are whether or not you have a sleep apnea diagnosis, and if a sleep study was conducted to reach the diagnosis.
It doesnt matter if you already use a CPAP machine or not, the VA requires a sleep study to be done in order to ever grant a claim for sleep apnea. Make sure you have this in your records before claiming sleep apnea as a secondary condition to PTSD!
Next, they will look over your history with PTSD to see how severe your symptoms are.
Finally, the examiner will be looking for proof that your sleep apnea is connected to your PTSD. Your best chance to prove this is to get an independent medical opinion . With an IMO, a doctor can explain why they believe your sleep apnea was at least as likely as not caused by or aggravated by your PTSD. This information can give the VA what they need to grant your sleep apnea a secondary service connection.
Also, during the exam you may be asked questions like:Do you stop breathing in your sleep?Do you wake up gasping for air or choking?Do you feel tired or have daytime sleepiness?Do you snore?
Have answers ready with as many details as possible.
Top 3 Reasons Why Va Claims For Sleep Apnea Get Denied
To begin, we must get inside the VA claim process to understand WHY the VA keeps denying your claim for Sleep Apnea.
In our experience, it comes down to 3 factors:
- #1. No Sleep Study
- #2. No current medical diagnosis of Sleep Apnea
- #3. No way to prove service connection under the law
But dont worry there are some simple strategies you can employ to overcome these 3 factors, even if the VA has already denied your VA claim for Sleep Apnea.
Okay, a couple things to keep in mind as we proceed:
Remember that the burden of proof in all VA disability compensation claims rests with the claimant YOU as the Veteran.
The good news is that the standard of proof for VA claims is relatively low, and only requires the claimant to prove that their Sleep Apnea VA claim is at least as likely as not caused or made worse by their military service OR by another service connected condition for secondary service connection.
Adherence To Cpap Therapy
Adherence to CPAP therapy is less common than doctors would like, simply because sleeping with the mask on can feel uncomfortable. Individuals with PTSD are significantly less likely to use CPAP therapy consistently, often due to masking discomfort, nightmares, and claustrophobia. Nightmares in particular are associated with higher resistance to CPAP therapy. Individuals with PTSD use CPAP therapy for a shorter amount of time only 3.5 hours on average and on fewer nights overall.
A study of veterans found that among those without PTSD, 70% adhered to CPAP therapy. Among veterans with PTSD, that adherence rate dropped to less than 50 percent.
Non-adherence to CPAP therapy has serious consequences. One study of individuals with PTSD and OSA found that those who followed their CPAP therapy experienced a 75% improvement in PTSD symptoms. For those who didnt, their symptoms got 43 percent worse.
Studies show the more frequently a person uses their CPAP therapy, the more their PTSD symptoms improve. CPAP therapy has an even stronger positive effect among those with severe PTSD, as opposed to mild to moderate symptoms.
Specifically, CPAP therapy can significantly reduce the frequency of nightmares and the distress they cause for individuals with PTSD. CPAP therapy also relieves the daytime sleepiness symptoms of PTSD, improving quality of life.
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Veteran Sleep Apnea Service Connected
A veteran can also establish service connection for sleep apnea on a secondary basis. This means that a veteran has an already service-connected disability that caused the veteran to have sleep apnea. In this case, there must be a medical nexus to link the sleep apnea to their already serviceconnected disability.
In Step #5 Youll Want To Get A Nexus Letter For Sleep Apnea From A Credible Independent Medical Professional
A Nexus Letter for Sleep Apnea is an evidence-based document prepared by a medical professional that helps to establish a connection between the veterans current disability and either their military service or another disability condition for secondary service connection.
A Nexus Letter is often the missing link, aka, the essential piece of evidence needed to help a veteran get his/her VA sleep apnea service connected.
So now Ive probably got you wondering: Brian, why are nexus letters so effective at proving service connection under the law?
Awe yes, Im glad you asked.
Simply put, its because VA disability claims are won or lost based on medical evidence.
Either you have enough medical evidence, or you dont.
In our experience, a well-crafted Nexus Letter for Sleep Apnea is the single most crucial document a veteran can provide the VA Rater to help prove service connection on an at least as likely as not basis.
Yep, it really is the single, most powerful way to prove service connection.
First, a credible Nexus Letter fulfills the third legal pillar of secondary service connection for Sleep Apnea mentioned above.
A Veteran must provide medical nexus evidence establishing a connection between the service-connected disability and the current disability .
If youre wondering How to Get a Nexus Letter for Sleep Apnea, weve made a list of the Top 5 Doctors Who Write Nexus Letters for Sleep Apnea.
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How Va Rates Hypertension
VA rates hypertension the same whether service connection is established directly, presumptively, or secondarily due to sleep apnea. Specifically, VA uses 38 CFR § 4.104 Schedule of Ratings, Cardiovascular System, Diagnostic Code 7101. The rating criteria are as follows:
- 60% diastolic pressure predominantly 130 or more
- 40% diastolic pressure predominantly 120 or more
- 20% diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more
- 10% diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control
Direct Service Connection For Sleep Apnea
For direct service connection you must show either of the following:
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Service Connection For Sleep Apnea Secondary To Ptsd
How Is Sleep Apnea Related To PTSD?
There are several different types of sleep apnea, and every person with sleep apnea experiences the condition to differing degrees of severity. Considering that around 20 percent of veterans are diagnosed with sleep apnea at some point in their lifetime, the VA has developed a schedular disability rating system for sleep apnea so that veterans whose sleep apnea was caused by their service can receive compensation.
There are a variety of conditions that occur in tandem with sleep apnea, but one of the most interesting ones among veterans is the relationship between sleep apnea and post traumatic stress disorder . Veterans are up to three times more likely to have PTSD than the general population. Men, who represent a large percentage of the veteran population, are also more likely than women to develop sleep apnea. This connection between PTSD prevalence in the military and the gender-predisposition of men to develop sleep apnea is part of what contributes to the high rates of sleep apnea among veterans with PTSD.
Getting VA Disability Benefits For Sleep Apnea Secondary To PTSD
How The VA Rates Sleep Apnea
Under 38 CFR § 4.97, the VA rates sleep apnea based on the severity of the condition and/or the type of treatment required.
Diagnostic Code 6847: Sleep Apnea Syndromes
Get Help With Your Sleep Apnea Claim
Va Disability Ratings And Sleep Apnea
To qualify for VA benefits for sleep apnea, veterans must first be diagnosed with the condition. This is typically done through a sleep study, either at a clinic or at your home. In addition, there must be evidence that this diagnosis either began during active military service or was made worse during service. In other words, there must be a current diagnosis, an onset, event or cause in service, and a link or nexus between those two.
Even if Sleep Apnea did not specifically begin in service, other conditions may be related. For example, some studies have found a link between Post-traumatic stress disorder and sleep apnea. Other conditions may also be related, but ultimately, only a doctor can offer a medical opinion to link a separate service-connected condition with sleep apnea.
An individual with sleep apnea may be eligible for VA benefits. Under the VA Ratings Schedule, a veteran with sleep apnea may be entitled to 0%, 30%, 50% or 100% benefits for sleep apnea, as follows:
- 0% Sleep Apnea Rating: asymptomatic, but with documented sleep disorder breathing
- 30% Sleep Apnea Rating: persistent daytime hypersomnolence
- 50% Sleep Apnea Rating: requires use of breathing assistance device such as continuous airway pressure machine
- 100% Sleep Apnea Rating: respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy.
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Lesson #: 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.
Thats 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.
Not a lot of VSOs or advocates get this when helping a Veteran file a VA Claim.
They think of Sleep Apnea as a disease of the obese, and then they tell them one of the big Fairy Tales about VA Claims.
Types Of Evidence To Submit To Help Prove The Connection
- Doctors Note, or Medical NexusIt can be helpful to have a doctor submit a letter stating that there is a causal relationship between your sleep apnea and your hypertension. Your doctor should state that they believe your hypertension is at least as likely as not caused by your sleep apnea.
- Relevant Medical RecordsRelevant medical records can help show the connection between the two conditions and prove that your hypertension is linked to your sleep apnea.
- Medical ArticlesArticles written for medical journals or other reputable sources can serve as evidence to support the causal relationship between sleep apnea and hypertension.
- Lay EvidenceLay evidence refers to statements that are written by the veteran, the veterans family, or fellow service members, which speak to the veterans medical conditions or their service. Lay evidence can help support a claim for hypertension secondary to sleep apnea, as the veteran can speak to their experience with both conditions. Importantly, however, the person writing lay evidence should only speak to what they know. This means that the veteran cannot necessarily submit a medical opinion saying that their sleep apnea directly caused their hypertension, but they can speak to how both conditions affect them.
How Sleep Apnea Affects Your Va Rating
May 2, 2020 By Rich Frankel
For individuals with sleep apnea, every day can be a struggle. A lack of sleep can make it difficult to focus or to complete basic tasks. If you have sleep apnea that is either the result of your military service or was caused by a different service-connected disability, you may be eligible for disability benefits from the Department of Veterans Affairs .
The VA provides benefits to veterans with a range of service-connected disabilities. The amount of benefits that you may receive is based on your level of disability, as determined by the VA rating system. Individuals with multiple disabilities related to their service may receive a combined rating.
If you have been diagnosed with sleep apnea as a veteran, you may be entitled to VA benefits. An experienced New Jersey veterans disability attorney can help you understand your right to benefits.
The Best Path To Proving Sleep Apnea Is Service Connected
I told you at the beginning I want to change your thinking.
I dont want you to think about the EASY way to Service Connect Sleep Apnea anymore. I want you to think about the BEST path to proving that sleep apnea is service connected, and the BEST way to get the VA sleep apnea disability rating you are entitled to.
Here are the ingredients to a properly developed claim for sleep apnea:
*A solid foundation of Lay and Medical Evidence showing when sleep apnea first began to present in the Veterans life
*A good medical understanding of the unique CAUSE/ORIGIN of YOUR sleep apnea.
* A good Lay and Medical presentation and assessment of the sleep apnea symptoms you have had from service, or service-discharge, to the present day.
* A 5-Star medical opinion, resting on 5-Star Lay and Medical Evidence, that demonstrates HOW your Sleep Apnea is related to military service.
* 5- Star Lay and Medical Evidence that show you your VA Sleep Apnea disability affects your daily life.
Those are the ingredients. How you mix them is the hard part.
Its one thing to give you the ingredients for a chocolate cake. Its an entirely different thing to mix those ingredients so that they turn into a cake.
Thats what you REALLY need you need the RECIPE for proving that sleep apnea is service connected.
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The Link Between Ptsd And Sleep Apnea
Sleep-disordered breathing can be a sign of untreated OSA, which is associated with worse symptoms of PTSD, as well as an increased risk of heart failure, dementia, and certain cancers. Sleep-disordered breathing is present in 95% of individuals who evacuated a fire, and 91% of victims who experienced consecutive crimes.
Veterans are up to three times more likely to have PTSD. Men, who represent a larger percentage of the veteran population, are also more likely to have sleep apnea. According to one study, 69% of Vietnam veterans with PTSD also had sleep-disordered breathing.
Among the general population, the risk for sleep apnea increases with age. However, young veterans with PTSD may have an outsized risk for their age group. One study found that 69% of young Iraq and Afghanistan war veterans screened positive for OSA.
Individuals with PTSD who also experience sleep problems such as OSA are likely to experience more severe depression, a higher suicide risk, increased substance abuse, and a poorer quality of life. Individuals who develop OSA before age 70 also have an increased risk of early death.
Fear Extinction And Rem Sleep
Good sleep benefits individuals with PTSD and plays an extremely important role in reducing the fear associated with traumatic memories. Studies show that sleep, especially REM sleep, helps facilitate fear extinction a process where your brain forgets the association of a neutral trigger with a fear response. Just as your brain learns to consolidate and remember events during REM sleep, it also works to reduce the fear associated with certain memories.
Both fear extinction and nightmares occur during REM sleep. When a person with PTSD wakes up from a nightmare, it disturbs their REM sleep and interrupts this important fear extinction process. If the individual also has sleep apnea, their tendency to experience disturbed sleep is even more likely. In fact, for some individuals with OSA, the majority of their apneas occur during REM.
Some researchers believe the connection between PTSD and sleep apnea stems from the brain. Individuals with PTSD have lower growth hormone levels than those without PTSD, and reduced GH secretion is associated with more awakenings during the night. Chronic stress, like that experienced by those with PTSD, can also lead to frequent awakenings.
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Sleep Apnea And Secondary Service Connection Explained
Service-Connection on a secondary basis requires a showing of causation.
A showing of causationrequires that the secondary disability be shown to be proximately due to, or the result of, a SC condition.
To establishcausation, the primary disability need NOTalready be SC, or even diagnosed, at the time the secondary condition isincurred. ReadFrost v. Shulkin U.S. Court of Appeals for Veterans Claims HERE.
Example: SC was granted for a back disability with radiculopathy effective in 2015. Credible evidence showed that the Veteran had a 20-year history of back pain and progressively worsening radiculopathy dating back to roughly 2001. The formal diagnosis of radiculopathy was not made until 2010.
The Veteran claimed SCfor a shoulder disability in 2016, stating that his early symptoms ofradiculopathy caused him to lose his balance, fall, and tear his rotator cuffin 2008. He provided a medical opinion linking his rotator cuff tear to afall, and the fall to sensory impairment and difficulty with proprioception dueto early symptoms of radiculopathy.
Result: As the medical opinion establishescausation for the rotator cuff tear in the shoulder due to the radiculopathy,the requirements for SC on a secondary basis are satisfied.
What Is Hypertension
Hypertension means high blood pressure. According to the Centers for Disease Control and Prevention , blood pressure is the pressure of blood pushing against the walls of your arteries . Blood pressure is measured using two numbers:
- Systolic blood pressure measures the pressure in your arteries when your heart beats
- Diastolic blood pressure measures the pressure in your arteries when your heart rests between beats
Generally speaking, a normal blood pressure level is less than 120 systolic and 80 diastolic.
High blood pressure, also referred to as hypertension, is blood pressure that is higher than normal. Blood pressure levels change naturally throughout the day based on your activities however, having blood pressure that measures consistently above normal may result in a diagnosis of hypertension. This condition is concerning because it places people at higher risk for other health problems, including heart disease, heart attack, and stroke.
Hypertension is typically diagnosed by healthcare providers after reviewing your systolic and diastolic blood pressure levels and comparing them to levels found in certain guidelines. Currently, the Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults adheres to the following measurements as they pertain to diagnosing hypertension:
- At-Risk systolic: 120-129 diastolic: less than 80
- High Blood Pressure systolic: 130 or higher diastolic: 80 or higher
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