Obstructive Sleep Apnea (OSA) is a widely misunderstood condition.

Unless the veteran has a solid diagnosis of OSA while on active duty, the condition may be impossible to claim as service connected.

Snoring may be a sign of OSA or it may not. OSA is a serious health condition and more information is brought into our knowledge banks every day.

To be awarded a benefit for OSA will require a medical record that supports your claim that you had OSA during your military service. A statement from your spouse or a buddy isn't likely to carry any weight.

If your OSA has been diagnosed well after your military service has ended but you've heard how lucrative the benefit is (50% if you use a CPAP) you should think long and hard before you apply for the award.

If you were a chronic heavy snorer while on active duty, can you document that? Did you ever make a sick call because of chronic daytime sleepiness? Have you ever been at fault in an accident where you fell asleep at the wheel of your vehicle? During any hospitalization or surgical treatment, did a health care provider make a note to your record about your airway obstruction or a breathing problem during anesthesia?

Once you're sure that you can prove your case, you may want to file that claim. If you don't believe that you have the evidence you'll need, consider delaying any action while you attempt to have a nexus letter written. That could require a formal IME that you'll pay for out of your own pocket.

If you're a heavy snorer today, whether or not you are able to make a service connection and receive a VA benefit, get a sleep study done. Sleep studies are now available for you to have it all done in the privacy of your own bedroom. You no loner must spend a night in a sleep lab...you can take a small piece of equipment home (a headband sort of arrangement) and wear it to bed. When you return it to your doctor the data gathered will be analyzed for a diagnosis.

Using a CPAP may reduce the incidence of adult onset diabetes,  heart disease, strokes and many other of the conditions that come to us as we age. Not only that...the daytime sleepiness you experience from the lack of a good nights sleep will be much less severe.

Medicare and most insurers will pay for the home sleep study and the CPAP you may need afterwards. It's well worth your time.

New survey aims to fix veterans’ sleep problems   

Researchers at Johns Hopkins University and the veterans wellness firm VetAdvisor are teaming up to see if they can help returning veterans get a little more rest.  

The Ratings

6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed):

Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy - 100%

Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine - 50%

Persistent day-time hypersomnolence - 30%

Asymptomatic but with documented sleep disorder breathing - 0%

Obstructive Sleep Apnea Is Elevated in Veterans With PTSD  

Do you have a rating for PTSD? Do you also have a positive diagnosis of OSA? Do you use a CPAP?

You may be eligible for OSA service connected benefits as a secondary condition even if you don't have a service medical record of OSA.

Consider that many of the medications that are used to treat sleep disturbances or mental health conditions may have an effect on your sleep patterns. If your OSA was diagnosed after you started taking medicines to aid your sleep or to treat some mental health conditions, you might want to consider filing for OSA as secondary to the service connected PTSD.

Before you decide to do that, review the side effects of the medicines and be ready to offer a sound reasoning for your claim. Once you're sure that the medicines you take cause or aggravate your OSA, file for the appropriate benefit.

Filing For OSA as a Secondary Condition 

Read about secondary conditions here.    

Heavy, oxygen depleting snoring may be something you knew about long ago. Your spouse may have complained. Your buddies may have commented on your heavy snoring while you were in your bunk.

You may have suffered overwhelming daytime sleepiness for years.

Now, how do you convince VA that the OSA had its origin while you were on active duty? Sometimes, you can't.

Maybe your OSA didn't manifest on active duty. Maybe the condition crept up on you as you were treated for other maladies like diabetes or PTSD.

No matter what your history is, it's worth considering whether or not you should file a claim for OSA. If you left the service 20 years ago and you've been in relatively good health but gained weight over the years and now you snore, you probably aren't service connected. If the medicine you take for your PTSD or any other condition contributes to your snoring and gasping for breath as you sleep, you may have a legitimate claim.

No matter what the basis of the claim, service connection for OSA is complex. You have to use precise language. For example, if you claim OSA as secondary to PTSD, you'll probably lose. If you claim OSA as secondary to the soporific effects of the medicines that doctors prescribe for your PTSD and you provide evidence that the medicine you take can cause, contribute to or aggravate OSA, you have a good claim.

Read the BVA appeals we'll list for you here. Learn from the mistakes and triumphs of others. Avoid the errors and duplicate the good work of those who have gone before you.


Service connection for obstructive sleep apnea, claimed as secondary to service-connected PTSD, is denied.   "the most persuasive medical opinion evidence weighs against the claim"


The appeal for service connection for obstructive sleep apnea, as secondary to diabetes mellitus, is granted.    "Resolving all doubt in favor of the Veteran, as is required by law, the Board finds that the Veteran's obstructive sleep apnea is aggravated by his service-connected diabetes mellitus. As such, the Board concludes that the Veteran's claim for entitlement to service connection for obstructive sleep apnea, as secondary to his service-connected diabetes mellitus, is warranted. Hanson v. Derwinski, 1 Vet. App. 512 (1991)."


Service connection for sleep apnea, to include as secondary to a service-connected disability is denied.  


Service connection for sleep apnea is warranted. The appeal is granted.


Entitlement to service connection for sleep apnea, claimed as secondary to service-connected PTSD, is denied.
 

Search for more cases here.   Enter key words and search through recent years. Key words may be granted, apnea, OSA, PTSD, secondary, denied, and so on. Prepare to spend hours at this task.

Nobody will do this for you. If you want to prevail, you must do it yourself.

Understanding OSA

Sleep Apnea Treatment May Lower Heart Risks

Sleep specialist Meir Kryger, MD, of the Yale University School of Medicine and the VA Connecticut Health System, tells WebMD the findings highlight the growing recognition that sleep disturbances play a significant role in chronic disease. “It is now clear that patients with heart disease or a metabolic disease like type 2 diabetes should be asked about their sleep habits, and they should be treated if they have sleep apnea,” he says.

Sleep Apnea (Obstructive Sleep Apnea - OSA) Wikipedia

Can You Take a Sleep Test at Home? The Latest Guidelines and Expert Advice


Sleep Study Reimbursement

Jim's Mailbag   


VAWatchdog "Eric" follows up the story below with even more data for you to use.

Jim;

Your readers will be surprised to learn just how much has been clinically connected to PTSD.  For example, PTSD has been shown as being tied to asthma.  Click here for the link.

You might want to call veterans attention to the National Institute of Health research resources website.  There, a veteran can perform a search "Diagnosis "A" AND Diagnosis "B", and get to see the very same journal articles that the VA examiner -should- be looking at.  Granted examiners rarely do the search themselves, so the vet would be well served to do this on their own.

A "Meritorious" claim would be one that shows a direct link between Diagnosis "A" AND Diagnosis "B".  But when ever possible the veteran should submit three such journal articles to show a secondary cause.  These should be cited on a VA From 21-3148 in proper APA or Blue Book format, as the RO's are often told to discard journal articles submitted by the veteran.  This will protect the veteran's rights should the examiner fail to address the journal article's in responding to the BDQ's.  Here the following case should also be cited, "Robinson v. Mansfield 21 Vet.App. 545 (2008)"  Where the court asserted that the Board MUST address every theory reasonably raised by the record.  Citation of a journal article on a VA Form 21-4138 or within a NOD in support of a theory of secondary service connection most certainly raises an issue in the record.

Then bring a copy of each article, or at least the abstract, to the exam just in case you have a cooperative examiner.  But CYA using the above steps at some point before expiration of the NOD.


Many thanks to Eric & Sniper2!


VAWatchdog "Sniper2" writes to point out an important case he's discovered.

Hey Jim;

I was denied comp for my sleep apnea claim recently.  The VA claimed I had not been treated or asked to be treated for sleep apnea during my active duty so no benefits.  I have been diagnosed by the VA with chronic apnea and issued a CPAP.

I found this appeals court case on the net and it rules in favor of a vet who wanted his sleep apnea to be recognized as secondary to his PTSD and/or PTSD meds. He never claimed to have been treated for sleep apnea while on active duty nor did he claim he ever asked for treatment.  The BVA granted full benefits of his OSA secondary to his PTSD irregardless of his past history showing he never asked for or received treatment while in service.

I filed for sleep apnea as secondary to my PTSD after reading this case.  I have already been called in for a CP exam and handed the Dr. a copy of this court case.  She seemed to be very interested in it as I watched her reading it.  Point of this of course is that this case could open a flood of sleep apnea claims that have been denied.  I feel 100% confident the VA will now award me 50% for sleep apnea as secondary to my PTSD.  The appeals court case does not distinguish between PTSD or PTSD meds as being qualifiers but vets should be aware that the VA will ask the vet which one he feels the apnea stems from.  Tell them both.

Have a good day buddy.

Sniper2

Reply;

Your message is an important one. Conditions that are either directly caused by a primary service connected condition or may be aggravated by the primary condition are often called "secondary" ratings. To establish a secondary cause can be tricky. Often enough, the nexus is routine...diabetes leading to PAD is a readily apparent cause and effect relationship. Other cause and effect scenarios won't be as obvious and will require a medical opinion in support of the hypotheses.

This case is a good example of how a veteran carefully crafted the necessary documents in support of his claim. This is the sort of patience and tenacity required when working with your VA.

Click here to read the case.