Alcohol Use Can Substantialy Aggravate Sleep Apnea
The medical literature actually demonstrates that alcohol use can make sleep apnea worse. For example, a recent meta-analysis on the topic reviewed 1,266 studies and concluded alcohol consumption is associated with worsening severity of snoring, altered sleep architecture, AHI, as well as lowest oxygen saturation among patients susceptible to snoring and obstructive sleep apnea . The American Academy of Sleep Medicine , has practice guidelines related to sleep apnea. The American Academy of Sleep Medicines practice guidelines related to obstructive sleep apnea include, as a standard of care in the field, that there be patient education on the impact of alcohol avoidance on sleep apnea. The avoidance of alcohol is also included as one of the behavioral strategies in managing sleep apnea .
How To Prove Hypertension Secondary To Sleep Apnea
To establish a nexus between your already service-connected sleep apnea and your hypertension, you will need to submit evidence proving the link between your two conditions.
Specifically, you will need to demonstrate two things to VA to be granted service connection for a secondary condition:
- A diagnosis for your secondary condition and
- Medical evidence showing the link between your service-connected condition and secondary condition.
Confirm A Medical Diagnosis Of Sleep Apnea With A Sleep Specialist
Once youve finished your Sleep Study, its important to review your results with a sleep specialist.
Its crucial to review your Sleep Study results in detail, specifically, to confirm whether you have a medical diagnosis of Sleep Apnea.
By far, the most common Sleep Apnea syndrome in Veterans is called Obstructive Sleep Apnea .
Did you know Veterans are nearly 4x as likely to have Obstructive Sleep Apnea as the average civilian population?
A quick note: According to medical research, the most common cause of Obstructive Sleep Apnea is WEIGHT GAIN / OBESITY.
This is really important!
Why?
Because weight gain / obesit is the #1 most common reason why the VA denies Sleep Apnea claims.
The C& P examiners will write some ridiculous denial such as, Its less likely than not that the Veterans Sleep Apnea is due to their military service. The most likely cause is weight gain / obesity, which occurred after they left the military. The Veteran has a BMI above 30.
As Ive explained before, the trouble with the C& P exam system is that medical providers are used to applying medical certainty principles to evaluate probability.
However, the VA rating system is supposed to be non-adversarial and NOT based on medical certainty.
The concept of medical certainty is a much higher standard of proof than is required for a claimant under the VA disability system.
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Top 3 Ways To Prove Service Connection For Sleep Apnea
While trying to prove service connection for Sleep Apnea might seem as elusive as a four-leaf clover, in todays post, Im sharing an expert level technique that can help you get your VA sleep apnea service connected, regardless of past denials.
Its called the Most Likely Cause Technique for your VA Sleep Apnea claim, and it works like magic.
The MLC Technique relies on you to map-out the most likely causation factors of your Sleep Apnea in a simple, 6-step process.
Its kind of like the choose your own adventure books you may have read as a kid.
So, strap-in, and lets start our journey to learn how to service connect your VA Sleep Apnea claim.
You may also be interested in the following Blog posts about Sleep Apnea VA Claims:
Obtaining A Sleep Apnea Diagnosis
Diagnosing sleep apnea requires a sleep study. To confirm sleep apnea and eligibility for disability compensation, the VA requires evidence to verify the existence and scope of your disability.
When your sleep is continually disrupted because of a condition that leads your body to stop breathing, you may have sleep apnea. If you suspect that you have sleep apnea, you will have to undergo a sleep study test to reach a diagnosis. The sleep studys technicians will test the following factors for any irregularities:
- Brain waves
- Breathing pattern
- Limb movement
Monitoring your breathing and other body functions will confirm whether you have sleep apnea or any other sleep-related disorders. Individuals who are diagnosed with sleep apnea after the study are then referred to an ear, nose, and throat doctor to rule out possible causes, as well as a cardiologist who will examine their nervous system to identify potential causes of sleep apnea.
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The Connection Between Sleep Apnea And Other Medical Conditions
While a veteran with sleep apnea may qualify for disability benefits solely on the basis of their service-connected disability, in some cases, sleep apnea is a result of another condition. In these situations, a veteran may be able to claim sleep apnea on a secondary basis if the underlying health issue is service-connected.
There is a range of health problems that are connected to sleep apnea. For example, a 2015 study found that Iraq and Afghanistan veterans with post-traumatic stress disorder had a high risk of developing sleep apnea. The severity of PTSD symptoms increased the risk of screening positive for sleep apnea symptoms.
There are a number of medical conditions that are associated with sleep apnea, including:
- Hypothyroidism
- Acromegaly
- Muscle diseases
In addition, sleep apnea may be caused by:
- Excess weight or obesity
- Alcohol consumption
- Some medications, including narcotic pain medications, sleep medicines, and sedative
For example, assume that you were diagnosed with asthma as a result of your service, and were awarded a VA rating for benefits as a result. If you then developed sleep apnea, you could seek an updated VA rating based on your combined disabilities. To do so, you will need to submit evidence of your sleep apnea diagnosis as well as a nexus between your asthma and sleep apnea.
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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How Are Ptsd And Sleep Apnea Connected
So, we know that sleep problems are frequently linked to post-traumatic stress disorder. But whats the specific connection between PTSD and sleep apnea?
As we pointed out in our blog post exploring the connection between anxiety and sleep apnea, a 2015 study in the Clinical Psychology Review considered the presence of sleep apnea to be a risk factor for PTSD.
Insomnia and excessive daytime sleepiness even within a month after a traumatic event are important predictors for the development of PTSD, the report claims. One specific sleep disorder sleep apnea may even intensify symptoms of PTSD, including sleeplessness and nightmares.
PTSD and sleep apnea share other connections. In a sample of 78 individuals seeking treatment for posttraumatic sleep disturbances 95% of those tested experienced diminished airflow during sleep which is suggestive of sleep-disordered breathing , according to the authors of a 2012 study published in the Journal of Clinical Sleep Medicine.1
That same study found that, among 44 consecutive crime victims with PTSD reporting nightmares and insomnia, 91% also had sleep-disordered breathing .
Untreated OSA appears to be associated with worse outcomes among patients with PTSD, the authors continued. Likewise, CPAP therapy has been shown to improve symptoms of depression among patients with concomitant PTSD.
Sleep Apnea And Military Service Connections
The key in getting a VA disability rating for sleep apnea involves establishing that military service caused the problem.
But in cases where you may not be able to establish a direct link between military service and the condition it may be possible that it is due to the effects of a different service-connected medical issue.
For example, PTSD is said to aggravate sleep disorders or introduce them veterans suffering from Gulf War Syndrome or other Gulf War-related conditions may also suffer from sleep apnea as a result.
How do you establish that sleep apnea is service-connected? If the first appearance of the problem occurs in your military medical records as opposed to being a pre-existing condition, that may be a step toward a VA disability rating.
Any military member experiencing sleep disorders should, in anticipation of needing this data at a later date, request a sleep study to be done in a military medical facility where possible to establish whether or not there is a service connection to the sleep issues.
You can also see a civilian medical provider to get supporting documentation of a service-connection for sleep apnea. The key will be having as much of the issue medically documented while still serving as possible and getting supporting medical opinions in addition to whatever treatment or study of your sleep issues happen while you are still serving.
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When Its Time To See Your Doctor About Sleep Apnea
If you suffer from PTSD and are concerned you may also have sleep apnea, consider seeing a doctor if:
- Your sleep partner complains of loud snoring or mentions that your pause breathing pauses during your sleep.
- You wake up gasping or choking during the night.
- You still feel tired after a full nights sleep.
- You have trouble staying awake at school or work, or when youre driving.
If you notice any of these signs, talk to your doctor about your sleep. With consistent treatment, including CPAP and talk therapy, the symptoms of PTSD and OSA can be significantly reduced.
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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
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How Might Sleep Apnea Be Related To Post
Post-traumatic stress disorder is a condition that occurs in individuals who have witnessed a distressing, traumatic, or shocking event. Many active servicemembers and veterans develop PTSD as a result of experiencing or witnessing something traumatic during their active-duty service.
Common symptoms of PTSD include:
- Re-experiencing trauma through intrusive thoughts, recurrent memories, flashbacks, and nightmares
- Difficulty sleeping and concentrating
- Irritable or aggressive behavior
- Difficulty maintaining relationships
These symptoms can be debilitating and could have a negative impact on a veterans life.
Studies indicate that individuals who suffer from PTSD have an increased risk of developing sleep apnea. Additionally, the more severe a persons PTSD is, the more severe their sleep apnea could be. There is a strong correlation between PTSD and sleep apnea in veterans, as many factors that could aggravate PTSD could also aggravate sleep apnea.
Tip #5 For Your C& p Exam For Sleep Apnea Secondary To Ptsd: Prepare To Talk In Detail About Your Life
You are going to want to give the C& P examiner a detailed description of your life before, during, and after service.
Be ready to explain how you noticed the development of your sleep apnea after suffering from PTSD. How was your life different before and after being diagnosed with PTSD?
What was it like from the time you got PTSD to when you developed sleep apnea? Stories can be powerful ways to detail connections. Telling your story to the examiner is a great way to help them understand why you are seeking a rating for a secondary condition.
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Conditions Linked To Sleep Apnea
When a veteran has numerous conditions that are not all service-connected, it is important to consider whether the conditions without service-connection should be service-connected secondarily. A condition is service-connected secondarily when an already service-connected condition, or its medication, causes or aggravates another condition.
If you have sleep apnea and any of the following conditions there may be a link between your service-connected condition and the other condition.
PTSD
The most common condition that sleep apnea is connected to is PTSD. If you think your sleep apnea is secondary to your PTSD see our previous post Sleep Apnea Secondary to PTSD.
Depression
People with sleep apnea are four times more likely to have depression than people without a sleeping disorder. Sleeping well is vital for your overall mental health. Sleep apnea can cause veterans to wake up tired and irritable. Inconsistent sleep over a period of time can wear down a person and cause mental health conditions. Many veterans with sleep apnea develop depression. Studies show that regardless of weight, age, sex, or race, sleep apnea symptoms are associated with the onset of depression
Stroke
Hypertension
Sleep apnea can both cause hypertension and aggravate your pre-existing hypertension. Sleep apnea causes your blood oxygen levels to drop, increasing your blood pressure . Moreover, hypertension can both cause sleep apnea and worsen it.
Heart Disease
Gastroesophageal Reflux Disease
Determine Direct Service Connection Vs Secondary Service Connection For Sleep Apnea
In Step #4, youll want to make the call on Direct Service Connection versus Secondary Service Connection.
In our opinion, the only time a Veteran should pursue Direct Service Connection for Sleep Apnea is IF and ONLY IF you did a Sleep Study while on active duty, which confirmed the presence of a Sleep Apnea condition .
Direct Service Connection Requirements
Direct Service Connection means that a particular disease or injury was incurred in service.
This is accomplished by affirmatively showing inception during service.
There are three components to proving Direct Service Connection:
- A current disability
- An event, injury, or disease in service, and
- A link or nexus establishing that the current disability had its onset or inception in service, which may be established by evidence of
- Chronicity and continuity, or
- Continuous symptoms or a medical nexus opinion.
All pertinent or relevant medical and lay evidence must be considered, including the service records .
For the legal principles of direct service connection, see 38 CFR 3.303.
Secondary Service Connection Requirements
In our experience, if you did NOT have a Sleep Study while on active duty and you did NOT get a medical diagnosis of Sleep Apnea in the military, you should attempt to service connect your Sleep Apnea VA claim SECONDARY to another service-connected disability.
Secondary Service Connection may be awarded to a claimant for the following under the provisions of 38 CFR 3.310 and 38 CFR 3.310:
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Can You Get A Va Award For Sleep Apnea
This is very common in a VA Sleep Apnea claim this condition may begin with an event today, but not develop into full-on Obstructive Sleep Apnea for years, or decades. Many folks believe that when there is a long stretch of time between service and a diagnosis with a medical condition, that there cannot be a connection between the two.
Sleep Apnea Secondary Conditions
The symptoms of sleep apnea can be very restrictive and harmful to a persons life. In many cases, prolonged sleep apnea can cause other serious conditions, such as:
- Depression
- Tinnitus
- Type 2 diabetes
If you are able to prove that the sleep apnea is service-connected, or that it is more probable than not that it was caused or aggravated by a primary condition, developing sleep apnea as a secondary condition may increase your VA rating.
Another condition that has a high level of comorbidity with sleep apnea is post-traumatic stress disorder .
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Lesson #: Sleep Apnea Is Affecting A Lot Of Veterans
* Diabetes
Here are a few examples of how Sleep Apnea has affected Veterans from all different eras of service:
* Don D. served mostly during the Cold War was in the best physical shape of his life he was an avid weight-lifter. That is, until he damaged his knees in-service and had to get a knee replacement at a military hospital. After that knee replacement, he could no longer lift weights the sudden weight gain the resulted caused his obstructive sleep apnea.
* Several Desert Storm, OIF, and OEF Clients have had Traumatic Brain Injuries which interfere with how their Nervous System works, and as a result, have a different kind of Sleep Apnea .
* Many Vietnam Veterans exposed to Agent Orange suffer from sleep apnea. They are ALL experiencing a Perfect Storm of Sleep Apnea problems: breathing disorders, mental health conditions, heart conditions and diabetes are all causing an epidemic of Sleep Apnea in our Vietnam Veterans.
No wonder Sleep Apnea is affecting so many Veterans sleep apnea can be the result of other disorders or medical conditions.