Narcolepsy VA Rating Complete Guide
If you’re a veteran who suffers from narcolepsy, you know how debilitating the condition can be. Submitting a claim for a VA rating for narcolepsy can be confusing, but at VA Claims Insider, we want to ensure you get the VA rating you deserve. Let us arm you with the knowledge you need to win your claim and get a narcolepsy VA rating!
- Narcolepsy VA Rating Complete Guide
- What is Narcolepsy?
- What are the Symptoms of Narcolepsy?
- The Two Types of Narcolepsy
- Additional Complications Veterans Experience
- What Are the Possible Causes of Narcolepsy?
- Getting a Narcolepsy Diagnosis
- How can you service connect your narcolepsy?
- Can Narcolepsy be secondary to PTSD?
- Tips for your VA disability claim for narcolepsy
- How Does the VA Rate Narcolepsy?
- Breaking Down the Rating
- TDIU and Narcolepsy
- About the Author
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What is Narcolepsy?
Narcolepsy is a neurological disorder that affects the control of wakefulness and falling asleep, but it is more than just falling asleep uncontrollably. Narcolepsy is a serious medical condition. People with narcolepsy experience excessive daytime sleepiness and often fall asleep unexpectedly during the day. They may also have disturbed nocturnal sleep and experience other symptoms such as dream-like hallucinations and paralysis upon falling asleep (sleep paralysis) or paralysis upon waking up.
What are the Symptoms of Narcolepsy?
The primary symptom of narcolepsy is excessive daytime sleepiness (EDS), which is an overwhelming urge to sleep during the day. EDS can be so severe that people with narcolepsy may fall asleep suddenly and without warning. Some narcoleptic patients have even reported falling asleep in the middle of talking or performing another activity.
The Two Types of Narcolepsy
There are two types of narcolepsy, type 1 and type 2.
Type 1 narcolepsy, also known as narcolepsy with cataplexy, is the more severe form of the disorder. A low amount of a brain hormone (hypocretin) can indicate Type 1. Veterans with type 1 narcolepsy exhibit all four symptoms: EDS, cataplexy, sleep paralysis, and hypnagogic hallucinations.
Cataplexy is the sudden loss of muscle tone while a person is awake. It leads to weakness and a loss of voluntary muscle control. Cataplexy is often triggered by sudden, strong emotions, such as anger or laughter.
Type 2 narcolepsy, also known as narcolepsy without cataplexy, is the less severe form of the disorder. Veterans with type 2 narcolepsy have EDS and may have one or more of the other symptoms.
The VA Narcolepsy Disability Benefits Questionnaire does not ask whether you are diagnosed with type one or type two narcolepsy. Instead, the Narcolepsy VA disability rating is based on the impact of the condition on each individual veteran’s daily life, specifically, the frequency and severity of the symptoms the veteran experiences.
Additional Complications Veterans Experience
Military members who serve in the Army, Navy, Marines, Air Force, and Coast Guard can experience symptoms of narcolepsy due to deployment-related stress. Alongside the main four most common symptoms listed above, veterans may experience other complications related to and conditions caused by the disorder. These include:
- Memory difficulties
- Inability to concentrate
- Withdrawal from social activities
- Changes in REM sleep
What Are the Possible Causes of Narcolepsy?
The exact cause of narcolepsy is not fully understood. The role genetics play is still unclear, but the disorder is thought to be caused by genetic and environmental factors. Some of the potential triggers include:
- Certain infections
- Head injuries
- Autoimmune disorders
- Changes in hormones
- Exposure to toxins
Getting a Narcolepsy Diagnosis
If you think you may have narcolepsy, it is important to see a doctor for a proper diagnosis. Narcolepsy can be difficult to diagnose because the symptoms are similar to other sleep disorders and medical conditions.
To diagnose narcolepsy, your doctor will likely take a detailed medical history and do a physical examination. Your doctor may also order blood tests and a sleep study. The sleep study will likely last one night and may take place at a sleep center.
After ruling out other potential causes of your symptoms, your doctor may diagnose you with narcolepsy. A formal diagnosis from a VA doctor may indicate whether you have either type 1 or type 2 narcolepsy.
How can you service connect your narcolepsy?
The first step in service-connecting any condition is to show evidence of a current diagnosis. This can be difficult with narcolepsy because the symptoms are similar to other conditions.
If you have a current diagnosis of narcolepsy, the next step is to show that your condition is related to your military service.
There are two ways to do this:
- Direct service connection: You will need to show that your narcolepsy began during or after active duty and that it is the result of an injury or event that occurred during service.
- Secondary service connection: You will need to show that you have a service-connected condition and that this condition has caused or aggravated your narcolepsy.
Can Narcolepsy be secondary to PTSD?
Yes, narcolepsy can be a secondary condition to PTSD. To service connect narcolepsy secondary to PTSD, you will need to show that your PTSD is related to your military service and that your narcolepsy is the result of your PTSD.
Tips for your VA disability claim for narcolepsy
- To prove these things, you will need to provide medical evidence and, if possible, eyewitness testimony. Writing a personal statement—also known as a “Statement in Support of a Claim”—can sometimes provide key supporting evidence. Start with a clear and concise statement of the issue. The more specific you can be, the better. To learn more about these statements, see: Is a Buddy Letter Important?
- Gather all relevant medical records, including documentation for diagnostic tests and treatment records.
- Make sure your records establish a connection between your current condition and your service or service-connected disability.
- Get a comprehensive evaluation from a qualified medical provider if you have not already done so.
- Be prepared to discuss your symptoms in detail, including frequency, severity, and any effect on your quality of life.
- Be honest about your health history and any other factors affecting your condition.
- Keep copies of everything you submit to the VA, including any correspondence with VA staff.
- Stay organized and keep track of deadlines throughout the claims process.
How Does the VA Rate Narcolepsy?
If you are able to service-connect your narcolepsy, you will be assigned a disability rating. The VA rates narcolepsy under the same criteria they use for neurological conditions and convulsive disorders, which is found in 38 CFR § 4.124a, Schedule of Ratings.
Narcolepsy can cause sudden disruptions to your work and can endanger your safety and the safety of others. In view of the kinds of challenges narcolepsy creates, the VA disability rating for narcolepsy awarded to each patient depends on the frequency of symptoms they experience and severity of their individual condition.
Breaking Down the Rating
The VA rates narcolepsy according to 38 CFR § 4.124a, Schedule of Ratings. According to diagnostic code 8108, narcolepsy should be rated under the same guidelines as epilepsy, petit mal DC 8911. The specific VA ratings criteria are below. As you read them, keep in mind the relevant notes as well.
Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness.
Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).
- 100% – At least one major seizure per month over the last year on average
- 80% – At least one major seizure in 3 months over the last year, or more than ten minor seizures weekly on average.
- 60% – At least one major seizure in 4 months over the last year; or 9-10 minor seizures per week on average
- 40 % – At least one major seizure in the last six months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly
- 20 % – At least one major seizure in the last two years; or at least two minor seizures in the last six months
- 10% A confirmed diagnosis of epilepsy with a history of seizures
Note (1): When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy.
Note (2): In the presence of major and minor seizures, rate the predominating type.
Note (3): There will be no distinction between diurnal and nocturnal major seizures.
Remember, this rating schedule is written for epileptic seizures but is also used to rate narcolepsy.
TDIU and Narcolepsy
With narcolepsy, a person who has severe symptoms may not be trusted to do a wide range of occupations. If you are unable to stay awake, jobs that require you to perform manual labor, use machines, or process time sensitive information may not suit you. Therefore, Total Disability Individual Unemployability (TDIU) can be obtained with narcolepsy since a patient with serious symptoms is not expected to be able to work in any profession. TDIU is the equivalent of a 100% VA disability rating.
If you cannot work because of your narcolepsy, you may be eligible for a Total Disability Individual Unemployability (TDIU) rating.
To qualify for a TDIU, you must be unable to maintain substantially gainful employment due to your service-connected conditions. In other words, you must be unable to earn a living.
To be granted a TDIU, you will need to provide evidence that your service-connected conditions have prevented you from working for at least 12 months. The VA will consider how your narcolepsy affects your ability to work and whether working conditions will exacerbate your condition. When determining your rating, they’ll consider any additional related disorders as well.
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About the Author
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).