Sleep Apnea Secondary to Depression and Anxiety: Is There a Connection for VA Disability?

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Sleep apnea is a serious condition that impacts breathing during sleep, leading to a host of physical and mental health issues.

But did you know that depression and anxiety—two of the most common mental health conditions among veterans—may contribute to or aggravate sleep apnea?

If you’re a veteran suffering from depression, anxiety, and sleep apnea, you may be wondering if these conditions are connected and whether you qualify for VA disability benefits on a secondary basis.

The good news is that the VA recognizes secondary service connection, meaning your sleep apnea could be linked to your service-connected depression or anxiety.

In this blog post from VA disability expert Brian Reese, we’ll explore the medical research behind the connection, review the evidence required to prove secondary service connection, share tips and strategies for strengthening your VA claim, and explain the VA rating criteria for sleep apnea secondary to anxiety and depression.

Let’s begin!

Pro Tip: You’ll need a Nexus Letter to connect Sleep Apnea as a secondary claim. We also recommend you have a private healthcare provider complete a DBQ for Sleep Apnea and submit it and your Nexus Letter with your Fully Developed Claim (FDC).

Summary of Key Points

• Connection Between Depression, Anxiety, and Sleep Apnea: Depression and anxiety can contribute to or worsen sleep apnea by disrupting sleep patterns, affecting respiratory control, causing weight gain, and through medication side effects.

• Evidence for Secondary Service Connection: Veterans need a sleep apnea diagnosis confirmed by a sleep study and a Nexus Letter linking their service-connected depression or anxiety to their sleep apnea.

• VA Ratings for Sleep Apnea: The VA rates sleep apnea secondary to depression and anxiety from 0% to 100% with breaks at 30% and 50% based on the severity of symptoms and treatment requirements, such as the use of a CPAP machine.

• Strengthening Your Secondary VA Claim: In our experience, veterans should consider submitting a Nexus Letter and a completed DBQ from a private healthcare provider as part of their Fully Developed Claim to maximize the chances of approval for secondary service connection.

Can Depression and Anxiety Cause or Aggravate Sleep Apnea?

Yes, depression and anxiety can contribute to the development or aggravation of sleep apnea.

Research suggests that the physiological and psychological effects of depression and anxiety can disrupt sleep patterns, leading to or worsening conditions like sleep apnea.

For example, anxiety-related hyperarousal and depression-induced changes in brain function may interfere with the body’s ability to maintain normal breathing during sleep.

Additionally, lifestyle factors associated with depression and anxiety, such as weight gain, medication side effects, or poor sleep hygiene, can increase the risk of developing or exacerbating sleep apnea.

Here’s how these conditions are connected:

#1. Disruption of Sleep Patterns

Depression and anxiety often interfere with normal sleep cycles. Anxiety can cause hyperarousal, making it difficult for the body to relax fully during sleep, while depression can disrupt the brain’s regulation of sleep stages. Both conditions may lead to fragmented or shallow sleep, increasing the likelihood of airway obstruction—a hallmark of sleep apnea.

#2. Impact on Respiratory Control

Chronic stress and anxiety can affect the central nervous system, including areas responsible for regulating breathing. This dysregulation may increase the risk of disordered breathing during sleep, contributing to or worsening obstructive sleep apnea (OSA) or central sleep apnea (CSA).

#3. Weight Gain and Physical Factors

Depression and anxiety are often associated with lifestyle changes that lead to weight gain, such as emotional eating or decreased physical activity. Excess weight, particularly around the neck and upper body, increases the risk of airway obstruction during sleep, a primary cause of obstructive sleep apnea.

#4. Medication Side Effects

Many individuals with depression and anxiety take medications such as sedatives or antidepressants, which can relax throat muscles or affect breathing control. These side effects may exacerbate sleep apnea symptoms or contribute to its onset.

#5. Inflammatory Response

Both depression and anxiety are linked to increased levels of systemic inflammation. Inflammation can affect the upper airway tissues, potentially increasing the likelihood of obstruction during sleep and worsening existing sleep apnea.

#6. Cyclic Relationship

Sleep apnea can worsen depression and anxiety symptoms by depriving the body of restorative sleep. This creates a feedback loop, where untreated mental health conditions and sleep apnea continually aggravate each other, making both conditions more severe.

Evidence Requirements for Secondary Service Connection

Here’s a list of questions the C&P examiner will review along with evidence requirements for VA claims for sleep apnea secondary to depression and anxiety:

• Does the veteran have a diagnosis of sleep apnea confirmed by a sleep study? If yes, indicate the type of sleep apnea, date of diagnosis, and sleep study results.

• Does the veteran have service-connected depression, anxiety, or both rated at 0% or higher? If yes, indicate the date of diagnosis and date of service connection.

• Is the veterans’ sleep apnea proximately due to or aggravated by their service-connected depression and anxiety? If yes, explain your medical opinion and rationale.

• Does the veteran have symptoms of sleep apnea? If yes, indicate the severity in terms of frequency, severity, and duration, along with the current treatment plan to include the need for a breathing device such as a CPAP.

How to Establish Secondary Service Connection for VA Disability Benefits

To establish a secondary service connection, veterans need to provide the VA with two primary pieces of evidence:

• Current Diagnosis of the Secondary Condition: The veteran must have a current diagnosis of the secondary condition, which in this case is sleep apnea. This diagnosis must be documented in a medical record by a qualified medical professional and confirmed by a sleep study.

• Medical Nexus Evidence Between the Two Conditions: The veteran must provide medical evidence that links the secondary condition to the already service-connected condition. Ideally, you submit a Nexus Letter for a secondary condition that explain how the new disability (sleep apnea) is proximately due to or aggravated by the primary service-connected condition (depression and anxiety).

What is the VA Rating for Sleep Apnea Secondary to Depression and Anxiety?

The VA rates obstructive, central, and mixed sleep apnea secondary to depression and anxiety from 0% to 100% with breaks at 30% and 50%.

Here’s the current VA disability rating criteria for sleep apnea according to 38 CFR, Part 4, the Schedule for Rating Disabilities, Diagnostic Code (DC) 6847, Sleep Apnea Syndromes:

100% VA Disability Rating for Sleep Apnea

A 100% rating may be assigned if sleep apnea is so severe that it necessitates the use of a CPAP machine or other assisted ventilation devices, and it significantly impacts the individual’s overall health and ability to function. This rating indicates total disability.

50% VA Disability Rating for Sleep Apnea

A 50% rating is assigned when sleep apnea is moderate to severe, persistent, and results in chronic daytime sleepiness and significant impairment of cognitive and social functioning. You require the use of a breathing device such as a CPAP machine. This is the most common VA disability rating for sleep apnea.

30% VA Disability Rating for Sleep Apnea

A 30% rating is typically assigned if sleep apnea requires the use of a CPAP (Continuous Positive Airway Pressure) machine or a similar device for treatment. This rating indicates moderate to severe sleep apnea.

0% VA Disability Rating for Sleep Apnea

A 0% rating is assigned when sleep apnea is diagnosed but does not require the use of a CPAP machine or other breathing assistance devices, and it does not significantly affect daily functioning. This means that there is no associated disability compensation. The 0% rating is non-compensable, meaning a veteran is not eligible to receive compensation.

Example Nexus Letter for Sleep Apnea Secondary to Depression and Anxiety [Download]

Click the link or button below to download an example nexus letter for sleep apnea aggravated by a veteran’s service-connected depression and anxiety.

Note: This letter is an example only and must be tailored to the facts and circumstances of your case.

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