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Migraines aren’t just debilitating on their own—they can also contribute to the development or aggravation of other serious conditions, such as sleep apnea.
Medical research suggests a link between chronic migraines and sleep apnea, potentially making this a viable condition for secondary service connection via aggravation through the VA.
In this blog post from VA benefits expert Brian Reese, we’ll explore the connection between migraines and sleep apnea, review the evidence required for secondary service connection, and explain the VA rating criteria for sleep apnea secondary to migraines.
Let’s begin!
Table of Contents
Summary of Key Points
- The Connection Between Migraines and Sleep Apnea: While migraines do not directly cause sleep apnea, they can aggravate the condition by disrupting sleep patterns, increasing pain sensitivity, and through the side effects of migraine medications that may impact airway stability.
- Evidence for Secondary Service Connection: Veterans must provide a current sleep apnea diagnosis confirmed by a sleep study and medical nexus evidence linking sleep apnea to service-connected migraines, demonstrating aggravation or worsening. Get a nexus letter from a private healthcare provider to help prove secondary service connection!
- Factors Contributing to Aggravation: Migraines can influence sleep apnea through chronic pain disrupting sleep, neurological abnormalities affecting breathing regulation, inflammation, and the use of sedative medications that increase the likelihood of airway collapse.
- VA Rating for Sleep Apnea Secondary to Migraines: Sleep apnea is rated between 0% and 100% with breaks at 30% and 50% based on severity of symptoms and treatment requirements, with the most common rating being 50% for cases requiring a CPAP machine and resulting in significant functional impairment.
Can Migraines Cause or Aggravate Sleep Apnea?
- Migraines Causing Sleep Apnea: Current medical research does not establish that migraines directly cause sleep apnea. Instead, the connection is likely correlative or indirect, stemming from shared risk factors like disrupted sleep patterns or neurological conditions.
- Migraines Aggravating Sleep Apnea: There is evidence suggesting that migraines may contribute to the aggravation of sleep apnea. Migraines are associated with factors such as sleep disruption, increased pain sensitivity, and the use of medications that can impact airway stability (e.g., muscle relaxants or sedatives). Poor sleep quality caused by migraines may exacerbate the symptoms of sleep apnea.
Migraines can influence sleep quality, airway dynamics, and overall health in several ways:
- Chronic Pain and Sleep Disruption: Migraine attacks often interfere with normal sleep patterns, leading to fragmented or poor-quality sleep that may exacerbate or trigger sleep apnea.
- Neurological Impact: Migraines are linked to abnormalities in the central nervous system, which can affect the body’s ability to regulate breathing during sleep, contributing to conditions like central or obstructive sleep apnea.
- Inflammation and Vascular Changes: Migraines involve inflammation and changes in blood vessel function that may increase susceptibility to airway obstruction or other complications associated with sleep apnea.
- Medication Side Effects: Some medications commonly prescribed for migraines, such as muscle relaxants or sedatives, can relax the throat muscles, increasing the likelihood of airway collapse during sleep.
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 migraines:
- 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 migraines 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 migraines? 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 (migraines).
What is the VA Rating for Sleep Apnea Secondary to Migraines?
The VA rates obstructive, central, and mixed sleep apnea secondary to migraines 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 Migraines [Download]
Click the link or button below to download an example nexus letter for sleep apnea aggravated by a veteran’s service-connected migraines.
Note: This letter is an example only and must be tailored to the facts and circumstances of your case.
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
