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In this post, Brian Reese the VA Claims Insider explains why the VA likely said: “Sleep Apnea Secondary to PTSD Denied” in your VA decision letter.
What’s the bottom line?
It is hard to prove service connection for Sleep Apnea Secondary to PTSD.
Why?
Because medical research is slim to none on the actual link or connection between PTSD and Sleep Apnea.
One thing we do know for sure: PTSD does not “cause” Sleep Apnea.
However, there might be a path to service connection for Sleep Apnea Secondary to PTSD using principles of “aggravation.”
We will also explain mission critical medical evidence requirements.
Alright, let’s jump into it!
Why Was Sleep Apnea Secondary to PTSD Denied?
In accordance with 38 CFR § 3.310 disabilities that are “proximately due to,” or “aggravated by,” or the “result of” a service connected disease or injury shall be service connected.
This means Sleep Apnea can be service connected to PTSD, but the process of getting there can be difficult.
Here are the top 3 reasons why the VA likely denied your secondary claim for Sleep Apnea and PTSD.
Reason #1: The VA Denied Your Claim Because There is No Evidence That PTSD Causes Sleep Apnea
The C&P examiner and VA Rater have valid arguments here.
Why?
Because PTSD does not “cause” Sleep Apnea.
However, there is research to support a connection between PTSD and Sleep Apnea based upon secondary principles of “aggravation.”
For example, it’s well documented that:
- PTSD and Sleep Apnea often co-exist and symptoms of one can worsen the symptoms of the other, and vice versa.
- Sleep Apnea can worsen sleep quality, causing daytime impairments and making PTSD symptoms worse.
- Treating one condition can positively impact the other due to the bidirectional relationship between PTSD and Sleep Apnea.
If the VA denied your claim because of “causation” issues, it is recommended to go back and review your VA decision letter.
The VA might have made an error in their decision, and thus, the next best step is to file a VA Higher Level Review.
Reason #2: The VA Denied Your Claim Because of Weight Gain, Obesity, BMI Increase Over Time
This is the most common reason why the VA denies claims for Sleep Apnea secondary to PTSD.
They aren’t wrong either; the most common reason for the development of Obstructive Sleep Apnea is weight gain and obesity.
But maybe your weight gain and obesity are due to another service connected disability?
Let me explain.
Sleep Apnea can be service connected secondary to PTSD, but usually only with weight gain and obesity as an intermediate step.
Thus, if the veteran is not overweight or obese, this option won’t work.
Obesity as an intermediate step for secondary service connection is only reasonably raised when there is evidence in the record that draws an association or suggests a relationship between the veteran’s current obesity or weight gain resulting in obesity, and service connected disability.
Incidental references to a veteran’s weight or weight gain are not sufficient to reasonably raise the issue.
Remember that obesity is not a “disability” for the purposes of service connection under 38 CFR 3.310 for secondary service connection.
However, obesity may be an “intermediate step” between a service connected disability (e.g., PTSD) and a current disability (e.g., Sleep Apnea) that may be service connected on a secondary basis under 38 CFR 3.310(a) or on the basis of aggravation under 38 CFR 3.310(b).
To determine whether obesity is an intermediate step between a service connected disability and the development of a current disability that may be service connected on a secondary basis, including by aggravation, the following criteria must all be satisfied:
- The service connected disability (PTSD in this case) must have caused the veteran to become obese (e.g., side effects of mental health medications can cause weight gain and obesity)
- The obesity, as a result of the service connected disability, must have been a substantial factor in “causing” the claimed disability, or
- “Aggravating” the claimed disability, and
- The claimed disability would not have occurred but for the obesity caused or aggravated by the service connected disability.
If the VA denied your claim because of weight gain and obesity issues, it is recommended to go back and review your VA decision letter.
Weight gain and obesity can be an “intermediate” step to service connection for Sleep Apnea secondary to PTSD, and you need to be armed with “why” the VA denied your claim.
The VA might have made an error in their decision and the next best step is to file a VA Higher Level Review.
Reason #3: You Didn’t Have a Quality Nexus Letter and DBQ for Sleep Apnea Secondary to PTSD
It is mission critical to have a Nexus Letter for Sleep Apnea secondary to PTSD.
We also recommend getting a DBQ for Sleep Apnea.
If you didn’t have a Nexus Letter at the time of claim submission, it’s highly likely that’s the reason you were denied because you failed to prove a link or connection between Sleep Apnea and PTSD.
Should I Get a Nexus Letter for Sleep Apnea Secondary to PTSD?
Yes, we highly recommend you get a Nexus Letter to connect Sleep Apnea and PTSD.
A Nexus Letter for Sleep Apnea will help you prove service connection, even if a prior Sleep Apnea claim was denied.
Should I Get a DBQ for Sleep Apnea Secondary to PTSD?
Yes, you should get a DBQ for Sleep Apnea to help you prove a current medical diagnosis and severity of symptoms.
The DBQ Nexus Combo for Sleep Apnea Secondary to PTSD
This Pro Tip encompasses two critical pieces of medical evidence (used in tandem) to help you service connect Sleep Apnea.
We recommend you have a private healthcare provider complete a DBQ for Sleep Apnea and submit it and your Nexus Letter with your VA Fully Developed Claim (FDC) online.
Why?
By using both at the time of claim submission, a VA Rater has all the information he/she needs to review and rate the claim.
Your claim is “Decision Ready,” and you might even be awarded VA disability benefits for Sleep Apnea without the need for a C&P exam.
If the VA denied your claim because you failed to prove the “Nexus,” you can get a Nexus Letter for Sleep Apnea secondary to PTSD and file a VA Supplemental Claim.
If the VA denied your claim and you did have a Nexus Letter, you can file a VA Higher Level Review to appeal the decision.
What is the Connection Between PTSD and Sleep Apnea?
PTSD and Sleep Apnea are both complex conditions, and the relationship between them has been a subject of much study.
While PTSD itself does not directly cause Sleep Apnea, research suggests that there may be a link between the two conditions.
Here’s how the two conditions might be related:
- Increased Risk: Individuals with PTSD may have a higher risk of developing Sleep Apnea. The stress and anxiety associated with PTSD can lead to various physical health problems, including sleep disturbances.
- Shared Risk Factors: Both PTSD and Sleep Apnea have some common risk factors like age, obesity, and substance use, which might contribute to the co-occurrence of these conditions.
- Sleep Disturbances: PTSD often involves sleep disturbances, including nightmares and interrupted sleep patterns. These disturbances can exacerbate or contribute to the development of sleep disorders like Sleep Apnea.
- Physiological Changes: PTSD can cause changes in the body that might increase the risk of Sleep Apnea. For example, PTSD can alter breathing patterns during sleep, which might contribute to the development of Sleep Apnea.
- Medication Side Effects: Some medications used to treat PTSD can affect sleep and potentially increase the risk of sleep apnea. They can also cause weight gain and obesity.
Pro Tip: It’s important to note that while there may be a correlation between PTSD and Sleep Apnea, correlation does not imply causation.
Need a Nexus Letter for Sleep Apnea Secondary to PTSD?
Are you trying to get a high-quality Nexus Letter to service connect Sleep Apnea?
Do you want a DBQ for Sleep Apnea to go along with your VA Fully Developed Claim (FDC)?
WE CAN HELP.
Veterans who become members of the VA Claims Insider Elite program get access to a network of independent medical providers who can write a Nexus Letter for Sleep Apnea as a secondary VA claim at reduced rates.
Why pay $1,500 to $2,000 for a Nexus Letter when you can get one for $595?
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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.
