VA Conditions Secondary to Sleep Apnea
Service-connected sleep apnea is a qualifying condition for VA disability benefits, and it often causes or worsens other conditions. These conditions might qualify as conditions secondary to sleep apnea, and veterans who develop them may be entitled to additional compensation and benefits.
If you have service-connected sleep apnea that has caused or exacerbated another condition, you might be eligible to file a claim for a secondary condition and receive a disability rating increase. You must present medical evidence showing a clear link between your sleep apnea and the other health condition. Veterans Guide can help you seek the additional monthly compensation and benefits you’ve earned.
Common Secondary Conditions Linked to Sleep Apnea
Sleep apnea can put strain on multiple systems in the body. Over time, this can trigger or worsen other health problems. Veterans with service-connected sleep apnea often develop secondary conditions that affect their breathing, digestion, mental health, or overall quality of life.
Asthma and Sleep Apnea
Studies show that obstructive sleep apnea, or OSA, is significantly more common in people with asthma—and the two often reinforce each other. One review found that adults with asthma have more than twice the odds of having OSA compared to those without asthma.
Several mechanisms explain how these conditions interact. OSA causes inflammation and negative pressure shifts in the airways, which can irritate the bronchial tubes and trigger asthma symptoms. OSA can also lower oxygen levels at night and make the airways more sensitive.
Asthma symptoms, such as wheezing, coughing, and shortness of breath, can also disturb sleep and worsen preexisting sleep problems in a sleep apnea patient.
GERD and Sleep Apnea
Sleep apnea can cause or worsen gastroesophageal reflux disease, or GERD. Studies show that approximately 40% to 60% of people with OSA also suffer from GERD.
One theory possibly explaining the link is that the increased respiratory effort during apneic events raises pressure across the lower esophageal sphincter, or LES, which is the muscle that keeps stomach contents from moving upward. This extra pressure may cause the LES to open and allow acid to flow into the esophagus .
Poor sleep can also intensify GERD symptoms. In turn, GERD can worsen the poor sleep associated with sleep apnea, which creates a vicious cycle.
Hypothyroidism and Sleep Apnea
While the research on whether sleep apnea can contribute to hypothyroidism is mixed, studies have shown altered thyroid function in people with OSA. This link could suggest that hypothyroidism may be secondary to sleep apnea.
Hypothyroidism may worsen sleep apnea. Patients with the condition often have increased thyroid size, which may obstruct the upper airway. Hypothyroidism may also alter the function of the respiratory muscles.
PTSD and Sleep Apnea
People with post-traumatic stress disorder, or PTSD, are more likely to develop OSA. Untreated OSA can also make PTSD symptoms worse.
Better sleep hygiene is often part of a patient’s PTSD treatment plan, and sleep apnea can get in the way of that. The Frequent awakening and poor-quality sleep caused by sleep apnea may intensify PTSD symptoms, such as irritability, trouble concentrating, and hypervigilance . This may explain why sleep apnea can be secondary to PTSD.
Individuals with PTSD are significantly less likely to use continuous positive airway pressure, or CPAP, therapy consistently. CPAP therapy can improve both OSA and PTSD symptoms, but masking discomfort, nightmares, and claustrophobia can affect adherence.
Mental Health Conditions and Sleep Apnea
Studies have linked OSA to major depression symptoms. Researchers found that symptoms such as snorting, gasping, or stopping breathing while asleep were associated with nearly all signs of depression, including feelings of hopelessness and failure. The likelihood of depression increased with the reported frequency of these events.
In one study, over 14% of adults with OSA reported anxiety. Certain OSA-related symptoms were more strongly linked to anxiety disorders than breathing difficulties themselves. These include frequently waking during the night or morning fatigue.
Chronic sleep fragmentation caused by OSA may disrupt the neurotransmitters that influence mental health. Sleep apnea can also cause significant fatigue, which may make it harder for patients with depression and anxiety to seek and adhere to mental health treatment. Some OSA patients with anxiety may have increased difficulty keeping their CPAP mask on, which can worsen both conditions.
Sinusitis and Sleep Apnea
Chronic sinus issues and nasal inflammation are common in people with obstructive sleep apnea. One study found that 80% of patients with OSA had at least one pathological rhino-sinus condition, such as chronic sinusitis.
These conditions, aggravated by sleep apnea, can cause nasal obstruction and lead to mouth breathing during sleep. This may destabilize the upper airway and worsen sleep apnea. Inflammatory swelling of the nasal passages may also narrow the airway and interrupt nighttime breathing.
Tinnitus and Sleep Apnea
A large study found that people with poor sleep—such as sleeping less than 8 hours per night, reporting sleep problems, or having OSA symptoms—were significantly more likely to experience tinnitus. Another study found that OSA specifically is a risk factor for developing tinnitus.
Researchers have proposed two main theories linking sleep apnea to tinnitus. One suggests that repeated drops in oxygen from sleep apnea may damage cells in the ears and lead to tinnitus. Another posits that loud, chronic snoring triggers the condition, since long-term noise exposure is a known risk factor for tinnitus.
How to File a Claim for Secondary Service Connection
A secondary connection is one caused or exacerbated by a primary service-connected condition for which a veteran has already received a disability rating. If the Department of Veterans Affairs approves a claim for a secondary condition, it will increase your VA disability rating, entitling you to greater compensation and benefits.
To receive a rating increase for a secondary service connection, you must prove that a primary service-connected condition, like sleep apnea, has caused or exacerbated another disabling condition. You must submit the correct VA forms and provide solid documentation, which may include a nexus letter from a medical provider. Here’s what the process entails.
Filing VA Form 21-526EZ
To apply, submit VA Form 21‑526EZ, the Application for Disability Compensation and Related Compensation Benefits, either online or by mail. You also have the option to bring your application in person to a local VA regional office or fax the application to 844-531-7818.
You’ll need evidence proving that you have a new physical or mental condition, and there’s a link between that condition and your already service-connected disability. The VA usually wants medical records or a doctor’s opinion to support this. In some cases, they may also accept lay evidence, such as a buddy statement using VA Form 21-10210.
What To Expect During a C&P Exam for Secondary Conditions
After you file your claim, the VA may ask you to complete a claim exam. This is also known as a compensation and pension, or C&P, exam. The exam helps the VA gather evidence to evaluate your disability claim if your current medical records don’t provide enough information to decide the claim.
At the C&P exam, a qualified examiner will review your medical history and ask questions about your sleep apnea and the affected secondary condition. They may perform a physical exam and request other tests, such as blood work or X-rays.
The exam may take from 15 minutes to over an hour. You don’t need to bring anything to the exam, but be sure to submit all your recent medical records in advance.
Providing Nexus Letters
A nexus letter is a written medical opinion that connects your new condition to an existing service-connected disability. While the VA does not require a nexus letter in every case, having one can significantly strengthen your claim.
The VA looks for a clear statement from a qualified health care provider explaining that your secondary condition is “at least as likely as not” caused or worsened by your service-connected condition. The letter should be detailed, reference relevant medical records, and explain the reasoning behind the provider’s opinion.
Frequently Asked Questions About Secondary Conditions to Sleep Apnea
In the following section, we answer common questions from veterans considering their compensation options for conditions related to service-connected sleep apnea.
Can Sleep Apnea Cause Other Conditions?
Yes. Sleep apnea has been linked to a range of physical and mental health conditions. It can either directly cause these conditions or increase a person’s odds of developing one.
What Are the Most Common Conditions Secondary to Sleep Apnea?
Common conditions aggravated by sleep apnea include:
- Asthma
- Gastroesophageal reflux disease, or GERD
- Hypothyroidism
- Post-traumatic stress disorder, or PTSD
- Anxiety and depression
- Sinusitis
- Tinnitus
Can Both PTSD and Sleep Apnea be Service-Connected?
Yes, it’s possible for both conditions to be service-connected. PTSD may be easier to link to military service than sleep apnea. If you have trouble proving that your sleep apnea resulted from military service, you could argue that your service-connected PTSD contributed to your sleep apnea.
Start Your Secondary Service Condition Claim Today
Proving your secondary service condition can help you access more of the resources needed to care for your basic needs. If you’ve developed a new or worsened condition as a result of your service-connected sleep apnea, Veterans Guide can connect you with a lawyer to help you file a claim.
Contact us today to learn more about the conditions secondary to sleep apnea and start moving forward with a free consultation.
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