How Does PTSD Cause or Aggravate Sleep Apnea?
The VA recognizes that a service-connected disability can cause or aggravate a secondary condition. Research has found an association between PTSD and sleep apnea, although having both conditions does not by itself establish secondary service connection. PTSD symptoms such as anxiety, hyperarousal, nightmares, and disrupted sleep may contribute to sleep problems, and medical evidence is needed to show how PTSD caused or worsened sleep apnea in an individual case.
Another possible connection involves weight gain. Some medications used to treat PTSD and other psychiatric conditions can cause significant weight gain, and excess weight is a major risk factor for obstructive sleep apnea. If PTSD or its treatment contributes to obesity, and that obesity in turn contributes to sleep apnea, the VA may consider obesity an intermediate step in establishing secondary service connection.
What Other Conditions Can Sleep Apnea Be Secondary To?
Sleep apnea may be secondary to another service-connected disability when medical evidence shows that the primary condition caused or aggravated the sleep apnea. Depending on the type of sleep apnea and the veteran’s medical history, possible connections may include:
- Orthopedic Conditions: Service-connected lower back, knee, hip, or ankle conditions may limit physical activity and contribute to weight gain. Because excess weight is a major risk factor for obstructive sleep apnea, obesity may sometimes serve as an intermediate step between an orthopedic disability and sleep apnea.
- Respiratory Illnesses: Asthma, chronic rhinitis, and sinusitis may be associated with breathing problems during sleep. Chronic nasal congestion or obstruction, in particular, can increase the risk of obstructive sleep apnea.
- Traumatic Brain Injury (TBI): In some cases, a brain injury affecting areas involved in breathing control may contribute to central sleep apnea, which occurs when the brain does not properly signal the muscles responsible for breathing.
What Other Conditions Can be Secondary to PTSD?
PTSD is associated with several physical health conditions that may qualify for secondary service connection when medical evidence shows that PTSD or its treatment caused or aggravated the condition. Examples include:
- Gastrointestinal Disorders: PTSD has been associated with gastrointestinal conditions such as Gastroesophageal Reflux Disease (GERD) and Irritable Bowel Syndrome (IBS).
- Migraines and Tension Headaches: PTSD is associated with a higher prevalence of migraines, and symptoms such as stress and disrupted sleep may contribute to headaches in some people.
- Cardiovascular Issues: PTSD has been associated with an increased risk of hypertension and other cardiovascular conditions.
- Erectile Dysfunction: PTSD is associated with sexual dysfunction, including erectile difficulties. Some medications used to treat PTSD may also cause sexual side effects.
What Evidence Is Needed to Connect Sleep Apnea to PTSD?
To establish sleep apnea as secondary to PTSD, you need evidence of a current sleep apnea diagnosis, an existing service connection for PTSD, and medical evidence showing that your PTSD or its treatment caused or aggravated your sleep apnea. A medical nexus letter can help establish this connection, although the necessary medical opinion may also come from other medical evidence or a VA examination. Under 38 C.F.R. § 4.97, Diagnostic Code 6847 assigns sleep apnea ratings of 0%, 30%, 50%, or 100%. A 50% rating applies when the condition requires a breathing assistance device such as a CPAP machine.
Evidence supporting your secondary claim may include:
- A Current Sleep Apnea Diagnosis: Medical records documenting obstructive, central, or mixed sleep apnea, typically supported by an appropriate sleep study.
- Service-Connected PTSD: Evidence that the VA has already established service connection for your PTSD.
- Medical Evidence of a Connection: Medical records or an opinion from a qualified healthcare provider explaining that your PTSD or its treatment caused or aggravated your sleep apnea. A medical opinion may use the standard “at least as likely as not” when addressing the relationship between the conditions.
What Are the Next Steps to File Your Secondary Claim?
To file a secondary sleep apnea claim, gather evidence of your diagnosis and its connection to your service-connected PTSD, then submit your claim to the VA.
- Document Your Diagnosis: Complete an appropriate sleep study and make sure your sleep apnea diagnosis is in your medical records.
- Submit an Intent to File: VA Form 21-0966 can protect an earlier effective date while you gather evidence.
- Gather Medical Evidence: Ask your healthcare provider for records or a medical opinion explaining how PTSD or its treatment caused or aggravated your sleep apnea.
- Address a Previous Denial: If your claim was previously denied, you may file VA Form 20-0995 with new and relevant evidence.
- Get Help: Contact us for guidance with your claim.
