If I had a nickel for every time I heard someone say the following statement about a VA Sleep Apnea claim, I might be able to buy a damn nice race car:
“The VA denied sleep apnea in my claim…they said it was because I had no sleep study in service,” the veteran says. “I will never prove my claim.”
You see, somewhere out there the general thinking – generally wrong thinking – has become that you need a sleep study in the military to prove that your current diagnosis of sleep apnea is related to your military service.
Even veterans who had a sleep study in the military are denied service connection for sleep apnea by the VA. Like you, they are left scratching their head wondering why.
I’ll tell you why.
They are putting the cart before the horse. The sleep study, while a critically important piece of evidence, is not DRIVING your VA sleep apnea claim
So that begs the question:
What DOES Drive the VA Sleep Apnea Claim?
This is so simple that most folks don’t believe it.
What really makes your VA Sleep Apnea claim race through the VA disability claim system is this one thing:
The sleep apnea diagnosis.
Your response, I imagine, might be something like this:
How does the diagnosis DRIVE your VA sleep apnea claim?
To understand HOW the diagnosis drives a veteran’s VA Sleep Apnea Claim, we have to first understand the 3 different types of Sleep Apnea: obstructive, central, and complex.
Let’s take a quick look at each.
Obstructive Sleep Apnea: aka, OSA, is a type of sleep apnea that occurs when your airway is blocked or obstructed.
Central Sleep Apnea: aka, CSA, is essentially a type of sleep apnea where the brain and the lungs are not communicating properly. It is, at its core, an interruption of the communication network between the brain and the breathing muscles.
Complex Sleep Apnea: In September 2006, researchers at the Mayo Clinic identified a new type of Sleep Apnea which they are calling “complex sleep apnea”. At its core, Complex, or mixed, Sleep Apnea is a type of sleep apnea with mixed causes. The causes of the condition can be a combination of CSA and OSA causes; it can also be that your CSA presents as OSA, and only becomes apparent as CSA after OSA treatment (this is called “Treatment Emergent CSA).
As an aside, there is a fourth type of sleep apnea that has popped up lately in the medical world: idiopathic sleep apnea. It’s sleep apnea that appears by itself, with no apparent causation. I’m not going to talk about it much here because I’m not seeing it in VA claims and appeals just yet. Just be mindful that a sleep apnea diagnosis isn’t all about neck girth and obesity.
Let’s look a little deeper at OSA for a minute – Obstructive Sleep Apnea is by far the most common type of Sleep Apnea that affects veterans. OSA largely results from a disruption in the normal breathing process.
#1: Air is pulled in through the nasal passages.
#2: It crosses the uvula – that dangling thing in the back of your throat
#3: It passes through the throat muscles, between the vocal chords, and enters your lungs.
Though the path from your nose to your lungs is a short one, there are a lot of parts of your body that air has to pass through.
An obstruction – or a problem – anywhere along that path of air, can cause Obstructive Sleep Apnea. Here is just a sampling of the problems that can obstruct the airway (notice how FEW of them have to do with obesity):
* Deviated Septum (damage to the piece of cartilage that separates your nostrils)
* Swelling in your nose due to allergic or other conditions
* Damage to your throat or uvula
* Your tongue can fall back and obstruct the airway
* Reduction in the opening in the throat, or a narrowing of the side walls of your throat
* Damage to your vocal chords can restrict your airway
* Any damage to your nose, face, mouth, throat, neck, chest, or diaphragm can cause the airway to be obstructed, or the airflow to be limited.
* Damage to the lungs themselves can lead to OSA. Conditions like COPD (due to asbestos or particulate exposure in burn pits, for example), blocks the air path at the point where the lungs move oxygen into the blood stream.
You may already be able to see how understanding the roots of your Sleep Apnea diagnosis can DRIVE your sleep apnea claim. The nature of the diagnosis of sleep apnea narrows the in-service events that we focus on for nexus purposes.
Think about it this way: if you are diagnosed with severe hearing loss, then to win your hearing loss claim, you aren’t going to waste your time telling the VA about your knee injuries.
If your Obstructive Sleep Apnea was caused by damage to your throat – focus on the in-service events that caused that damage.
Was it inhaling the air around the Burn Pits? Was it the blow to the throat when you were thrown against the side of the Hum-vee in that mortar attack?
By focusing on what CAUSED the airway obstruction, you are forcing the VA to focus on the in-service event and the nexus.
You wouldn’t necessarily focus on proving the same in-service events if you were diagnosed with central sleep apnea, though. You’d focus on the things that caused nerve damage that led to the central sleep apnea, brain trauma, or brain chemistry, for example.
It’s this simple. Know your diagnosis, and you know what in-service events are most important to tie to it for purposes of establishing the element of nexus in a service connection claim.
Example: How a Sleep Apnea Diagnosis Drives the VA Sleep Apnea claim.
Let’s take an actual veteran’s sleep apnea claim (I’ve disguised this veteran’s identity because this is a true story).
* SSG Jones got out of the Army – never had a sleep study done in the military – after serving 2 tours in Iraq and 1 in Afghanistan.
* About 2 years after her discharge, she began having sleeping problems. Her husband told her she would snore loudly and wake up in the night – often stopping breathing.
* She sought treatment, and after a couple of sleep studies, was diagnosed with OSA – Obstructive Sleep Apnea.
* She filed a claim with the VA, but was told that without a sleep study in the military, there was no evidence of service connection for her Sleep Apnea.
So she went back to her doctor – she knew the diagnosis drives the Sleep Apnea Claim – to understand HER diagnosis better.
The doctor told her that the genioglossus muscle – the muscle that connects the tongue to the jawbone – was substantially weakened and causing her tongue to fall backward while sleeping, blocking the airway.
Turns out, SSG Jones was raped in the Army – a very violent rape by a Senior NCO in her unit.
The violence of the rape caused a lot of damage to her jaw, back and neck muscles, including breaking her jaw.
When the jaw was reset, it was done in such a way that caused the genioglossus muscle to weaken substantially – although it happened over time.
A statement from the doctor, and some additional medical evidence regarding those facts, was enough to win the case for sleep apnea, and it is now (at least for this veteran) a service connected condition. (The VA had already conceded the rape occurred as part of another part of this Veteran’s claim).
This examples proves my point, and it is one worth repeating: To recover VA disability compensation in your sleep apnea claim or appeal, first you must know and understand your sleep apnea diagnosis. By doing so, you necessarily figure out which in-service events are most important to tie to it for purposes of establishing the element of nexus in a service connection claim.
Bottom Line: Understanding YOUR VA Sleep Apnea diagnosis Drives YOUR Claim.
Once you understand the diagnosis and what doctors call the etiology – or origin – of your condition, proving service connection of sleep apnea is often a much easier path.
To learn more about how this works, check out my book: “Put it to Rest: Your VA Sleep Apnea Claim”.
This book is a must-read: I wrote it after talking to several doctors, hundreds of veterans who were denied sleep apnea in their VA disability claim, and after reading hundreds if not thousands of BVA and Court Decisions about Sleep Apnea.
In the book I show you:
* How to use Medical & Lay Evidence in your Sleep Apnea Claim
* The 39 Conditions KNOWN to cause, aggravate, or be caused by Sleep Apnea
* The 4 Most Common VA Sleep Apnea scenarios and how to prove service connection in each
* The 5 Reasons that 76% of VA Sleep Apnea claims are denied – and how to fix the problem in YOUR case.
Check out the VA Sleep Apnea Field Manual. By subscribing to the Veterans Law Blog® you get a free copy of the eBook version – along with many more training manuals and instructional videos.
If you prefer a paper copy, you can get it direct from the publisher by clicking here, or buy it on Amazon, by clicking on the link below:
If it’s “all too much” and you’re ready to hire an attorney that is accredited to handle VA Claims, and who focuses a lot of his firm’s law practice on VA Sleep Apnea claims, check out the Attig Steel law firm and request a consultation about your VA sleep apnea appeal.
EXCELLENT INFO SIR AND I WILL USE IT IN MY CLAIM!!!!!