Obstructive Sleep Apnea (OSA) is a common sleep disorder where the airway repeatedly collapses during sleep, causing breathing to stop and start, resulting in fragmented rest and daytime fatigue. For veterans seeking disability benefits from the Department of Veterans Affairs (VA), the central question is whether this condition is considered related to their military service. The VA disability claims system utilizes different pathways to establish this connection. Understanding how the VA classifies the relationship between a veteran’s service and their diagnosis is important for a successful claim.
Understanding Presumptive Service Connection
Presumptive service connection is a mechanism where the VA assumes a disability was caused by military service without the veteran having to provide a direct medical link. This status is granted when a veteran served in a specific location or during a defined time frame and later developed one of a list of designated conditions. This approach shifts the burden of proof away from the veteran, streamlining the claims process significantly. Common examples include certain cancers and illnesses linked to Agent Orange exposure or specific chronic multisymptom illnesses for Gulf War veterans. However, sleep apnea is not generally included in the VA’s standard lists of presumptive conditions, though a limited exception exists for certain Gulf War veterans where sleep disturbances may be considered under the umbrella of undiagnosed illnesses or chronic multisymptom illnesses.
Sleep Apnea and the Standard Direct Service Connection
When a condition is not presumptive, a veteran must establish a direct service connection, which requires proving three distinct elements to the VA.
- The veteran must have a current diagnosis of sleep apnea, typically confirmed by a formal sleep study (polysomnography).
- There must be evidence of an in-service event, injury, or disease that occurred during military service.
- A medical nexus must link the current diagnosis of sleep apnea to that specific in-service event.
This medical nexus is a formal opinion, often provided by a physician, stating that the sleep apnea is “at least as likely as not” due to the documented military event. Connecting a diagnosis that occurs years after service directly to an in-service event is frequently challenging. While an in-service diagnosis of sleep apnea would satisfy this requirement, many veterans only experienced symptoms like loud snoring or daytime tiredness while serving. Lay or buddy statements from fellow service members who witnessed sleep disturbances can be used to document the onset of symptoms during active duty. The Compensation & Pension (C&P) exam is where a VA examiner reviews all evidence and provides an opinion on the direct service connection.
Sleep Apnea as a Secondary Condition
The most common and often successful path for service connection for sleep apnea is through a secondary claim. A secondary service connection is established when an existing service-connected disability causes or aggravates a separate, non-service-connected disability. Sleep apnea is frequently linked to other conditions that are already service-connected, allowing veterans to bypass the difficulty of proving a direct link to a specific in-service event.
Mental Health Connections
Studies have shown a strong correlation between Post-Traumatic Stress Disorder (PTSD) and sleep apnea. The chronic stress and hyperarousal associated with mental health conditions like PTSD are thought to contribute to or worsen sleep-disordered breathing.
Physical and Medication Connections
Another frequent secondary connection involves weight gain resulting from a service-connected disability, such as an orthopedic injury or a mental health condition that limits physical activity. The resulting obesity is a well-established risk factor for Obstructive Sleep Apnea (OSA). Similarly, certain medications prescribed to treat service-connected conditions, like some psychotropic drugs for mental health, can lead to weight gain or directly impact respiratory drive, creating a secondary connection to sleep apnea.
In each secondary claim, the veteran must obtain a medical nexus opinion that explicitly links the service-connected primary condition to the development or aggravation of the sleep apnea.
Impact of Recent Legislation on Sleep Apnea Claims
The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act, commonly known as the PACT Act, significantly expanded the list of presumptive conditions for veterans exposed to toxic substances like burn pits. Despite the focus on respiratory illnesses and toxic exposure, the PACT Act did not add sleep apnea to the list of generally presumptive conditions. Veterans exposed to burn pits or other toxins in designated areas still cannot claim sleep apnea as a stand-alone presumptive condition based solely on their service location.
The legislation did, however, create new avenues for secondary service connection by adding many respiratory conditions to the presumptive list. Conditions such as chronic rhinitis, sinusitis, and asthma are now presumptive for veterans who served in certain toxic exposure zones. A veteran can now establish a service connection for one of these respiratory conditions due to burn pit exposure and then file a secondary claim for sleep apnea, arguing the presumptive respiratory condition caused or aggravated the sleep disorder. This new framework simplifies the establishment of the primary service connection.