Filing a secondary sleep apnea claim with the VA can be a challenging process. Many veterans experience issues with getting their claims approved—not because they lack a diagnosis or symptoms, but because the connection (or “nexus”) between their sleep apnea and a service-connected condition is often not properly established. This article will guide you through key aspects of secondary sleep apnea claims, including sleep studies, nexus letters, and the role of obesity as an intermediate step.
Step 1: Getting Diagnosed with Sleep Apnea
The first step in filing a successful claim is obtaining a formal diagnosis of sleep apnea. Your primary care provider will likely start by asking you a series of questions, including:
- Do you snore?
- Do you have restless leg syndrome?
- Have you experienced daytime fatigue or difficulty concentrating?
They may also measure the thickness of your neck—a common screening method for sleep apnea, though somewhat outdated.
Types of Sleep Studies
Once you’ve been referred for a sleep study, you have two options:
- Sleep Center Study: This is the more thorough option. You’ll spend the night at a sleep center where medical professionals will monitor your breathing, heart rate, and other key indicators while you sleep.
- At-Home Test: If a sleep center study isn’t available, you may be given an at-home test. While this is less comprehensive, it can still provide enough evidence for a diagnosis.
Whenever possible, push for the sleep center study. It typically provides more objective data, which can strengthen your claim.
Step 2: Diagnosis and CPAP Prescription
If your sleep study confirms a diagnosis of sleep apnea, your doctor will likely prescribe a CPAP machine. From a VA rating standpoint, simply having the CPAP prescription is enough to qualify for a 50% disability rating—you don’t have to prove that you use it regularly.
Step 3: Establishing the Nexus (The Hard Part)
The biggest hurdle for most veterans is proving the connection between sleep apnea and an existing service-connected condition. About 95% of secondary sleep apnea claims are denied due to weak or missing nexus evidence.
Understanding the Intermediate Step
VA regulations require a clear medical link between your sleep apnea and a service-connected condition. This is where the intermediate step comes in. An intermediate step is a condition or factor that bridges the gap between your service-connected disability and your sleep apnea.
Example: Obesity as an Intermediate Step
Obesity cannot be claimed as a service-connected disability on its own. However, it can serve as an intermediate step in linking a service-connected condition to sleep apnea under 38 CFR § 3.310. Here’s how it works:
-
Service-Connected Condition Causes Obesity
- Example: A veteran with a service-connected back injury becomes less active due to chronic pain, leading to weight gain.
-
Obesity Contributes to Sleep Apnea
- Medical evidence must show that the obesity significantly contributed to the development of sleep apnea.
-
Sleep Apnea Would Not Have Occurred Without the Obesity
- The claim should argue that the veteran’s sleep apnea wouldn’t have developed if the service-connected injury hadn’t caused obesity.
Other Intermediate Steps
Besides obesity, other potential intermediate steps include:
- Medications – Certain medications prescribed for service-connected conditions (e.g., painkillers) can cause weight gain, respiratory issues, or muscle relaxation that worsens sleep apnea.
- Mental Health Conditions – PTSD, depression, and anxiety can contribute to weight gain, poor sleep patterns, and other factors that lead to sleep apnea.
Step 4: Crafting a Strong Nexus Letter
A poorly written nexus letter is one of the most common reasons for denial. Your doctor must clearly establish the medical connection between your sleep apnea and a service-connected condition, addressing the intermediate step if necessary. The letter should:
- Confirm your sleep apnea diagnosis.
- Explain how a service-connected condition caused obesity (or another intermediate step).
- Establish that the intermediate step significantly contributed to sleep apnea.
- Conclude that the sleep apnea would not have occurred without the service-connected condition.
Final Thoughts
Winning a VA secondary sleep apnea claim is not impossible, but it requires strong medical evidence and a well-written nexus letter. If you’re struggling with your claim, seek help from a qualified VA claims expert or an experienced veterans’ advocate. Establishing the intermediate step is often the key to success, especially when obesity or medication is involved.
Disclaimer: This article reflects the author’s opinion based on experience and research regarding VA sleep apnea claims. It is not legal or medical advice. Veterans should consult with a qualified VA claims specialist or medical professional for guidance specific to their situation.
