In this article, we will explore the top three conditions that VA rating specialists often see veterans claim as secondary to their service-connected sleep apnea.

A Word of Caution:

Before diving in, it’s important to note that nothing is guaranteed in the VA claims process. If someone claims they can guarantee a favorable outcome, they are likely misleading you. There have been many cases where VA rating specialists thought a claim would be approved, only for it to be denied. On the other hand, claims that seemed far-fetched have sometimes been approved. Keep this in mind when submitting claims for secondary conditions.

For secondary conditions, it is essential to provide a Nexus statement—a document prepared by a medical professional that explains how your condition is linked to your military service. Veterans have the option of undergoing a Compensation and Pension (C&P) exam or having their private doctor complete a public Disability Benefits Questionnaire (DBQ), available on the VA’s website.

The Top 3 Conditions Claimed Secondary to Sleep Apnea:

1. Hypertension (High Blood Pressure)

The first condition commonly claimed as secondary to sleep apnea is hypertensive vascular disease, also known as hypertension. Let’s focus on the 10% rating criteria, as this often causes confusion. For a 10% rating, one of the following must be true:

• Diastolic pressure is predominantly 100 or more
• Systolic pressure is predominantly 160 or more
• There is a history of diastolic pressure predominantly 100 or more, and continuous medication is required for control.

It’s essential to meet both requirements for a 10% rating in the third scenario: a history of diastolic pressure of 100 or more and the need for continuous medication. Veterans can track their blood pressure at home and keep a spreadsheet as evidence. If you believe you meet the criteria for a 20% rating (diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more), providing your own records or notes from your doctor is crucial.

Additionally, hypertension or isolated systolic hypertension must be confirmed by readings taken on two or more occasions over at least three different days. So, whether you are monitoring your own blood pressure or having a private doctor or VA doctor take readings, proper documentation is essential.

2. Diabetes Secondary to Sleep Apnea

The second condition often claimed as secondary to sleep apnea is diabetes mellitus, particularly Type 2 diabetes. For these claims, you need a medical professional to provide a diagnosis and a rationale linking the diabetes to sleep apnea via a Nexus statement.

It’s not a bad idea to research medical studies or literature supporting this connection—sources like the Mayo Clinic often provide valuable insights. Additionally, you can refer to the Diabetes Mellitus Type 2 DBQ, which can guide your claim.

In this form, Section 3A asks if the veteran has any recognized complications of diabetes, such as:

• Diabetic peripheral neuropathy (affecting the upper or lower extremities)
• Diabetic nephropathy or renal dysfunction
• Other complications

Section 3B asks if any of these conditions are “at least as likely as not” caused by diabetes, which constitutes a secondary medical opinion.

If you’re dealing with other conditions like hypertension, stroke, skin conditions, or eye conditions, these can also be linked through secondary conditions, sometimes referred to as “stacking.” In this case, the doctor completing the DBQ must provide a clear rationale in the remarks section explaining how they reached their conclusions.

3. Depression Secondary to Sleep Apnea

The third common condition linked to sleep apnea is depression. Veterans claiming depression secondary to sleep apnea must clearly explain to the C&P examiner how their sleep apnea contributes to their mental health condition.

For instance, you could describe how severe snoring or breathing issues force you and your spouse to sleep in separate bedrooms, which may impact your emotional well-being and relationship. It’s also important to familiarize yourself with the General Rating Formula for Mental Disorders to determine if you meet the criteria for a 0%, 10%, 30%, 50%, 70%, or 100% disability rating.

There are proposed changes to these criteria coming in April 2025, so be sure to stay updated if you’re pursuing a mental health claim.

Conclusion:

These are the top three conditions that VA rating specialists frequently see veterans claim as secondary to their service-connected sleep apnea: Hypertension, Diabetes, and Depression. Many veterans succeed in their claims by submitting private evidence or attending a C&P exam.

Disclaimer:

This article is for informational purposes and should not be considered professional legal or medical advice. While the author has had a successful VA rating outcome, veterans should conduct their own research and apply the relevant findings to their specific cases.

Why Seeking Assistance from Veterans Service Organizations (VSOs) Like Disabled American Veterans (DAV) Is More Sensible and Cost-Effective Than Hiring a Lawyer for VA Appeals

When appealing a VA decision, especially on conditions like vertigo as secondary to service-connected bilateral hearing loss and tinnitus, veterans often face a difficult choice: Should they hire a lawyer or seek the assistance of a Veterans Service Organization (VSO) like Disabled American Veterans (DAV)? The implications of this decision can significantly impact the outcome of a claim, as well as the financial burden on the veteran.

Here’s why obtaining help from a VSO is often the more practical and cost-effective choice.

1. Cost-Free Representation

One of the most compelling reasons to work with a VSO is that they provide their services free of charge. VSOs like DAV offer trained representatives who assist veterans through the claims and appeals process without imposing legal fees.

In contrast, VA-accredited attorneys charge fees that can be up to 20% of the retroactive benefits awarded. While these fees are regulated, they can still amount to a significant cost, especially in cases where veterans wait years for a favorable decision.

2. Expertise in Complex Claims

VSOs have representatives who are well-versed in the VA’s requirements and regulations, making them highly effective in assisting with complicated cases. Veterans attempting to prove a secondary service connection for conditions such as vertigo, which may stem from hearing loss or tinnitus, can benefit from the expertise of VSO representatives who have experience in similar cases.

For example, in VA Case 0211929, a veteran successfully appealed for service connection for vertigo as secondary to service-connected bilateral hearing loss and tinnitus. The veteran argued that their vertigo was linked to these conditions, and after providing medical evidence and testimony, the Board granted the appeal. Cases like this highlight the importance of presenting the right medical evidence, which VSOs are skilled in gathering and presenting.

3. Access to Resources and Medical Evidence

VSOs have access to critical resources that can make or break a VA claim. They often collaborate with medical experts, specialists, and psychologists to gather the evidence needed to support claims of secondary service connection. In cases like the one mentioned above, where proving that vertigo is caused or aggravated by hearing loss and tinnitus is crucial, VSOs can leverage these resources to provide comprehensive support.

Lawyers may not have the same direct access to these resources unless they hire external experts, which can further increase costs for the veteran.

4. Deep Understanding of the Appeals Process

VSOs work with the VA regularly and have a deep understanding of its appeals process. This expertise can prevent unnecessary delays and common errors that may weaken a veteran’s case. In cases like proving that vertigo is secondary to hearing loss and tinnitus, this familiarity with VA procedures can be invaluable.

In the aforementioned VA Case 0211929, the veteran successfully appealed because the VSO representatives knew how to navigate the VA’s complex system, ensuring that the correct medical evaluations and evidence were provided. These organizations understand how to align their arguments with VA requirements, increasing the likelihood of a favorable outcome.

5. Advocacy and Veteran-Centered Focus

VSOs are focused entirely on advocating for veterans. Organizations like DAV exist solely to serve veterans and are motivated by the goal of ensuring they receive the benefits they deserve. This can make a significant difference in the quality of representation veterans receive.

Unlike attorneys, who may be motivated by financial compensation, VSO representatives are committed to the well-being of veterans, often advocating for cases involving complex secondary conditions like vertigo without financial incentives.

6. Long-Term Support

In addition to providing free and specialized assistance during the appeals process, VSOs like DAV offer long-term support for veterans. They help with future claims, changes in disability ratings, and any other challenges a veteran may face in securing or maintaining benefits.

This is especially important for veterans dealing with chronic conditions, such as vertigo, tinnitus, and hearing loss. The ongoing support from a VSO can provide veterans with peace of mind, knowing that they have dedicated advocates throughout their VA journey.

Real-World Success: VA Case 0211929

A prime example of how VSOs can help veterans succeed in proving secondary service connection claims is VA Case 0211929. In this case, the veteran contended that their vertigo was related to their service-connected hearing loss and tinnitus. Initially, the claim was denied, but through the appeals process, with the assistance of their representative, the veteran was able to present compelling medical evidence, including an expert opinion, which established the link between these conditions.

The Board ultimately found that the vertigo was indeed secondary to the veteran’s bilateral hearing loss and tinnitus, granting the appeal. This case demonstrates how the expertise and advocacy of a VSO can lead to a successful outcome, particularly in cases involving complex medical conditions.

7. Proven Track Record

VSOs have a long history of helping veterans succeed in their appeals. Their proven track record of securing benefits for veterans, often through cases like VA Case 0211929, provides veterans with a sense of trust and confidence in their representation. For veterans with complex claims, such as proving a secondary service connection for vertigo, VSOs are equipped to handle these challenges effectively and efficiently.

Conclusion

For veterans appealing a VA decision, particularly in cases involving complex medical issues like proving that vertigo is secondary to bilateral hearing loss and tinnitus, seeking assistance from a Veterans Service Organization such as Disabled American Veterans is often the more practical and cost-effective option. With free representation, specialized expertise, access to valuable resources, and a strong commitment to veterans’ well-being, VSOs provide a comprehensive and highly effective alternative to hiring a lawyer.

Using DAV or other services VSOs can help a veterans obtain a case of highlight the critical role that VSOs play in helping veterans win their appeals and secure the benefits they deserve.

Take a look at the following from an actuak VA case:

CONCLUSION OF LAW

The criteria for service connection for a disorder manifested by vertigo, secondary to service-connected hearing loss and tinnitus disabilities, have been met.

Citation Nr: 1708783	
Decision Date: 03/22/17    Archive Date: 04/03/17 

https://www.va.gov/vetapp17/Files2/1708783.tx

Successful cases like VA Case 0211929 and others via this Google Search links:

https://www.google.com/search?q=tinnitus+cause+vertigo+VA+Case+approved&oq=tinnitus+cause+vertigo+VA+Case+approved&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRigATIHCAIQIRigATIHCAMQIRigATIHCAQQIRigAdIBCTE4MDgyajBqN6gCALACAA&sourceid=chrome&ie=UTF-8

VA Warns Congress of Potential Benefits Payment Disruptions Due to $15 Billion Budget Shortfall

The Department of Veterans Affairs (VA) has informed Congress that it may face a nearly $15 billion budget shortfall this year and next, largely due to a higher-than-expected number of veterans utilizing VA services. This shortfall could affect both benefits and health care programs.

A significant portion of the deficit is attributed to the PACT Act, which has led to an increase in benefits claims, potentially leaving the VA $2.9 billion short in its benefits accounts this year. Additionally, health care accounts could fall short by nearly $12 billion next year, driven by unexpected costs related to staffing and prescription drugs.

In response to these concerns, the VA stated that it is collaborating with the White House and Congress to address the budgetary challenges in a manner that protects veterans’ interests.

“Currently, due in large part to the historic PACT Act, the VA is delivering more care and benefits to more veterans than ever before,” said VA Press Secretary Terrence Hayes. “These efforts are life-changing for veterans, their families, caregivers, and survivors, and the VA remains committed to ensuring they receive the care and benefits they deserve.”

However, there are warnings that if funding is not secured by the end of the fiscal year, benefits payments could be disrupted. Chairman of the House Veterans Affairs Committee, Mike Bost (R-Ill.), criticized the VA for what he described as fiscal mismanagement, noting that this is the largest budget shortfall the department has experienced under any administration.

Bost has demanded that VA Secretary Denis McDonough provide answers regarding the shortfall, raising the possibility of a subpoena if the VA does not comply by July 26.

For this fiscal year, the VA anticipated spending around $193 billion on benefits payments. While disability benefits payments have been slightly lower than projected so far, an increase is expected by year-end, particularly due to the PACT Act. There is also an anticipated rise in GI Bill payments following a Supreme Court ruling that expanded education benefits for veterans.

“If the Veterans Benefits Administration lacks sufficient funding, compensation and pension payments to over 7 million veterans and survivors, along with readjustment benefit payments to over 500,000 individuals, scheduled for October 1, 2024, are at risk,” officials warned.

In March, the VA requested nearly $370 billion for fiscal 2025, including $134 billion in discretionary spending primarily for medical care. While this represents a 13% increase from the previous year, discretionary funding is slightly reduced due to budget caps imposed by Congress.

The VA’s budget request anticipated a reduction of about 10,000 employees in the Veterans Health Administration, but the agency now expects to have about 20,000 more employees than initially projected. Additionally, pharmacy and prosthetic costs for next year could exceed expectations by $4 billion if current pricing trends continue.

The VA also noted that increased use of community care services, where veterans receive care from non-VA providers, is contributing to the budget shortfall. The program’s costs are now projected to increase by 16.5% next year, up from the originally forecasted 12%.

Despite these challenges, the VA views the higher-than-expected costs as a positive indicator of the success of the PACT Act, which expanded care and benefits for veterans exposed to toxins during their service.

“Significant growth in care has resulted from new benefits and enrollment opportunities under the PACT Act, alongside unprecedented outreach efforts to inform veterans about these opportunities,” Hayes added.

Chairman Bost, however, criticized the VA for not adequately planning for the PACT Act’s impact and for using budgetary tactics he described as “gimmicks.” He also questioned the VA’s drastic change in staffing projections, noting the difficulties in hiring quality healthcare workers amid shifting targets.

Source:

https://www.veterans.senate.gov/2024/7/sen-moran-statement-on-va-budget-shortfall

FACT SHEET: President Biden to Announce 1 Million PACT Act Claims Approved, Benefits Delivered to Veterans in all 50 States and U.S. Territories

President Biden signed the landmark bipartisan Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act into law in August 2022, enacting the most significant expansion of benefits and services for toxic exposed veterans in more than 30 years.  Named in honor of Sergeant First Class Heath Robinson, a decorated combat medic who died from a rare form of lung cancer, this historic legislation is delivering timely benefits and services to veterans—across all generations—who have been impacted by toxic exposures while serving our country.

Thanks to this transformational law, the President will announce that more than 1 million PACT Act related claims have now been granted.  More than 888,000 veterans and survivors across all 50 states and U.S. territories are now receiving new service-connected disability benefits.
 
President Biden believes that our nation has a sacred obligation to properly prepare and equip the troops we send into harm’s way – and to care for them and their families when they return home. Sometimes military service can result in increased health risks for our veterans, and some injuries and illnesses like asthma, cancer, and others can take years to manifest. These realities can make it difficult for veterans to establish a direct connection between their service and disabilities resulting from military environmental exposures such as burn pits – a necessary step to ensure they receive the disability benefits and health care they earned. The PACT Act eliminated these barriers and ensures veterans get the care and services they deserve.

President Biden has made clear that supporting our veterans is a commitment that unites all Americans – Democrats, Republicans, and Independents — and it’s why he made supporting our veterans a core element of his Unity Agenda. Under President Biden’s leadership, the Department of Veterans Affairs (VA) has processed claims at the fastest rate in history, and is delivering health care to more veterans than ever before. Today, to mark a key milestone in this effort, the President will join veterans and their families at the Westwood Park YMCA in Nashua, New Hampshire to discuss how the historic PACT Act has delivered lifesaving health care and benefits to more than 888,000 veterans and survivors.

Today, the Biden-Harris Administration will also release new national and state-by-state data on PACT Act claims granted. 
 
The Administration has helped veterans in every state and territory receive the services and care they deserve by:

• Screening veterans for toxic exposures: More than 5.4 million veterans have received free screenings for toxic exposures from VA under the PACT Act – a critical step to catching and treating potentially life-threatening health conditions as early as possible.
• Delivering benefits to veterans and their survivors: Since enactment, VA has delivered more than $5.7 billion in earned PACT Act-related benefits to veterans and their survivors. VA is delivering these benefits to veterans at the fastest rate in history, processing 1.57 million total claims thus far in this fiscal year – 28% more year-to-date than the previous all-time record. In total, VA has processed 1,327,228 PACT Act claims since August 10, 2022.
• Prioritizing veterans with cancer: As a part of President Biden’s Cancer Moonshot, VA has prioritized claims processing for veterans with cancer – delivering nearly $637 million in PACT Act benefits to veterans with cancer. VA also prioritizes claims for veterans with terminal illnesses and veterans experiencing homelessness.
• Spreading the word to veterans and their survivors: Thanks to the PACT Act outreach campaign, veterans and survivors are applying for their earned benefits at record rates. Since August 2022, veterans and survivors have submitted 4.17 million total claims. This includes 1,655,810 PACT Act-specific claims applications.
• Increasing VA’s capacity to serve veterans: Thanks to new PACT Act authorities, VA has been able to expand its workforce in order to serve veterans as quickly and effectively as possible. In total, both the Veterans Health Administration and the Veterans Benefits administration have achieved their highest growth rates in 20 years.
• Eliminating benefits delays for veterans: Instead of phasing in conditions over several years (as outlined in the legislation), the Biden-Harris Administration decided to make all conditions in the PACT Act presumptive for benefits as of August 10, 2022, the day the bill was signed into law. This decision expedited the timeline for veterans to receive their earned care and benefits by several years.
• Accelerating health care eligibility for veterans: As of March 2024, VA opened up eligibility for toxic exposed veterans to enroll in VA Health Care without first having to prove a service-connected disability and regardless of their deployment location, nearly ten years earlier than called for in the PACT Act. Thanks to new PACT Act eligibility, more than 145,000 veterans have newly enrolled in VA Health Care since August 10, 2022.

These historic efforts to address military toxic exposures build on the Biden-Harris Administration’s recent work to support our nation’s veterans, including:

• Ending veteran homelessness. No one should be homeless in this country, especially not those who served it. That’s why President Biden is proposing a guaranteed voucher for extremely low-income veterans, a population at especially high risk of homelessness. Last year, VA found permanent housing for over 46,000 veterans, expanded access to health care for homeless Veterans, expanded access to legal assistance for homeless Veterans, helped more than 145,000 Veterans and their families retain their homes or otherwise avoid foreclosure, and awarded more than $1 billion in grant funding to help homeless Veterans. These efforts are leading to results: from 2020 to 2023, there was a nearly 5 percent decline in veteran homelessness. And, tomorrow, Dallas will announce that it has effectively ended veteran homelessness.
• Securing jobs for our veterans. Roughly 200,000 service members transition from the military each year and the Biden-Harris Administration is committed to providing them and their spouses the support they need to find good paying jobs. This includes helping connect veterans to registered apprentice programs, so they can transfer the skills they learned in the military.
• Removing barriers to mental health care. Next week, VA will take action to remove all cost-sharing for the first three behavioral health visits for veterans enrolled in VA health care, helping to ensure that all those in need can get the care they need. This action builds on VA’s new policy allowing eligible veterans and certain former service members in acute suicidal crisis to go to any VA or non-VA health care facility for no-cost emergency health care – over 50,000 veterans and service members have used this benefit since it launched in 2023. VA is doing everything it can, including expanding mental health screenings, increasing access to legal and financial support, and hiring more mental health professionals, to help veterans get the help they need. For veterans and family members who may be experiencing a crisis, the Veterans Crisis Line is available 24/7 by dialing 988 and then pressing 1.
• Supporting veterans and caregivers. Last year, President Biden signed an Executive Order directing the VA to cut red tape and give veterans who need assistance at home more flexibility to pick their own caregivers. As part of those actions, VA also launched a pilot program, known as the Virtual Psychotherapy Program for Caregivers, to provide mental health counseling services to family caregivers caring for our nation’s heroes. The program successfully completed its pilot phase and is now a permanent program. Since October 2023, the program has provided over 4,937 psychotherapy sessions to family caregivers. And, last year, President Biden signed an Executive Order calling for the most comprehensive set of administrative actions in our nation’s history to support the economic security of military and veteran spouses, caregivers, and survivors.

If you are a veteran, visit www.va.gov/PACT or go to your local VA hospital to see if you are eligible for PACT Act benefits and services.

For a state-by-state breakdown of PACT Act data, click here.

The Veterans Pension program provides monthly payments to wartime Veterans who meet specific age or disability criteria and have income and net worth within certain limits. Learn more about your eligibility for this benefit.

The VA assigns disability ratings based on the severity of a veteran’s service-connected condition. These ratings are expressed as a percentage from 0% to 100%, reflecting the degree to which the disability decreases the veteran’s overall health and ability to function.

When a veteran has multiple disabilities, the VA uses a combined rating system rather than simply adding the percentages together. This is done using a method that accounts for the impact of each additional disability on the veteran’s remaining health. For example, if a veteran has two disabilities rated at 30% and 20%, the VA doesn’t simply add them to get 50%. Instead, they use a specific calculation where each disability’s impact is measured on the remaining “healthy” percentage of the body, often resulting in a combined rating that is lower than the sum of individual ratings​

Current Veterans disability compensation rates

Learn more about how the VA assigns disability ratings and use the official VA combined disability rating calculator by visiting the VA’s Disability Ratings Page.

VA’s Claim Status Tool allows Veterans to view the status of their VA claims online using their VA.gov login. This tool displays which claims are in process and identifies any actions Veterans need to take. It also gives Veterans the ability to review recent claim activity.

Claim Status Tool Enhancements

VA recently enhanced the Claim Status Tool to improve your digital, self-service experience. The tool now shows a breakdown of the eight-step disability claims process, making it easier to understand where your claim currently stands. The steps include:

• Step 1: Claim received
  VA receives your claim in its system.
• Step 2: Initial review
  VA reviews your claim for basic information (e.g., name, Social Security Number).
• Step 3: Evidence gathering
  VA reviews your claim to ensure it contains all necessary information. VA may ask for more evidence at this step of the claims process. Additional evidence could include a claim-related medical exam or medical records from a VA or non-VA provider.
• Step 4: Evidence review
  VA reviews all collected evidence for a claim.
• Step 5: Rating
  VA decides your claim and determines the disability rating.
• Step 6: Preparing decision letter
  VA prepares the decision letter. Though this letter cannot be viewed on VA.gov until Step 8, it will identify if you are eligible for additional benefits. This letter will include details such as disability ratings, the amount of monthly payments, and when payments begin.
• Step 7: Final review
  A senior reviewer from VA will conduct a final review of the claim and decision letter.
• Step 8: Decision letter available
  You can view and download your decision letter for the claim on the Status page of the Claim Status Tool.

More About the Claim Status Tool

The Claim Status Tool contains three main tabs:

• Status: The Status tab tells you what actions you can take to support your claim and lists requests for third parties.
• Files: The Files tab displays information requests to you, a button for uploading files, and a list of supporting documents you have submitted to VA.
• Overview: The Overview tab provides you with a description of the claims process, spotlights each step, and explains that the process may return to a previous step if more information is needed.

You no longer have to contact a call center or regional office for claims information. The Claim Status Tool allows you to access important claim information whenever you need it. This tool is another step forward in VBA’s ongoing mission to support Veterans and their families. To learn more about using the Claim Status Tool, please visit the Claims Status page.