REM sleep behavior disorder (RBD), an uncommon sleep disorder that causes people to lash out in their sleep, is finally being studied in closer detail. A connection between RBD, PTSD, and TBIs has been reported in several studies. Because TBIs and PTSD are common conditions among veterans, many veterans may also experience RBD and want to know if it can be service connected for VA disability. However, it can be difficult to find information on how the VA handles or rates RBD.
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In this article about VA ratings for REM sleep behavior disorder:
What is REM sleep behavior disorder?
REM sleep behavior disorder, or RBD, is a parasomnia (a disruptive sleep condition). It causes a person to unknowingly act out negative behaviors they’re dreaming about while asleep.
The REM sleep cycle typically occurs about 90 minutes after falling asleep. Dreams occur in this sleep phase. For most people, dreams are functions of the mind and have no physical manifestation. However, it’s different for a person with RBD. Their muscle movement does not “turn off” during REM. They become physically agitated, actively and unknowingly moving their body in their sleep.
In some instances, their movements can be aggressive or violent, putting others around them at risk. A person with RBD may display behavioral symptoms during sleep, including kicking, punching, flailing their arms, and physically lashing out. After waking up, they remember details about what they were dreaming of but have no recollection of their physical movements.
These episodes can repeatedly happen throughout the night because they follow the normal REM sleep cycles. That means they can happen four times during a typical night’s sleep, but a person may also go as long as a week or month between occurrences.
REM sleep behavior disorder is most common among men over 50.
PTSD and TBIs in veterans
Post traumatic stress disorder (PTSD) is a mental health condition that is more common among veterans than the civilian population. About 6% of male veterans will have PTSD in their lifetimes. About 13% of female veterans will have the condition. Gulf War veterans in particular experience a higher rate of PTSD than other veterans.
PTSD is caused by experiencing or seeing a traumatizing, terrifying event. Symptoms include intrusive thoughts relating to the inciting event, feeling detached and hopeless, and trouble sleeping and concentrating.
TBIs, or traumatic brain injuries, are caused by some sort of injury or impact to the head or penetration of the skull. TBIs can cause a wide range of mood and behavioral issues. These issues include nerve damage, trouble speaking, hearing, and seeing, and, in more severe cases, can lead to seizures or comas.
Nearly half a million TBIs have been reported among U.S. military service members in the 21st century. Veterans may have experienced TBIs in combat or even training.
The link between PTSD, TBIs, and RBD
Evidence suggests a link between PTSD, TBI, and RBD, often occurring in individuals who recently experienced trauma. The report shows PTSD is a common factor in many veterans with REM sleep behavior disorder. This is with and without a traumatic brain injury. It also found REM sleep behavior disorder to be “significantly higher” among veterans than the civilian population.
Other studies have also found a link between TBI, PTSD, and REM sleep behavior disorder. While the VA has not recognized the connection between these conditions, if you are a veteran with a service-connected TBI or PTSD who later developed RBD, this research could help support your claim for increased compensation.
What is the VA rating for REM sleep behavior disorder?
Despite the growing research that connects TBIs, PTSD, and REM sleep behavior disorder, not much is known about how the VA handles RBD claims. This can be frustrating for veterans looking for information or case examples on VA ratings for the condition.
Because REM sleep behavior disorder is a parasomnia, much like sleepwalking and nightmares, the VA may rate it similarly. The VA rates similar sleep disorders using the General Formula for Mental Disorders as follows:
| Description | Rating |
|---|---|
| Total occupational and social impairment | 100% |
| Occupational and social impairment, with deficiencies in most areas | 70% |
| Occupational and social impairment with reduced reliability and productivity | 50% |
| Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily) | 30% |
| Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication | 10% |
| A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication | 0% |
PTSD and RBD
Veterans with service-connected PTSD who are also experiencing the symptoms of REM sleep behavior disorder could be owed more disability compensation from the VA.
Both conditions are rated using the same formula for mental disorders. The VA’s pyramiding rule prevents you from receiving benefits for the same symptoms twice. However, it is possible the VA has not included your RBD symptoms in your PTSD claim or mentioned them in your C&P exams. You may have never realized these symptoms could be related to your PTSD, and therefore service connected.
If you have both conditions, you may want to discuss whether they are connected with your healthcare provider. Including the symptoms of your RBD could lead to an increased mental health rating.
VA Rating for REM sleep behavior disorder secondary to TBI
The Schedule of Ratings for TBIs is well known for being complicated to understand. How the VA rates a TBI and what diagnostic codes it assigns depends on the residuals of the injury. Residuals can be emotional or behavioral, cognitive, or physical.
Emotional or behavioral residual TBI symptoms are rated using the same General Formula for Mental Disorders that is used when rating PTSD. Just like with PTSD, if your REM sleep behavior disorder is linked to your TBI but its symptoms aren’t included in your claim, you could be owed an increased rating.
If the residuals that are currently being rated for your TBI are cognitive or physical, you may especially want to discuss whether your RBD stems from your TBI with your healthcare provider.
An additional rating for RBD under the General Formula for Mental Disorders could help increase your combined rating. It could also help you qualify for TDIU if the combined effects of your TBI and sleep disorder make it difficult to hold down a job. Veterans receiving a 70% VA rating for REM sleep behavior disorder would be eligible for TDIU.
“They brought me from being stuck at 30%. Denial after denial. Finally rated at 70%. Appealed for total and unable to work disability since 2014. Without Woods and Woods, I would still be stuck at 30%.”
F.H.
How our VA disability lawyers can help
Woods and Woods has helped thousands of veterans get the VA benefits they deserve. We are familiar with how the VA works and how to create a case that gives you the best chance of winning. Call us for a free case evaluation to find out how we can help. If we take your case, you only pay if you win, and we never touch your future monthly checks.
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FREQUENTLY ASKED QUESTIONS
While there is not much information available about VA ratings for REM sleep behavior disorder, the VA will likely rate the condition similar to other sleep disorders. This would mean the condition would be rated under the General Formula for Mental Disorders.
Several studies have found a link between PTSD, traumatic brain injuries, and REM sleep behavior disorder (RBD). Veterans with service-connected TBI or PTSD who have developed RBD may be owed additional compensation from the VA for the symptoms of the condition.
