VIDEO: Sleep Disorders — How They Can Affect Your VA Disability Claim 

“Today we’re going to be talking a little bit about sleep disorders. My name is Zack Evans with Woods and Woods Attorneys in Evansville, Indiana.” 

Why does good sleep hygiene matter?  

“The first reasons good sleep hygiene matters are alertness and effectiveness. Sleep hygiene has an impact on your metabolism and your overall physical health. It also can impact your safety in the workplace. If you’re getting poor sleep and you’re not alert while you’re driving, it can be a danger to yourself and other motorists. If you’re not alert while you’re at work, you’re likely to suffer from lower effectiveness. 

“If you’re not getting good sleep, that can impact you physiologically. It can impact your hormone levels and it can impact the way your body fights infection. Sleep hygiene is something that regulates all of the body’s systems. If you get poor sleep, it’s a lot more difficult for you to be an effective person. It impacts everything. Sleep is the way for your body to recharge. Your mental health and your ability to maintain mood stability is greatly impacted by your sleep hygiene. 

“Even things like injury recoveries, which we wouldn’t automatically associate with something like sleep, can be greatly impacted by your sleep hygiene. What’s one of the things the doctor tells you after you have an operation or are in the middle of fighting an illness? The doctor will tell you, “Get plenty of rest. Drink a lot of water.” If you’re not getting rest, you’re not giving your body down time to fight an infection or to heal from an injury or a surgical procedure.” 

Service connecting narcolepsy 

“The first condition we’re going to be discussing today is narcolepsy. Narcolepsy is characterized by sudden, intense attacks of sleep onset. Often, these are unpredictable. Over time, this can lead to dangerous symptoms such as hallucinations. This is an extreme safety issue on the job. 

“Think about a retired veteran who suffers from narcolepsy and is an over-the-road truck driver. This would be fatal to their CDL license. Narcolepsy onset usually occurs between 10 and 30 years old. Think about the significance of that. Usually, that’s the age that someone is serving in the military, so it’s not uncommon that when we do see a narcolepsy case, the onset occurs while they’re serving in the United States Armed Forces. 

“The exact cause of narcolepsy is unknown. Research has not gotten us far enough to tell us what the true root cause of this condition is. It could be multi-factorial.

“What we’re going to be looking for is problems in service. We’ll be looking through your file and looking for service treatment records, or STRs as we call them. When we’re scanning your service treatment records, we’re going to be looking for disciplinary violations. Were you falling asleep in the mess hall? Were you late to Reveille? Did you fall asleep on watch? These disciplinary records from command can be a good signpost that we found something related to a sleep disorder. And if it’s uncontrolled sleep onset and you were later diagnosed with narcolepsy after you left service, that’s good evidence of onset. 

“Narcolepsy is a somewhat rare disorder, but you are not alone. Vets can win service connection for this and if that happens, from my perspective, that’s the ballgame on TDIU, because you’re nearly unable to work in any capacity. 

“It doesn’t matter whether it’s a factory and you fall asleep on the production line, which for obvious reasons is a danger, or if you’re in an office setting and you cannot stay awake at a keyboard at a computer.” 

Service connecting insomnia 

“The next condition we’re going to be discussing is insomnia. This is a chronic inability to fall asleep. This condition is a big one, and I see this a lot in my clients’ cases. 

“Insomnia is rated under the diagnostic code for mental health symptoms. It’s considered a symptom or a complication of an underlying mental health disorder. Sometimes it can be rated as its own condition. PTSD, depression, and anxiety can sometimes all present with insomnia as a component of the symptom complex.  

Unfortunately, those who are unable to maintain healthy levels of sleep or stay asleep for long periods of time so that the brain can get enough REM sleep to recharge, end up in a vicious cycle of worsening mental health symptoms. Whenever I’m viewing service treatment records or I’m viewing a case file, what I’m looking for with insomnia onset is paths to direct service connection. I’m looking for long shifts, I’m looking for long watches. I’m looking for interrupted sleep. Were you interrupted by submarine alarms? Were you interrupted by security alarms or air raid alarms on foreign operating bases?  

“These types of things can interrupt your circadian rhythm, and over a long period of time can greatly impact your ability to return to baseline even once you leave the military and attempt to return to civilian life. 

“Aside from direct theories of service connection, we also look for ways to identify potential secondary causes of insomnia. Good examples of this include tinnitus, orthopedic injuries, ailments, pain, and mental health disorders, as I’ve discussed previously. Think about lying awake and ruminating in bed at night, or PTSD sufferers who are constantly playing over their period of trauma from their time in service.  

“Another pretty frequent cause of insomnia is nocturia. This could be a result of kidney issues or certain types of cancer like prostate cancer, where you have to wake up in the middle of the night to go to the bathroom. If this happens enough, this can really impact your sleep hygiene.” 

Service connecting sleep apnea 

“Another sleep disorder that we see commonly in veterans’ claims files is sleep apnea. Sleep apnea is known as the silent killer, and I’m going to get into why that is in just a moment. 

“Have you been told that you snore a lot? That you snore loudly? That you stop breathing at night? Do you wake up sweating? Are you out of breath? Do you have nightmares about running? Being chased? Being underwater? Do you wake up with morning headaches? 

“These could all be signs that you suffer from sleep apnea. Most people who suffer from sleep apnea are not aware of it themselves. The key to why sleep apnea is so dangerous is blood oxygen saturation. Blood oxygen saturation is how much oxygen, whenever you take a deep breath, your blood is carrying. Whenever you stop breathing during sleep, your blood oxygen saturation drops, and this is extremely dangerous for the body systems, including the heart and the brain. 

“There are two types of sleep apnea: central and obstructive. Central sleep apnea is related to something that occurs in the brain where your brain essentially forgets to or does not tell your body to take a breath. We see these commonly in TBI patients. Think about veterans who have been exposed to IED blasts in combat zones.  

“You also see it in stroke and tumor patients, and we see stroke veterans who commonly suffer from that cardiovascular ailment as a result of complications of diabetes and hypertension coming from their Agent Orange exposure in Vietnam. 

“Additionally, if you suffer from a brain tumor, think about a Vietnam veteran also exposed to Agent Orange who develops a glioblastoma. These are the types of things that can lead to a central sleep apnea. They’re somewhat rare, but they do occur and vets are service connected for them. 

“Obstructive sleep apnea affects veterans, and it is by far the most common that we see in veterans’ case files. Obstructive sleep apnea is caused whenever you suffer an airway collapse. Usually, this happens when you’re lying on your back in bed. The muscles in your throat around your airway will relax and allow the airway to close. If it’s closed for a long enough period of time and you’re not able to take a breath through this obstruction, your body will be flooded with stress hormones to wake you from your REM-level sleep just enough to gasp for that breath of air.  

This is why spouses report to us commonly that their partner has stopped breathing in the middle of the night. So, there might be a lot of loud snoring and all of a sudden it goes silent, and then they wake, and they gasp for air. That’s your brain flooding your body with stress hormones to wake you to exhaust that oxygen debt. So, this gets back to the blood oxygen saturation that we were talking about earlier. The only way for your brain to wake you up and rouse you from that state of relaxation and to clear that obstruction is to flood you with stress hormones. 

“If your spouse is telling you that you stop breathing or that you snore very loudly during your sleep, you really need to get a diagnosis. You need to get a sleep study. 

“When you get a sleep study, it’s not as scary as it sounds. You go to a facility, a clinic, or some of them can even be performed in the comfort of your own home. They might set up a camera and put some diodes on you, or they might clip your little finger with a monitor, and what they’re doing is they’re measuring your blood oxygen saturation. They’re measuring your breathing and they’re measuring your heart rate. They’re trying to figure out what’s happening to you during sleep because there are certain hallmarks of brain activity, pulse rates, and blood oxygen saturation that occur with sleep apnea patients.” 

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How medicine affects your sleep apnea VA claim 

“The next thing you need to do is make a meds list. Don’t leave anything out. There are a lot of medications out there on the market that can either cause or significantly worsen sleep apnea. Good examples of these are mental health medications that have a sedative effect and especially opioid medications that are used for pain or orthopedic injuries. 

“Think about the number of veterans out there that have knee problems, knee replacements, hip problems, or back problems, and they have to take some type of opioid medication to get through the day and to get their day-to-day tasks done. This medication has an effect on the brain that suppresses that stress response. So, it’s more and more difficult for your brain to wake the body up to retire that oxygen debt. The reason this is dangerous goes back to blood oxygen saturation. Your body has to dip to a lower and lower level of blood oxygen saturation for your brain to wake you up. So, it takes more and more cortisol — it takes more and more of those stress hormones. 

“The negative impact of sleep apnea is much greater if you’re on some of these medications. Make a list and make sure that you report that to your doctor and when you call us, make sure you tell us about all of these medications so that we have a full picture of what could be causing your sleep apnea or making it worse.” 

VA rating for sleep apnea 

“From a ratings perspective, the reason that sleep apnea is so important for veteran claimants when it comes to disability payments and disability claims, is the amount that a sleep apnea rating is worth.” 

Getting a 30% VA rating for sleep apnea 

“The two most common ratings for sleep apnea are 30% and 50%. A 30% will be awarded for something called persistent daytime hypersomnolence. That’s a fancy way of saying you’re tired all the time. If you wake up and you’re feeling unrefreshed or you have those headaches in the morning, or let’s say for whatever reason, you just feel like you’re a step or two slower consistently. Then you may qualify for a 30% rating.  

“A good way of finding this out is by doing a self-test. The test is called the Epworth Sleep Scale. It’s a simple battery of questions that asks you if you’re sitting, reading, sitting in a car, having a conversation with someone, and how likely you are to nod off. It’s on a scale of not likely to very likely. Then you’ll get a score at the end of that, and that tells you how tired you are throughout the day. So, that’s the type of battery of questions that you can use to assess your level of fatigue throughout the day. That is something that we use to help our clients assess if  

they need to go get a sleep study or if they need to go talk to a doctor. It can potentially assess what the condition is worth to you.” 

 
Getting a 50% rating for sleep apnea 

“The second rating level that we see very often is the 50% rating. The 50% rating is associated with a diagnosis of sleep apnea with a sleep study, and a prescription of a CPAP, which is a Continuous Positive Airway Pressure Device. That is a mask, or sometimes a canula just on the nose, and there’s a gentle puff of air that’s constantly pushed into your body. It holds your airway open so that you never experience that oxygen debt while you sleep. 

“The effect of that is that you are not being roused from sleep by your brain. You’re not being interrupted. Your REM sleep stays consistent, and your sleep hygiene is maintained. The problem with CPAP usage is that some veterans find it extremely difficult to use, especially veterans that have comorbid mental health disorders. It can easily lead to feelings of panic or claustrophobia, and sometimes it’s just uncomfortable to wear and can make the situation worse in other ways. It can impact your sleep hygiene in ways that weren’t necessarily anticipated whenever it was first prescribed to you.” 

How Woods and Woods can help 

“If you suffer from a sleep condition, give us a call or go online. My name is Zack Evans at Woods and Woods. I’d love to help you out.”