Active duty military members have been shown to be more susceptible to sleep disorders, such as sleep apnea. The causes of sleep apnea in military members and Veterans can be related to toxin exposure (such as smoke from burn pits), trauma, both physical and mental, weight gain secondary to disabilities that prevent exercise, among other things.
We know that sleep apnea can be caused or related to other conditions common to Veterans, but what about the conditions sleep apnea causes? Can a Veteran who is service connected (i.e., receiving benefits) for sleep apnea file a claim for other secondary conditions? The answer is yes, and we will discuss some of the conditions caused by sleep apnea below:
- Mental Health
- Erectile Dysfunction
Mental Health Secondary to Sleep Apnea
It’s no surprise that lack of sleep can cause mental health problems. Anyone who has ever slogged through a day of work after spending a night caring for a sick child can attest to that. However, sleep apnea appears to be linked to more than just transitory or situational depression. Studies have shown sleep apnea to be associated with several diagnosable mental health conditions including clinical depression, anxiety, bipolar disorder, and even schizophrenia.
Sleep apnea can also worsen pre-existing mental health conditions, particularly attention deficit disorder. Disrupted sleep is known to wreak havoc on a person’s attention span, so the effect on a person with an attention disorder can be even greater. People with mild depression can suddenly find that sleep apnea has worsened their symptoms to include severe symptoms such as violent behavior or even suicidal ideation.
What’s more, it appears that sleep apnea can increase one’s susceptibility to developing post-traumatic stress disorder. While sleep apnea cannot be the cause of post-traumatic stress disorder, it seems to lower a person’s mental defenses, making it more likely for the disorder to develop after experiencing a stressful incident such as a firefight or improvised explosive device (IED) detonation. Because of this, post-traumatic stress disorder and sleep apnea are considered comorbid, meaning that they frequently exist together regardless of which one caused the other or whether they were both caused by an outside influence.
Hypertension Secondary to Sleep Apnea
Having obstructive sleep apnea increases the risk of developing hypertension. This is particularly true if the condition goes untreated with a CPAP machine. The increase in hypertension comes from the drop in blood oxygen levels that occur due to sleep apnea.
Longstanding hypertension can lead to heart failure. Medical studies have found that most people with heart failure have a history of hypertension. Conversely, the absence of hypertension in middle age is associated with a lower risk of heart failure. Through this link, sleep apnea can effectively lead to heart failure as a result of hypertension.
Hypertension also increases the risk of stroke, which is another leading cause of death and long-term disability. High blood pressure damages the arteries throughout the body over time, which means they can burst or clog more easily. Weakened arteries inside the brain from high blood pressure greatly increase the chances of having either an ischemic (clot) or hemorrhagic (burst) stroke.
Headaches Secondary to Sleep Apnea
The American Migraine Foundation has reported that people with migraines are between 2 and 8 times more likely to experience sleep disorders than the general public. There are several factors contributing to the increased likelihood. Sleep apnea has been identified as a risk factor for daily chronic headaches, particularly those that occur in the morning. Additionally, irregular sleep is a common trigger for migraines, meaning that those people susceptible to migraines will experience them far more often if they suffer from sleep apnea.
Diabetes Secondary to Sleep Apnea
While diabetes is usually considered to be linked to sleep apnea through obesity, the two conditions may be more closely related than previously explored. Recent studies have reported that sleep apnea alters glucose metabolism, promotes insulin resistance, and may even cause type 2 diabetes. Even if sleep apnea does not cause diabetes per se, it has been shown to increase the severity of the condition.
Erectile Dysfunction Secondary to Sleep Apnea
Many men suffering from sleep apnea also find that they develop a loss of sexual function. A German study in 2009 found that the majority of male participants with sleep apnea also had erectile dysfunction. While studies have not been able to explain why the two conditions are linked, it appears that sleep deprivation may be the key factor. Men’s bodies produce insufficient testosterone when sleep deprived, which results in decreased sexual function.
How Berry Law Can Help
The experienced VA Appeals lawyers at Berry Law are committed to helping fellow Veterans in their fight for disability compensation. If you have been denied disability benefits for a disability secondary to sleep apnea or have been given an unsatisfactory rating, we can help you appeal. Contact Berry Law today for a free case evaluation.
— Update: 05-01-2023 — cohaitungchi.com found an additional article VA Disability Ratings for Hypertension and Sleep Apnea from the website cck-law.com for the keyword va hypertension secondary to sleep apnea.
To understand VA ratings for hypertension and sleep apnea, it is important to understand the conditions and how they work together.
What is Hypertension?
Hypertension means high blood pressure. According to the Centers for Disease Control and Prevention (CDC), blood pressure is the pressure of blood pushing against the walls of your arteries (i.e., blood vessels that carry blood from the heart to other parts of the body). Blood pressure is measured using two numbers:
- Systolic blood pressure – measures the pressure in your arteries when your heart beats
- Diastolic blood pressure – measures the pressure in your arteries when your heart rests between beats
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Generally speaking, a normal blood pressure level is less than 120 systolic and 80 diastolic.
High blood pressure, also referred to as hypertension, is blood pressure that is higher than normal. Blood pressure levels change naturally throughout the day based on your activities; however, having blood pressure that measures consistently above normal may result in a diagnosis of hypertension. This condition is concerning because it places people at higher risk for other health problems, including heart disease, heart attack, and stroke.
Hypertension is typically diagnosed by healthcare providers after reviewing your systolic and diastolic blood pressure levels and comparing them to levels found in certain guidelines. Currently, the Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2017) adheres to the following measurements as they pertain to diagnosing hypertension:
- At-Risk (prehypertension) – systolic: 120-129; diastolic: less than 80
- High Blood Pressure (hypertension) – systolic: 130 or higher; diastolic: 80 or higher
However, VA defines hypertension as 90 or higher for diastolic and 160 or higher for systolic. VA ratings are given at 10, 20, 40, and 60 percent based on these numbers.
Hypertension usually has no warning signs or symptoms, and many people may be unaware that they have this condition. Essentially, taking your blood pressure is the only way to know whether you have high blood pressure.
Hypertension is usually caused by unhealthy lifestyle choices, such as not getting enough regular physical activity and exercise. However, other health conditions, including diabetes and obesity, can also cause or increase the likelihood of hypertension.
In some cases, people with hypertension can lower their blood pressure into a healthy range by making lifestyle changes (e.g., getting 150 minutes of physical activity each week, not smoking, eating a healthy diet with limited sodium and alcohol, keeping a healthy weight, managing stress).
On the other hand, some people need to take medicine to manage their blood pressure. Examples of medications for hypertension include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers.
How VA Rates Hypertension
VA rates hypertension the same whether service connection is established directly, presumptively, or secondarily due to sleep apnea. Specifically, VA uses 38 CFR § 4.104 – Schedule of Ratings, Cardiovascular System, Diagnostic Code 7101. The rating criteria are as follows:
- 60% – diastolic pressure predominantly 130 or more
- 40% –diastolic pressure predominantly 120 or more
- 20% –diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more
- 10% –diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control
What is Sleep Apnea?
Sleep apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted during the course of the night. There are three main types of sleep apnea, including the following:
- Obstructive Sleep Apnea – the most common form of sleep apnea; occurs when the throat muscles intermittently relax and block your airway during sleep
- Central Sleep Apnea –occurs when your brain does not send the proper signals to the muscles that control breathing
- Complex (Mixed) Sleep Apnea Syndrome –occurs when someone has both obstructive sleep apnea and central sleep apnea
Signs and Symptoms of Sleep Apnea
The signs and symptoms of these three types of sleep apnea tend to overlap, sometimes making it difficult to determine which type you have. Symptoms can include:
- Loud snoring
- Gasping for air during sleep
- Awakening with a dry mouth
- Morning headache
- Hypersomnolence, or excessive daytime sleepiness
- Difficulty concentrating
Diagnosing Sleep Apnea
To confirm a sleep apnea diagnosis for VA disability compensation purposes, VA requires that a sleep study be conducted.
If you have previously been diagnosed with sleep apnea, but have not undergone a sleep study, VA will not consider that diagnosis enough evidence to verify eligibility for compensation.
VA may then rate the condition at 0, 30, 50, or 100 percent, depending on severity.
Treating Sleep Apnea
For mild cases of sleep apnea, doctors may suggest lifestyle changes such as losing weight or quitting smoking, if applicable.
In more serious cases, doctors may prescribe the use of a continuous positive airway pressure (CPAP) machine. A CPAP machine delivers air pressure through a mask while you sleep that is somewhat greater than that of the surrounding air. This allows your upper airway passages to remain open, thereby preventing apnea and snoring.
Service Connection and VA Ratings for Sleep Apnea
To establish service connection for sleep apnea on a direct basis, veterans must show evidence of the following:
- A current diagnosis of sleep apnea, as confirmed by a sleep study;
- An in-service event, injury, or illness; and
- A medical nexus (i.e., link) between their sleep apnea and the in-service event, injury, or illness
Once service connection is awarded, sleep apnea is then rated under 38 CFR § 4.97, Diagnostic Code 6847 – Sleep Apnea Syndromes (obstructive, central, mixed). Veterans are assigned a 0, 30, 50, or 100 percent rating depending on the severity of their condition. The rating criteria are as follows:
- 100% – chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy, or cor pulmonale (i.e., the enlargement or failure of the right side of the heart due to lung disease)
- 50% – if a veteran requires the use of a breathing assistance device, such as a CPAP machine
- 30% – the veteran is experiencing persistent daytime hypersomnolence (i.e., a condition characterized by chronic daytime sleepiness that does not improve even with sufficient sleep)
- 0% – if the veteran’s condition is asymptomatic (i.e., condition that is not producing symptoms) but has a documented sleep disorder
Relationship Between Hypertension and Sleep Apnea
According to the American Heart Association journals and other research, obstructive sleep apnea is highly relevant to patients with hypertension.
- An estimated 50 percent of patients with hypertension also have obstructive sleep apnea.
- Obstructive sleep apnea represents the most prevalent secondary contributor to hypertension.
- Another study found that people with untreated sleep apnea were 6 times more likely to experience cardiovascular complications, such as hypertension.
Researchers believe that when breathing is restricted, oxygen levels in the body decrease, thereby causing an increase in blood flow. Increased blood flow places additional pressure on the blood vessels’ walls, ultimately causing higher-than-normal blood pressure levels. Overall, there is a clear causal relationship between sleep apnea and the development of hypertension.
Forms of Service Connection for Hypertension
Direct Service Connection
Similar to sleep apnea claims, veterans must establish the following three elements when applying for direct service connection for hypertension: (1) a current diagnosis of hypertension; (2) evidence of an in-service event, injury, or illness; and (3) a medical nexus linking the diagnosis to the in-service occurrence. However, direct service connection is not the only way in which veterans can be compensated for hypertension. Instead, veterans may be eligible for service connection for hypertension on a presumptive or secondary basis as well.
Presumptive Service Connection
VA presumes certain conditions are related to veterans’ military service. In this case, service connection will be awarded without having to provide a medical nexus opinion. For hypertension, VA presumes service connection if veterans receive a diagnosis within one year of discharge from military service and the condition is rated at least 10 percent disabling.
Secondary Service Connection
A secondary service-connected condition is one that results from a condition that is already service-connected. In claims for secondary service connection, proving a medical nexus is especially important. With regard to the conditions discussed herein, veterans may be eligible for service connection on a secondary basis for hypertension as due to sleep apnea. That is, if a veteran is service-connected for sleep apnea and later develops hypertension, they should subsequently be service-connected for hypertension based on the medical evidence outlined above.
To apply for secondary service connection for hypertension, veterans can file a claim the same way they would file an initial claim for service-connected compensation.
How to Prove Hypertension Secondary to Sleep Apnea
To establish a nexus between your already service-connected sleep apnea and your hypertension, you will need to submit evidence proving the link between your two conditions.
Specifically, you will need to demonstrate two things to VA to be granted service connection for a secondary condition:
- A diagnosis for your secondary condition; and
- Medical evidence showing the link between your service-connected condition and secondary condition.
Types of Evidence to Submit to Help Prove the Connection
- Doctor’s Note, or Medical Nexus—It can be helpful to have a doctor submit a letter stating that there is a causal relationship between your sleep apnea and your hypertension. Your doctor should state that they believe your hypertension is at least as likely as not caused by your sleep apnea.
- Relevant Medical Records—Relevant medical records can help show the connection between the two conditions and prove that your hypertension is linked to your sleep apnea.
- Medical Articles—Articles written for medical journals or other reputable sources can serve as evidence to support the causal relationship between sleep apnea and hypertension.
- Lay Evidence—Lay evidence refers to statements that are written by the veteran, the veteran’s family, or fellow service members, which speak to the veteran’s medical conditions or their service. Lay evidence can help support a claim for hypertension secondary to sleep apnea, as the veteran can speak to their experience with both conditions. Importantly, however, the person writing lay evidence should only speak to what they know. This means that the veteran cannot necessarily submit a medical opinion saying that their sleep apnea directly caused their hypertension, but they can speak to how both conditions affect them.
Was Your VA Disability Claim Denied?
The veterans’ benefits attorneys and advocates have decades of experience successfully representing veterans and their families before the Department of Veterans Affairs, the Court of Appeals for Veterans Claims, and the Federal Circuit. If your VA claim has been denied, we may be able to help. Contact us today at 800-544-9144.
— Update: 06-01-2023 — cohaitungchi.com found an additional article The Link between Sleep Apnea and Hypertension from the website www.hillandponton.com for the keyword va hypertension secondary to sleep apnea.
Are you suffering from obstructive sleep apnea syndrome and hypertension? Recently, it has been widely accepted by the medical community that obstructive sleep apnea (OSA) is a risk factor for the development of hypertension, also known as high blood pressure. You may be among the more than 18 million Americans that have been diagnosed with sleep apnea, but may be unaware that you have developed hypertension as a complication of obstructive sleep apnea.
According to the Centers for Disease Control and Prevention, there is a high prevalence of obstructive sleep apnea among veterans. This may be because veterans are disproportionately affected by risk factors that lead to obstructive sleep apnea, like psychological distress, mental illness, and respiratory conditions. Many veterans, particularly Gulf war veterans, develop respiratory conditions like COPD, asthma and chronic bronchitis, due to exposure to chemicals and other toxic substances. This makes veterans more susceptible to developing obstructive sleep apnea.
In order to better understand what this could mean for your VA claim, we must first discuss the relationship between obstructive sleep apnea and hypertension.
What Is High Blood Pressure?
Blood pressure is the force that the blood exerts on the walls of the blood vessels. According to the American Heart Association, high blood pressure, or hypertension, occurs when this force is consistently too high. This is measures by the relationship between systolic blood pressure, the force that occurs each time the heart pumps our blood, and diastolic blood pressure, the force that occurs between heartbeats.
High blood pressure occurs when the systolic pressure is 130 or higher and the diastolic pressure is 80 or higher (130/80 mm Hg). This is classified as stage 1 hypertension. The American College of Cardiology recently lowered the for stage 1 hypertension systolic limit from 140 to 130.
High blood pressure is a risk factor for heart disease and heart failure, so cardiology specialists will monitor hypertensive patients for signs of cardiovascular disease. Individuals with hypertension might take medication for their condition and track their levels through techniques like ambulatory blood pressure monitoring. Cardiology specialists will also recommend lifestyle changes like weight loss and a healthy diet for blood pressure reduction. The Journal of the American Medical Association (JAMA) frequently publishes recommendations for blood pressure reduction and control.
Some individuals may have a severe type of high blood pressure called resistant hypertension. This condition is hypertension that stays high despite the use of several antihypertensive medications.
What Is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is a sleep disorder in which breathing stops temporarily throughout the sleep cycle. Experts estimate that of the general population of the United States, about 22 million individuals are living with OSA. Out of these individuals, about 80% of the mild to moderate cases are undiagnosed. Breathing can stop for a few seconds or several minutes. These episodes of sleep apnea can occur a few times or dozens of times.
It is important to note that we are only discussing obstructive sleep apnea at the moment. This is because hypertension is only linked to obstructive sleep apnea and not the other kind of sleep apnea – central sleep apnea.
Obstructive sleep apnea occurs when the muscles in the back of the throat and tongue relax. Consequently, blocking your airway and preventing breathing from happening. Episodes of obstructive sleep apnea typically end with the person waking up briefly in order to reopen his or her airway.
Some common symptoms of obstructive sleep apnea include:
- Loud snoring
- Coughing, gasping or choking
- Excessive daytime sleepiness
- Observable episodes of stopped breathing
- Sore throat or dry mouth
- Nighttime sweating
- Mood changes and difficulty concentrating
- Morning headaches
Diagnosis of obstructive sleep apnea generally requires a sleep study, which often uses a technique called polysomnography to measure breathing. If detected, there are several options for the treatment of OSA. Specific treatments will depend on OSA severity. Specialists measure OSA severity on a scale called the hypopnea index. The index measures the number of apneas that occur per hour.
Many people with obstructive sleep apnea need to use a continuous positive airway pressure (CPAP) machine during the night. They might use a nasal continuous positive airway pressure device or one that covers the mouth as well. CPAP therapy machines deliver air pressure into the nose and mouth to keep the air passages open during sleep.
While sustained CPAP treatment can be effective for many OSA patients, severe OSA may require treatments like surgery. Severe OSA is when the patient has 30 or more apneas per hour of sleep. This is particularly true when they don’t respond to airway pressure treatment.
What Is The Link Between Obstructive Sleep Apnea and Hypertension?
According to the American Heart Association, obstructive sleep apnea is implicated as a factor in the development of hypertension. Recent studies show that 50% of patients with hypertension also have associated obstructive sleep apnea. The Wisconsin Sleep Cohort study, which was a long-term sleep heart health study, also found that individuals with untreated severe sleep-disordered breathing were 2.6 times more likely to experience coronary heart disease or heart failure than adults without this disorder.
So, there is evidence that sleep apnea affects blood pressure. In individuals without these conditions, blood pressure naturally dips at night. Studies show that some people with OSA don’t experience this dip in blood pressure. These individuals are referred to as “nondipping.” The prevalence of nondipping OAS patients may indicate a link between high blood pressure and obstructive sleep apnea.
Obstructive sleep apnea impairs sleep quality by shortening sleep intervals. This causes elevated blood pressure. Why is this? Obstructive sleep apnea causes disrupted or limited breathing while you are asleep. When breathing is limited, oxygen levels in the body can drop. This drop in blood oxygen levels causes an increase in blood flow. Increased blood flow puts pressure on the blood vessels’ walls which causes elevated blood pressure levels. This suggests a connection between sleep apnea and blood pressure spikes.
Blood pressure levels are not just elevated at night. In many people that have obstructive sleep apnea, blood pressure remains elevated during the daytime when breathing is normal. Also, consider how proper diet and regular exercise help to control normal blood pressure. Obstructive sleep apnea is often accompanied by respiratory conditions, like asthma, shortness of breath, and other respiratory problems that may make it difficult to exercise regularly. As a result, blood pressure levels may be adversely affected.
What Does This Mean For My Disability Claim?
If you are seeking VA benefits for high blood pressure and sleep apnea, you need to file a claim for secondary service connection to receive compensation for both of these conditions. Secondary service connection is when a service-connected condition or injury causes a new condition or aggravates a non-service connected disability. In this case, if a veteran is already service-connected for obstructive sleep apnea and later develops hypertension because of their obstructive sleep apnea, they can file a claim for hypertension secondary to obstructive sleep apnea. To receive compensation for this secondary condition, you need a current diagnosis of hypertension.
For VA purposes, elevated blood pressure, or hypertension, is considered a systolic blood pressure reading of 160 or more and a diastolic pressure reading of 100 or more, i.e. 160/100 mm Hg. Hypertension must be confirmed by blood pressure readings taken two or more times on at least three different days. If secondary service connection is granted for your hypertension disability, blood pressure readings help determine both the severity of your hypertension and the rating percentage that the VA could potentially assign to your claim.
When making an association between sleep apnea and hypertension for a VA claim, evidence is needed to support your claim. There are several kinds of evidence that can be used to support this secondary claim. Service treatment records and medical records from the VA or private medical facilities detailing your condition may be helpful. Medical articles and literature that discuss the relationship between obstructive sleep apnea and high blood pressure are also beneficial. A favorable medical opinion from a doctor, such as a cardiology specialist, that states that your hypertension is caused by, or a complication of, obstructive sleep apnea may also be very beneficial for your claim. You can file a claim for hypertension as secondary, or as a complication of, obstructive sleep apnea by visiting with the Veteran’s Administration by visiting their website.
The attorneys at Hill & Ponton are also available to help you with your claim. Our attorneys are dedicated to working with former service members, so veterans can obtain the disability compensation they deserve. If your VA claim has been denied, contact us today for a free case evaluation.association between sleep apnea and hypertension