Nexus letters are essential to winning a claim for sleep apnea VA benefits. If you don’t have a solid nexus letter to connect sleep apnea to military service, you could face denied claims, time-consuming appeals, and thousands of out-of-pocket dollars in sleep apnea treatment annually. But getting a VA sleep apnea nexus letter that works isn’t easy.
Veterans must meet VA requirements when filing a VA sleep apnea benefits claim. We’ve prepared this quick guide to sleep apnea nexus letters to help simplify the process.
Proving Sleep Apnea Is Military Service Related
To win a VA benefits claim for sleep apnea, veterans must show that either:
- Sleep apnea developed during service, OR
- Sleep apnea developed after service because of something that occurred during service (or something that is already service connected)
In other words, sleep apnea benefits are won through direct or secondary service connection. Proving direct service connection can be relatively straightforward. Veterans can show that sleep apnea started during service by providing military medical records, performance records, and other evidence recorded during service.
Explaining sleep apnea on a VA claim via secondary service connection is more challenging. Here, veterans must provide a written opinion from a medical professional. This written opinion will compare and contrast findings from the scientific literature with the veteran’s medical history and current diagnoses to show that their sleep apnea was likely caused by military service.
VA Ratings for Secondary Sleep Apnea
Most veteran sleep apnea benefits are obtained through secondary service connection, including diagnoses of obstructive sleep apnea (OSA), central sleep apnea (CSA), or complex sleep apnea.
Under Diagnostic Code 6847, the VA offers secondary sleep apnea ratings of 0% to 100%.
- 0 percent: Documented sleep disorder, no symptoms of sleep apnea
- 30 percent: Overtired during the day (hypersomnolence), does not improve with extended sleep
- 50 percent: Require sleeping device–CPAP, BiPAP, NIPPV, NIV, MAD, APAP, nasopharyngeal stent, nasal dilator, tongue-retaining mouthpiece, genioglossal nerve stimulation implant—or other device to assist breathing during sleep due to sleep apnea
- 100 percent: Chronic respiratory failure, including carbon dioxide retention, cor pulmonale, or tracheostomy
Total Disability Individual Unemployability (TDIU) benefits for sleep apnea are also available. Combining your sleep apnea rating with other disability ratings may take you to a 100% total disability rating or raise your combined rating to 70 percent, in which case you would qualify for TDIU benefits if you are unable to sustain a gainful occupation due to your service-connected disabilities.
What Health Conditions Can Cause Sleep Apnea?
To obtain secondary service connection for sleep apnea, most veterans will associate the sleep apnea with a current service-connected health condition. Sleep apnea nexus letters can function to link several service-related conditions to sleep apnea, including:
- Sleep apnea secondary to post-traumatic stress disorder (PTSD)
- Sleep apnea secondary to tinnitus
- Sleep apnea secondary to asthma
- Sleep apnea secondary to depression
- Sleep apnea secondary to allergic rhinitis
- Sleep apnea secondary to obesity
- Sleep apnea secondary to sinusitis
- Sleep apnea secondary to adjustment disorder
- Sleep apnea secondary to generalized anxiety disorder
For example, a veteran may be service-connected for obesity due to mental health conditions or physical injuries acquired during military service. Because obesity is associated with the development of obstructive sleep apnea, a veteran with service-connected obesity can obtain secondary service connection for sleep apnea. In most cases, obesity results from something that is service connected, which in turn leads to sleep apnea. For instance, a psychiatric condition and the medication used to treat it leads to weight gain and then sleep apnea.
Proving Your PTSD Caused Sleep Apnea
The most common way veterans obtain sleep apnea benefits is through secondary service connection to PTSD. Numerous studies have demonstrated a causative link between sleep apnea and PTSD among veterans.
Some of the more popular citations for sleep apnea secondary to PTSD include:
- Prevalence Of Obstructive Sleep Apnea in Patients with Post-traumatic Stress Disorder and Its Impact on Adherence to Continuous Positive Airway Pressure Therapy: A Meta-Analysis
- A Narrative Review of the Association between Post-Traumatic Stress Disorder and Obstructive Sleep Apnea
- Obstructive Sleep Apnea and Post-traumatic Stress Disorder among OEF/OIF/OND Veterans
To prove to the VA that your sleep apnea was caused by service-connected PTSD, you need a sleep apnea nexus letter tailored to your specific symptoms and treatment needs. The medical expert who writes this nexus letter will describe to the VA why they believe that your PTSD either caused or aggravated your sleep apnea. The nexus doctor may include evidence like scientific literature citations, personal medical records, military records, and other documents to help link your sleep apnea to PTSD.
Disability Benefits Questionnaire for Sleep Apnea Secondary to PTSD
Veterans should fill out the sleep apnea disability benefits questionnaire (DBQ) and submit this along with the nexus letter to the VA. The sleep apnea DBQ provides an organized space for veterans to describe the severity of their sleep apnea, list their symptoms, and explain possible connections to existing disabilities.
The VA wants to see a specific type of language and evidence in both the DBQ and nexus letter. Therefore, most veterans will consult with an experienced veterans’ disability lawyer and medical expert (usually supplied by the veteran’s disability lawyer) in preparing their sleep apnea claim.
C&P Exam for Sleep Apnea Secondary to PTSD
Before you can file a claim for sleep apnea secondary to another health condition, you must get a sleep apnea diagnosis. Veterans are diagnosed with sleep apnea through a sleep test or “polysomnography study,” which evaluates your breathing patterns, heart rate, oxygen saturation, and other vitals during sleep. VA provides C&P exams for sleep apnea that can be performed in a sleep lab or by supplying equipment for you to use at home. Veterans can also use their private physician to obtain a sleep apnea diagnosis.
A C&P exam can also evaluate causation, providing an opinion on any potential link between your sleep apnea and another condition like PTSD. However, the VA C&P exam may be biased, as the VA isn’t necessarily interested in handing out more money to veterans.
When trying to prove secondary service connection for sleep apnea, veterans should contact a private doctor to provide an unbiased nexus letter.
Service Connecting Other Conditions Secondary to Sleep Apnea
The prolonged oxygen deprivation and sleep deprivation caused by sleep apnea can cause other health problems that the veteran can claim secondary to sleep apnea, including:
- Chronic Migraines
- Acid Reflux (GERD)
- Atrial Fibrillation
Once you get service connected for sleep apnea, you may be able to connect other health conditions to sleep apnea to increase your VA benefits further.
How to Write a Sleep Apnea PTSD Nexus Letter
In general, veterans cannot write their own nexus letters, unless they are a trained medical practitioner. A certified medical expert must write the nexus letter (also called an Independent Medical Opinion or IMO) to establish a legitimate connection between sleep apnea and PTSD for VA benefits. Finding such doctors can be challenging but there are providers that are experienced with the VA system.
In writing a sleep apnea secondary to PTSD nexus letter, the contents must be tailored to the individual veteran, reference peer-reviewed scientific literature showing a link between sleep apnea and PTSD, and include a medical expert opinion connecting the literature findings to the veteran’s conditions.
For example, a sleep apnea PTSD nexus letter should include:
- Affirmation of current sleep apnea (active pathology)
- Affirmation of PTSD
- Thorough review of veteran’s VA claims files
- Careful review of medical documents from before, during, and after service
- Qualifications or license to evaluate sleep apnea
- Conclusion that sleep apnea was “at least as likely as not” caused by PTSD
- Detailed rationale for this conclusion based on the evidence presented
- Objective discussion of any factors that do not support a link between PTSD and sleep apnea
- Mention that the claims file was reviewed
Medical doctors with extensive experience serving as experts in legal proceedings, particularly VA legal proceedings, understand how to include each factor the VA requires to support a veteran’s claim for sleep apnea secondary to PTSD.
How Much Do Sleep Apnea Nexus Letters Cost?
On average, a sleep apnea nexus letter from a medical expert specializing in legal proceedings and VA claims can cost upwards of $1,500. This is why most veterans work with a veterans’ disability lawyer.
Top-notch attorneys who assist veterans in preparing VA benefits claims and appeals have a team of experts on hand to supply the evidence needed to support these claims. Many of these veterans benefits lawyers provide their services for a contingency fee, and only get paid when the veteran wins their claim, to include reimbursement at the end for any costs to obtain medical nexus opinions.
By far, the cheapest and most effective way to get a nexus letter for sleep apnea secondary to PTSD or any other condition is to consult with a veterans’ disability law firm that is willing to provide all the resources you will need.
Our Veterans’ Disability Benefits Law Firm helps veterans win difficult, hard-to-prove claims and appeals for VA benefits. Contact us today at 888.291.0734 or Use This Online Form.