Obstructive Sleep Apnea as a secondary to PTSD

Long story short; my service connected PTSD creates disturbed sleep patterns that most likely caused (and or made worse/aggravated) my OSA. Want to see how? Read the whole article.

Hello, my name is Paul Russell Parker III, and welcome to my website. If you’re here reading this, it means that you’re a Veteran, like myself, or you know a Veteran and you’re trying to help them. It also means that you’re looking for a way to service connect your Obstructive Sleep Apnea to your military service, or more specifically, link it to your Post Traumatic Stress Disorder. From here on out, I’ll write Obstructive Sleep Apnea as OSA and Post Traumatic Stress Disorder as PTSD.

The reason why I’m making this post is because there are many second or third hand accounts on how to do it floating around out there that may not help at all. There’s also a lot of hearsay or rumors. I wanted to shed a light and hopefully I can help someone.

First of all, I have PTSD and OSA. I was able to link my OSA as a secondary to PTSD, and I’ll detail how I did it. First things first, you have to have the disabilities. If so, pursue the claim. For anybody with doubts about others, let me address something. A lot of people out there will complain of fakers or people making things up to get service connected disabilities. They doubt that people who are at a certain percentage really rate that percentage or really have that disability. I want to help ease the mistrust or erase the disbelief out there before I start.

To have a service connected disability means that you have medical records of it happening during your military service. It was diagnosed, accepted, and or treated by a military medical professional. It did no go away, and you are or were being treated for it over a long period of time. To get the disability service connected, it means that you are out of the military or about to get out, and are either still being treated for it, or even a civilian doctor was able to diagnose and see it as well. So, you put in a claim for a disability to be service connected. The VA will have a contracted medical professional look over your service treatment records, your civilian treatment records, and have an appointment with you to confirm the diagnosis and severity of your disability. In that appointment, or series of appointments, you will have your disability confirmed for at least the second to third time.

Then, it’s either service connected, deemed not service connected, deemed non existent due to lack of records, or deemed that an injury did occur, but it is not chronic in nature so it’s not service connected. From my experience and the experience of others I know personally, a few disability claims are rejected almost for no reason and may be deemed service connected after a supplemental claim, a higher level review, or through an appeal. It could takes months to years, and involve multiple avenues or recourses to have a disability accepted as service connected. My point is, its not easy to get something service connected. The person you doubt, actually had to go through at least two different doctors, and everything had to meet a very high standard set by the VA.

Anyways, now that we got that out of the way, lets get back to why you’re here. You have OSA and you want to get it service connected. You may not have had OSA while in service, but you have it now. You also have PTSD, and you are service connected for it. So, how do you link the two? Are the two actually linked? Does one cause the other?

The gold standard is to have any disability documented while you’re in the military. With that, you’ll always get a disability service connected with little to no effort as long as its chronic and long lasting. Something that won’t go away in the meantime or get better any time soon, if ever. Unfortunately, that’s rarely the case for most people. This includes myself, I have disabilities that incurred while I was active duty, but I can never get them service connected because I didn’t go to medical for them while I was in. There are no service treatment records. I pushed through injuries or was talked out of going to medical by others. I was in the Marine Corps, and there’s a certain belief among people in the Marines that going to medical is a sign of weakness. Well, when you’re pushing 40 and that injury you ignored when you were 19 is making life difficult, you will regret that mentality when you’re paying out of pocket for copays to treat it and finding it difficult to do your overly physical job.

This is going to be mainly for people who already have PTSD service connected, and were diagnosed with OSA after they left the military and do not have OSA service connected. An option some people inadvertently pursue is to put in a claim to service connect the OSA as a primary service connected disability. In most, if not all cases, it will be denied. The person will be very upset, because the VA themselves diagnosed the OSA, put the Veteran through sleep studies, and are treating them for OSA with a CPAP or other similar sleep/respiratory therapy. This is a mistake on the Veterans part. Just because you have OSA, and the VA diagnosed you with it, doesn’t mean that you can get it service connected. To get a disability service connected, you need to show that an injury or illness occurred during military service. No records of when or how your OSA started or was treated while you were on active duty? No primary service connection.

In this case, you have OSA that you’re not service connected for but you’re service connected for PTSD. Does one cause the other? Are they linked? Many will argue that they are not linked and there’s no causation. I was even denied by the VA at one point, because the VA rater who handled my claim deemed that a mental condition (PTSD) does not have a physical effect on the throat or components of the throat. That would make it seem pretty straight forward that you can’t link OSA to PTSD, right? Wrong. That denial was quickly reversed.

When trying to link a disability to another, you need to know what the VA says about a secondary service connected disability. According to the VA’s website on when to file claims and types of claims, a “Secondary service connected claim is a claim for a new disability that’s linked to a service connected claim you already have.” More specifically, “You can file a secondary claim to get more disability benefits for a new disability that’s linked to a service connected disability you already have.” They even provide examples that I’ll paraphrase, “you develop arthritis caused by an injury that you’re already service connected for or your service connected high blood pressure causes heart disease later on in life.” You can see the VA’s website link where I got that information by clicking here.

One thing that isn’t mentioned is that the VA also details that secondary service connected disabilities are disabilities that are caused by a primary service connected disability and or made worse/aggravated by a primary service connected disability. This is an important item to note, because I have been denied and seen others denied by half of that criteria, ignoring the other half. Or means both or, one or the other. The OR part is something that people need to keep in mind and look for in denials. I’m not sure where to find the exact writing in the rule book because I’m not a VA employee, but I’ve experienced it myself. In a letter I received from the VA detailing a denial, it was stated that a primary service connected disability did not cause the secondary disability that I was trying to service connect. I pointed out in a higher level review that they didn’t opine whether the primary service connected disability aggravated/made worse my secondary disability and the VA had to go back and get the medical opinion updated to state if it was not only caused or not, but also if it was made worse/aggravated by the primary service connected disability as well.

The VA rater made a decision with only half of the criteria and thought that I wouldn’t catch the mistake. It is actually a clear and unmistakable error on the VA’s part, and you can appeal a denial based on that kind of omission. That could change a denial into an approval.

That means that you don’t have to prove that your OSA was caused by PTSD. On my first attempt, my OSA was service connected as a secondary disability to my PSTD, because PTSD can cause and or make worse/aggravate OSA. You just can’t state that and expect to be service connected as a secondary for it. You have to have prove how your PTSD aggravates or makes worse your OSA. Not for all of humanity, but for your individual case.

I’m going to provide the link to two articles that I reviewed and found helpful for Veterans who have PTSD and want to link their OSA to their PTSD. These are scientific, medical studies on the National Institutes of Health website. One on PAP adherence for Veterans with PTSD found here and one on the Impact of PTSD on CPAP Adherence in Patients with OSA found here. The first article is geared mainly for Veterans with PTSD and the second article is geared mainly for combat Veterans with PTSD. I find that both can be very informative for anybody with PTSD and help you understand your symptoms, regardless of how your PTSD came about. You can search for other disabilities on their website and find other medical studies that could prove helpful. Here’s what those studies had to do with my case.

While I was on active duty in 2004, I sought treatment at first from the Chaplain but he referred me to the Division Psychiatrist. I sought treatment because I was having what I thought was a spiritual crisis brought on by effects of my participation of the 2003 Invasion of Iraq as a Lance Corporal with the 1st Marine Division. I didn’t know what was going on with me. I couldn’t sleep, I was having nightmares, flashbacks, I was always on edge. I was always tired throughout the day. I’d wake up at night and couldn’t get back to sleep. Things bothered me and I didn’t want to be around people I used to always hang out with anymore. I avoided watching the news or talking about my deployment. I had actually forgotten many things about my deployment for the first few months after I came home. I felt sad a lot. To my surprise, I was diagnosed with PTSD. I had no clue what PTSD was. I left active duty not too much later and I was able to get my PTSD service connected. At PTSD appointments with the VA, I made the same complaints, and my primary care provider put me in for sleep studies as well as treated me for PTSD. She found that my complaints included OSA symptoms. They found that I had OSA through sleep studies I had at a VA Medical Center. I was given a CPAP and went on with my life.

Years later, I was told to put in a claim for OSA. I did. I provided my service medical treatment records, my treatment records from the VA, a letter I wrote of how my PTSD effected my CPAP adherence, and I went to my compensation and pension exam with a VA contracted medical professional. I answered a few questions and left within 5 minutes. I was worried, but I received good news. My PTSD could have caused and or made worse/aggravated my OSA. How? My treatment records showed a history of complaints of sleep fragmentation, sleep disturbances, sleep disordered breathing, PTSD related insomnia, PTSD induced nightmares, anxiety attacks at night, not being able to get full nights rest, rolling and thrashing around at night, troubled sleep patterns, waking up randomly and not being able to go back to sleep because of the PTSD, etc.

The VA contracted Doctor conducting my exam for compensation saw my PTSD disturbed sleep habits and correctly opined that those type of sleep disturbances very well could have caused and or aggravated my OSA. In a nutshell, if I’m not sleeping well, I’m not adhering to my CPAP therapy. If I can’t effectively treat my OSA with my CPAP therapy, my OSA is not getting better or maintaining, is it? If I tear off my mask, or don’t reach REM sleep because of my PTSD disturbed sleep habits, I’m not adhering to treatment. It is not my fault either, its not a conscious decision to avoid sleep or to wake up at random times and have a hard time going back to sleep. One may not cause the other, but they both can aggravate or make worse the other.

So, that’s how I linked my OSA to my PTSD. Others have done it differently and used other explanations. How I went about it might not be how you go about your case because your PTSD might effect your OSA in another way. Others have used VSO’s or had Nexus letters from their doctors. I suggest that you take your time, develop your case, gather all of your evidence, get help from a doctor or VSO if needed, and present your case as honestly and thoroughly as possible. Thanks for taking the time to read the article and if it helped, let me know.

Copyright February 8, 2021. PRP3 The Author Media


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