Sleep Apnea: Myths and Truths

Sleep apnea is one of the disability contentions viewed most suspiciously by the VA. It is also one of the most denied. This is mostly because many Veterans follow really bad internet legal advice or advice from paid consultants that have no problem stealing from and lying to Veterans.

Many Veterans have been led to believe that PTSD, tinnitus, or musculoskeletal conditions “caused” their sleep apnea. Let us be clear: they did not. Veterans have been fed a bunch of lies by people who want to do nothing but steal from them, and then they perpetuate those lies to others, believing they are true - only to find out later they aren’t, but by then it is too late.

Don’t be a statistic. Don’t be one of the Veterans that will never get sleep apnea connected due to repeated fraudulent claims.

The myth concerning secondary connection of sleep apnea to mental health, and specifically PTSD, is perpetuated because some Veterans get connected. And of course, that leads you to the assumption: well then it is true, PTSD does cause sleep apnea and I should file that way because it wasn’t documented in my service treatment records! No.

What is true, is that medications for PTSD and mental health conditions have side effects. Medication side effects, in combination with the sedentary lifestyle related to depression, can be linked to weight gain which is a known cause of sleep apnea.

There are two forms of sleep apnea. Many Veterans are diagnosed with obstructive sleep apnea which, by definition, is caused by a mechanical obstruction. That means it is caused by obesity, jaw problems, and other throat conditions, not a mental health condition. The other type is central, and it is less understood, but is thought to be caused by the brain itself. PTSD can theoretically aggravate central or mixed sleep apnea, but it can’t cause it and certainly can’t cause obstructive sleep apnea.

We know, someone told you they were service connected secondary to their PTSD - either they didn’t understand the connection (which was actually related to the side effect of a medication), or they slipped through due to a medical opinion from a paid doctor who wrote a fraudulent medical opinion.

The VA has gotten wise to these consultants and doctors and will link you to their fraud. If they do, you will never get your sleep apnea service connected - ever, and if connected, the connection can be permanently removed.

It is also important to understand that correlation is not causation. Some Veterans believe ringing in the ears (tinnitus) can cause sleep apnea. The truth is the many Veterans were exposed to loud noises and many develop sleep apnea for many reasons, but just because a veteran has both conditions does not mean one caused the other.

What most Veterans overlook is the most plausible way to connect the condition - direct service connection. “But I need to have had it diagnosed in service or symptoms documented in my service medical records!” Not true.

If you had symptoms in service, and you document those symptoms in a credible manner in a written statement, that is enough to service connect your sleep apnea condition.

The criteria for service connection is:

  • A current diagnosis; and
  • Continuity of condition (meaning that the condition is there and getting worse, not that you had a one-time event); and
  • A link between the condition and your active duty service.
Medical Opinion

Nowhere in the law does it say the evidence used to provide that link must come from your service medical records. Nowhere. What it does say is that you need evidence.

Assuming you have a current diagnosis, then you have a chronic disease which has continuing symptoms. You need to document the condition from the point of diagnosis forward with CPAP/BiPAP use. The logs from the machine and medical appointments serve that purpose. The link to service, known as a nexus, and the period from when the condition beginning and the diagnosis must be documented with written testimony.

Several Veterans have taken their case all the way to the Circuit of Veterans Appeals Court (CAVC) to pave the way for you: Buchanan, Jandreau, Davidson, and Layno. And they have given you the ability to use written testimony to prove your case. In fact, nothing but written testimony. The caveat is that the evidence must be credible. I have written other articles about testimonial evidence, and you can read those, but the Courts have found that written testimony in itself is enough to prove a service connection.

Buchanan and Davidson are all about the written testimony, but Jandreau and Layno are the icing on the cake that you need to prove your case. Jandreau and Layno said that if you report symptoms that are consistent with a medical diagnosis and that if a medical professional later diagnoses a condition consistent with those symptoms, that the statement of the symptoms is enough to service connect the condition, because it provides strong evidence that you had it before the condition was diagnosed.

If you didn’t have symptoms in service, does that destroy your chances of service connection? Not necessarily.

If you have service-connected PTSD, and it causes you to grind your teeth badly (called bruxism), that is a mechanical condition and it can demonstrate a connection to sleep apnea. It’s also possible that we can link weight gain to a medication you are on with service-connected depression and a sedentary lifestyle. It isn’t a lost cause. However, if you are the rater and have a claim with credible evidence of the condition in service and another where the Veteran claims it is related to their mental health condition, which do you view credible and which do you view suspiciously?

Unfortunately, with the high percentage rating of sleep apnea, many Veterans are attracted to the condition, and many consultants and doctors take advantage of Veterans as a result. They make huge promises and propagate rumors because it makes them big money.

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