so
welcome everyone to another edition of cck live my name is michael estrido and joining me today i
have kayla d'onofrio and alex sacks in this video today we will be discussing secondary conditions
to sleep apnea so by way of introduction sleep apnea is a potentially serious sleep disorder
in which a person's breathing is repeatedly interrupted throughout the night there really
are three main different types of sleep apnea sleep apnea that's known as obstructive sleep
apnea central sleep apnea and also what's known as complex or mixed sleep apnea variation of the two
for mild cases of sleep apnea doctors may suggest simple lifestyle changes such as
losing some weight or quitting smoking where applicable but in more serious cases doctors often
prescribe the use of what's known as a continuous positive airway pressure machine or what is
commonly referred to as a cpap machine this machine delivers air pressure through a mask which
a person wears while they sleep so kayla turning to you maybe you can get us started with service
connection for sleep apnea and different ratings that an individual could expect for the condition
sure um so like any service connection process one thing that va is going to require before
they grant service connection is that a veteran has a diagnosis for sleep apnea in particular va
does require that a sleep study be conducted to confirm the diagnosis which means that even if
your medical records show an existing diagnosis of sleep apnea va's not going to consider it
sufficient evidence unless there's a sleep study that accompanies it to provide that diagnosis from
once veterans are service connected for sleep apnea va can grant it on either a secondary or
direct basis meaning that va on a direct basis has conceded that it's directly related to the
veteran service it began in service on a secondary basis meaning that it's related
to another service-connected condition either way the condition is going to be rated under the same
regulation it's going to be 38 cfr 4.97 under the diagnostic code 6847 and this would include
any sleep apnea syndrome so obstructive central or mixed sleep apnea like mike just discussed
veterans will be assigned a rating of either 0 which would be a non-compensable rating
30 50 or 100 depending on the severity of the condition and the treatment that would
be required for that condition including the prescription of a cpap machine one thing that
we do want to notice that va has recently proposed changes to their sleep apnea rating criteria the
proposed changes sort of take into account more the symptoms and the effectiveness of treatment
as of right now those ratings are just proposed nothing is final but we do have
a video where we go into a lot more detail a lot more in depth discussion about those
proposed changes on our youtube channel that we definitely recommend checking out if you
are interested in getting more information yeah that's that's great kayla and important to note uh
alec turning to you um and the reason we're here in this video today is to talk about secondary
conditions to sleep apnea so maybe you can talk about secondary service connection in this context
absolutely i'll give a broad overview and then we'll get into some discussion about some of
those uh common secondary conditions that we see as caused by or aggravated by sleep apnea so as we
mentioned a secondary service connected disability is one that has resulted from a condition that is
already service connected in cases of secondary service connection the medical nexus opinion
must link the veteran's secondary condition to the already service-connected disability
as opposed to service which would be you know the direct service connection
uh nexus element to make so veterans struggling with sleep apnea often develop other conditions as
a result some of which can be a secondary service connected and there are many conditions that this
encompasses including but not limited to i'll start with asthma asthma is a condition that
affects a person's airways and makes it difficult for them to breathe with asthma the airflow the
airways narrow and produce extra mucus this can often interfere with daily life and research
has indicated that people who have asthma are more likely to develop obstructive sleep apnea
this could be because both asthma and sleep apnea affect the upper and lower respiratory tracts when
the muscle when the throat muscles are weakened due to asthma there's a greater likelihood for
the throat to collapse and create obstruction of the airway which again is obstructive sleep apnea
and va reads asthma under the regulation 38 cfr 4.97 this is diagnostic code 6602
and similar to uh sleep apnea actually the ratings range from zero to one hundred percent
going zero ten thirty sixty to a hundred um then veterans uh may pursue service connection for
asthma on a presumptive basis under another separate regulation 3.317 specifically if
they served in the south and southwest asia theater of operations during certain dates
often almost at the gulf wars it's important to note that under the regulation 4.96 where there is
long or plural involvement a single rating will be assigned under the diagnostic code that reflects
the predominant disability of the two of asthma or sleep apnea and that gets a little technical
but you can uh hopefully count on va to to rate that right correctly on the predominant disability
um and that that will cover for asthma yeah and that the last point is a really important one i
think um you know oftentimes we'll see clients or at least i've seen clients who have both
conditions um and there may be merit to service connection for both conditions both diagnoses but
um unfortunately on you know the way the regulation is structured as you just
um detailed um you know there's a specific requirement that va rate the condition
um for a single condition based on how severe or whichever condition is more severe um so another
another really common um condition that we find that can be linked secondarily to sleep apnea is
gastroesophageal reflux disease or commonly known as gerd gerd is a digestive digestive
disorder that occurs when stomach acid flows back up from the stomach into the
into the esophagus on this cough this often causes discomfort and inflammation
veterans who suffer from sleep apnea may find that the condition aggravates or even causes directly
and this is because while you know an individual is asleep the body may not clear the veteran's
esophagus as it would when the veteran would otherwise be awake and thereby exacerbating
the veteran's gerd condition gerd like we said can also contribute to sleep apnea directly
typically for gerd va rates this condition by analogy and often it looks to 38 cfr
section 4.114 specifically diagnostic code number 7346 and under diagnostic code
7346 ratings typically range from a ten percent rating a thirty percent rating or a sixty percent
disability rating depending on the presence and severity of a variety of different symptoms that
are outlined uh in the regulation and specifically the diagnostic code uh kayla do you want to talk
a little bit about hyprothyroidism sure um so hypothyroidism or an underactive thyroid occurs
when the thyroid gland doesn't produce sufficient thyroid hormone so what will happen is if a
veteran has sleep apnea they'll have chronic loss of sleep and that can contribute to or enhance
hypothyroidism symptoms which might include things like increased fatigue or poor memory or
concentration alternatively hypothyroidism can cause um can cause changes to the upper airway
if it's left untreated which can then lead to or aggravate sleep apnea symptoms so kind of the same
as gerd where that relationship can go both ways between sleep apnea and hypothyroidism conditions
of the thyroid are rated under the regulation 38 cfr 4.119 and there are several different
diagnostic codes under this rating schedule that will just kind of accommodate different thyroid
conditions and the symptoms thereof but another really common condition or common conditions that
we see secondary to sleep apnea are mental health conditions mental health conditions might include
things like anxiety depression or in some cases even ptsd which we do see as commonly linked to
sleep apnea the lack of sleep from sleep apnea can lead to feelings of depression or can cause
develop development of anxiety around the fact that they are unable to sleep well or the lack
of sleep associated with sleep apnea can aggravate underlying mental health conditions that already
existed which would include things like ptsd um or depression or anxiety any mental health condition
can severely impact a person's well-being and their ability to function in their everyday life
but all mental health conditions are rated under the same regulation under the same rating criteria
which would be defined under 38 cfr 4.130 and those ratings go from 0 10 30 50 70 or 100
depending on the severity of their condition um again like those sleep
apnea ratings va has proposed some changes to the reading schedule for mental disorders
we're again not going to go into too much detail about that today um but you can check out our
other video on youtube that goes into a lot more detail about some of those proposed changes
yeah and and similarly with how you mentioned earlier the at least the proposed changes for
sleep apnea um the changes to the mental health condition regulation are really important so i
really encourage all of our viewers to take a look at those on our site and
just become a little bit more familiar with them if indeed they do become
you know final regulations uh alec turning back to you um sinusitis do you want to talk
a little bit about that condition and how it can be uh linked secondarily to sleep apnea
sure sinusitis is a condition where a person's sinuses become swollen or inflamed for three
months or longer despite treatment it affects the nose the throat and head much like sleep
apnea so the two conditions have been linked and veterans can receive secondary service connection
for sinusitis linked to the sleep apnea the va is going to rate sinusitis under 38 cfr section 4.97
according to the diagnostic code 6510 through 6514 and we see disability percentage ratings at 0
10 30 and 50 so chronic sinusitis has also been linked to military burn pit exposure and
is now a presumptive condition for veterans who served in qualifying locations and time periods
so although um the list that you both have discussed today isn't certainly exhaustive
i think everyone can see that there are just really a number of different conditions and
there are more um that can be linked secondarily to you know a veteran's service-connected sleep
apnea i mean that can be great for um getting additional medical treatment or
um increased ratings due to the varying conditions uh but kayla what happens in the situation where
a veteran is unable to work and one of the reasons that the veteran is unable to work
is at least due to the veteran's service connected sleep apnea can you talk a little bit about that
situation yeah so what would happen is if a veteran's service-connected sleep apnea and
any conditions related to it or really any other service-connected conditions cause or contribute
to the veteran not being able to work they may be eligible for a benefit called a total disability
rating based on individual unemployability or tdiu tdiu is another avenue for a veteran to conserve a
va to secure a va disability compensation level at 100 or which basically just means they're
going to be paid at the 100 rate even if their combined rating isn't 100 so what that means is
that a veteran doesn't have to be rated at 100 for sleep apnea or for any of the secondary conditions
by themselves all they have to show is that their service connected sleep apnea along with
any other service-connected conditions prevent them from securing and following substantially
gainful employment veterans can qualify for tdiu under the regulation 38 cfr 4.16 a provided they
meet certain rating requirements which would be would call their scheduler rating requirements
those requirements are that a veteran would have to have one service connected disability rated at
60 or higher or if they have more than one service connected disability one of those disabilities has
to be rated at at least 40 percent and they have to have a combined rating of 70 or higher so an
example of that might be if a veteran is service connected for sleep apnea at 50 and ptsd at 30
their combined rating would be 70 and because the sleep apnea by itself is at 50 they would qualify
for tdiu under those scheduler requirements even if a veteran doesn't meet those scheduler
requirements however they may still be eligible for tdiu on what va would call an extra scheduler
basis they would just still have to show that those disabilities prevent them from securing and
following substantially gainful employment in the same way they would in any other circumstance yeah
and exactly and what we've seen in our practice i know many others have seen as well is that
seeking tdiu as an extra scheduler benefit under 4.16 b is oftentimes far more complex
and more difficult to get granted for the veteran unfortunately than if the veteran were to pursue
or otherwise qualify for uh tdiu benefits under 4.16 a um so that's you know despite
the kind of initial rating threshold requirements that you went through kayla
um it's oftentimes if a veteran can meet those requirements much easier to then
get a grant of tdiu which in and of itself is a reason to sometimes seek service connection for
sleep apnea by any means necessary either direct or as we've talked about today a secondary basis
so as i mentioned earlier you know this is not an exhaustive list by any means of conditions
that can be related to sleep apnea please visit our website for a much more comprehensive list
and you'll find a lot of resources available to you so i think that about
does it for today's video thanks for tuning in we're glad you could join us as always
and as always please be sure to subscribe to our channel on youtube and follow us on social
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