Nexus Letter for Sleep Apnea & Sleep Disorders

A nexus letter is an essential piece of evidence that will support a positive outcome in your application for sleep apnea VA benefits. When the VA grants you a disability rating for a service-connected disability, even if the percentage is 0% you are entitled to free healthcare provided by the VA. If the VA disability rating you are awarded is at 10% or greater, then you will be eligible not only for VA-provided healthcare, but also tax-free monthly disability payments from the VA.

Despite the fact that your nexus letter for sleep apnea is of central importance to the success of your claim, it is not easy to get one that will accomplish your goals. To be approved, you must meet the requirements to prove your service-connected sleep apnea to the VA, and following is a guide to help you understand the role that nexus letters play in the process.

Proving Your Sleep Apnea Diagnosis is Connected to Your Military Service

For a veteran to be eligible to collect VA disability benefits for sleep apnea, the veteran must demonstrate one of the following through evidence:

• The veteran developed sleep apnea during their qualifying active service, or that,
• The sleep apnea developed as a result of an event, injury, or illness that occurred during service, or as a result of something that already has a proven service connection.

Sleep apnea benefits are achieved either through direct connection to your service, or through a secondary service connection. Providing that your sleep apnea is directly connected to your service is generally a straightforward process. Veterans are able to demonstrate that their sleep apnea began during their active military service by providing military medical records, records of performance, and additional evidence that may have been collected or recorded during active service.

If you are seeking to collect VA disability benefits for sleep apnea as a secondary service connection, the process can be more difficult. To achieve a sleep apnea VA rating as a secondary condition, it is necessary that you provide the written opinion of a medical professional that your sleep apnea is secondary to a VA-connected disability. The written medical opinion compares and contrasts your current status and diagnosis and medical history in conjunction with scientific literature to prove that your sleep apnea was more likely than not caused by your active military service.

Did you develop a sleep disorder during or after military service?

PTSD, anxiety, depression, Parkinson’s disease, weight gain, chronic pain, Gulf War syndrome, toxin exposure, medications, and other service-related events can lead to the development of a wide variety of sleep disorders. Our medical experts provide VA nexus letters to service connect various forms of sleep disorders.

Common Sleep Disorders in Veterans

There is no question that many sleep-related conditions develop as a result of military service, whether due to environmental factors, traumatic experiences, or physical injuries. Understanding the nature of these conditions is helpful for anyone considering a disability claim through the VA. Below are some of the most common sleep disorders veterans face and how they are evaluated for VA disability benefits.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is one of the most frequently diagnosed sleep disorders among veterans. It occurs when the airway becomes blocked during sleep, causing repeated pauses in breathing and oxygen deprivation. Obesity, PTSD, and traumatic brain injury are often linked to the development of OSA in veterans. The VA assigns a disability rating for sleep apnea based on symptom severity and whether a CPAP machine or other medical intervention is required. Sleep apnea is often secondary to sinusitis claims.

Central Sleep Apnea

Unlike OSA, central sleep apnea (CSA) is caused by the brain failing to send the proper signals to control breathing during sleep. This condition is often associated with neurological disorders, medication use, or damage to the central nervous system. Veterans with CSA may experience periodic pauses in breathing while sleeping, insomnia, excessive daytime drowsiness, and shortness of breath upon waking. Because CSA is frequently linked to traumatic brain injury, opioid medication use, and other service-related factors, veterans can apply for disability benefits by providing medical evidence demonstrating its connection to military service.

Insomnia

Insomnia is a persistent difficulty in falling, staying, or achieving restful sleep despite having the opportunity to do so. It is one of the most common sleep disorders among veterans, often linked to PTSD, anxiety, chronic pain, and stress. Since insomnia is frequently secondary to other service-related conditions, veterans seeking disability benefits must establish a connection to an underlying issue, such as PTSD or chronic pain, to qualify for compensation. The impact of insomnia cannot be overstated.

Hypersomnia

Hypersomnia is characterized by excessive daytime sleepiness and prolonged sleep duration, even when a person gets enough rest at night. Hypersomnia can develop as a result of neurological damage, depression, or medication side effects. In some cases, it may also be linked to undiagnosed sleep apnea or other underlying conditions. Veterans applying for VA disability benefits must provide medical evaluations, sleep studies, and service-related documentation to demonstrate the impact of hypersomnia on their daily lives.

Narcolepsy

Narcolepsy is a chronic neurological disorder that affects the brain’s ability to regulate sleep-wake cycles. This condition can significantly impact a veteran’s ability to work, drive, and function in social settings. Because narcolepsy is a lifelong condition, obtaining VA disability benefits requires strong medical evidence, including a formal diagnosis and proof that symptoms began during or were aggravated by military service.

Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders occur when a person’s internal clock is misaligned with the natural day-night cycle, making it challenging to maintain a regular sleep schedule. Veterans who were exposed to irregular work hours, night shifts, or combat deployments often develop these disorders, leading to long-term sleep disruptions. Another form of circadian rhythm disorder is non-24-hour sleep-wake syndrome, which commonly affects blind veterans or those with neurological injuries, causing their sleep cycle to shift gradually over time. These disorders can severely impact a veteran’s ability to work and function normally, making VA disability benefits an essential resource for those struggling with persistent sleep disruptions.

PTSD-Related Sleep Disturbances

Many veterans experience sleep disorders as a direct result of post-traumatic stress disorder. PTSD-related sleep disturbances often involve recurring nightmares, night terrors, and a heightened state of alertness that prevents restful sleep. Hypervigilance, a common symptom of PTSD, can cause veterans to feel constantly on edge, leading to prolonged insomnia and fragmented sleep patterns. Since PTSD is a commonly recognized service-connected condition, veterans experiencing sleep disturbances related to PTSD can often receive VA disability benefits as part of their overall mental health rating.

Sleep apnea is one of the most common sleep disorders we see at Elite Medical Review Associates. A strong nexus letter is necessary to win service-connection for sleep apnea in most cases. And getting one can be challenging.

Typically, symptoms of sleep apnea are not documented during service. However, witness statements from bunk mates, relatives, spouses, roommates, partners, and friends can provide strong evidence of sleep apnea. Persons nearby the veteran during sleep may report loud snoring, long gaps of time with no breathing, gasping for air, insomnia, fatigue, problems concentrating, or sudden irritability.

For many veterans, our doctors write nexus letters supporting sleep apnea secondary to service-connected rhinitis, sinusitis, deviated nasal septum, and other secondary links.

The most common cause of sleep apnea in veterans is weight gain. Various service-related orthopedic problems like back pain, knee pain, or joint pain may prevent proper exercise and activity, causing significant weight gain in the years following service.

Our VA nexus letter doctors have succeeded in winning service connection for sleep apnea secondary to an orthopedic disability for numerous veterans.

We have also been successful in cases where the veteran may have experienced in-service weight gain, have been put in the weight control program, or started to exhibit the signs of metabolic syndrome in service that continued to develop years after service, ultimately leading to obesity and resulting sleep apnea.

One of the most common situations our VA nexus letter doctors see at Elite Medical Review Associates is veterans with a 90% combined VA rating who are employed and seeking an additional 50% rating to achieve a combined rating of 100%.

In these cases, if a veteran has multiple service-connected disabilities that can cause sleep apnea or an intermediary condition that can cause sleep apnea—such as obesity, our medical experts can write an opinion to support service connection for sleep apnea in the VA nexus letter context.

No matter what type of sleep disorder you have been diagnosed with, our veteran-focused medical professionals at Elite Medical Review Associates will examine all potential links to service and prepare a strong, convincing nexus letter to submit with your VA benefits claim.

How to Get a Service-Connected Nexus Letter for Sleep Apnea

The majority of veterans who are approved for VA disability benefits for sleep apnea obtain them through a secondary service connection, which includes diagnosis for obstructive sleep apnea (OSA), central sleep apnea (CSA), or complex sleep apnea.

#1: Obtain a Sleep Apnea Diagnosis

Are you experiencing persistent fatigue despite a full night’s sleep? It could be sleep apnea. A definitive diagnosis typically involves a polysomnography study, evaluating nighttime symptoms like irregular breathing and elevated heart rate. This assessment can be conducted in a sleep lab or at home. A nexus letter for sleep apnea becomes pertinent post-diagnosis.

#2 Identify Causation or Aggravation

You then need to determine whether to claim sleep apnea as a primary or secondary condition. If documented signs appeared during service, even without a formal sleep study, primary claim eligibility may apply.

Many veterans opt for secondary connection, commonly linking sleep apnea to pre-existing service-connected conditions like PTSD. Additionally, secondary claims may stem from mental health disorders such as depression or physiological conditions like sinusitis or asthma.

At Elite Medical Review Associates we will assist in reviewing your records to devise the optimal medical strategy before pursuing a sleep apnea nexus letter.

#3 Obtain a Nexus Letter for Sleep Apnea

Once the connection—whether to PTSD or another condition—is established, validating this link with the VA requires a nexus letter. By obtaining such documentation, veterans can solidify their case for service connection regarding sleep apnea.

How can you establish the link between sleep apnea and your PTSD?

The most effective method to establish the link between your sleep apnea and your PTSD (or other mental health conditions such as depression or anxiety) is to procure a comprehensive, individualized sleep apnea nexus letter authored by a doctor. The nexus letter should incorporate references to your medical records and latest medical findings. What sets our practice apart is that our physicians are not only former C&P examiners but also proficient in the requisite legal terminology essential for a successful nexus letter for sleep apnea.

Primary Health Conditions Leading to Sleep Apnea as a Secondary Condition

The most common way that veterans access sleep apnea compensation benefits is by claiming sleep apnea as a secondary condition. The following are the most common primary conditions that sleep apnea is secondary to:

• Asthma
• Depression
• Allergic rhinitis
• Tinnitus
• Post-traumatic stress disorder (PTSD)
• Obesity
• Generalized anxiety disorder
• Adjustment disorder
• Sinusitis

Whatever the source of your service-connected sleep apnea, a nexus letter will help to enhance your claim, increasing the chances of a favorable outcome with the initial application.  However, if it is denied, then a veterans’ disability benefits lawyer can help you make the most of your appeal or supplemental claim.

Decades of experience with veterans’ disability claims, our doctors are renowned for their meticulous research, recognition of all relevant scientific links between service events and sleep disorders, and diligent nexus letter preparation.

Appealing a Denied Sleep Disorder Claim

Receiving a denial for a VA disability claim related to a sleep disorder can be frustrating, but it is not the end of the process. Many veterans face initial claim denials due to insufficient medical evidence, lack of a clear service connection, or errors in the VA’s evaluation process. Understanding why the claim was denied and taking the necessary steps to strengthen the appeal can significantly improve the chances of receiving benefits. A VA disability appeal could be the answer you are looking for.

Understanding the Reasons for Denial

The first step in appealing a denied claim is carefully reviewing the VA’s decision letter. The letter will outline the specific reasons for the denial, which commonly include failure to establish a service connection, lack of sufficient medical documentation, or the VA determining that the condition is not severe enough to warrant compensation. In some cases, the VA may acknowledge the presence of a sleep disorder but assign a rating for sleep apnea or another condition that does not accurately reflect the level of impairment.

Gathering Additional Medical Evidence

One of the most effective ways to strengthen an appeal is by submitting additional medical evidence that clearly establishes the severity of the condition and its connection to military service. Veterans should obtain a sleep study from a qualified medical professional if they have not already done so. A nexus letter for sleep apnea from a physician can also be instrumental in explaining how the sleep disorder developed due to military service or how it is secondary to an existing service-connected condition such as PTSD, traumatic brain injury, or chronic pain.

Filing an Appeal

Veterans can file an appeal through one of three appeal options if a claim is denied. This begins with submitting a Higher Level Review appeal, a Supplemental Claim appeal, or a Notice of Disagreement (NOD), formally appealing directly to the Board of Veterans Appeals.

Requesting a Disability Rating Increase

In cases where the VA grants service connection but assigns a lower-than-expected disability rating, veterans can appeal to request an increased rating. For example, the rating for sleep apnea depends on whether the veteran requires a CPAP machine, oxygen therapy, or experiences significant impairment in daily life. If the VA initially assigns a 0% or 30% rating but new medical records show worsening symptoms and the use of the CPAP machine, the veteran may qualify for a higher rating upon appeal.