In the past, Mefloquine was commonly prescribed to military personnel as an antimalarial drug. However, it has since been linked to serious neurological and psychiatric side effects, including chronic sleep disorders, which now plague many of our nation’s heroes on a daily basis.

Veterans who took Mefloquine during deployments to malaria-endemic regions report insomnia, vivid nightmares, night terrors, and excessive daytime sleepiness, often persisting long after discontinuing the medication. These health concerns make day-to-day life challenging and can hinder one’s mental health and overall quality of life.

We have seen many veterans who are experiencing Mefloquine-associated sleep disorders struggle with securing their VA disability benefits. With your claim, the VA requires medical evidence proving that sleep disturbances are service connected. The VA requests proof that your sleep disorders are a result of or were aggravated by your military service. Since Mefloquine toxicity is often misdiagnosed as PTSD and other mental health conditions, getting proper recognition and compensation for these symptoms can be difficult.

A VA nexus letter can be crucial evidence in establishing this connection. A medical professional’s written nexus letter provides an expert opinion linking Mefloquine exposure to chronic sleep disturbances, strengthening a veteran’s claim.

Mefloquine Use in the Military

Mefloquine was first licensed by the U.S. Food and Drug Administration (FDA) in 1989. Still, the military began relying on this malaria-prevention drug long before it was available to the public. The first reported use of the drug in the military dates back to the 1970s, and scattered use continued throughout the 1980s until it was formally authorized in 1989.

The United States military made heavy use of Mefloquine in Somalia in the early 90s, before relying on it again extensively in Afghanistan and Iraq. In 2009, the military began to phase the drug out after the Pentagon downgraded Mefloquine as a drug of last resort due to dangerous side effects. In 2013, the FDA placed a black box warning on the drug due to the risk of permanent neurological damage.

Mefloquine’s Connection to Sleep Disorders

Mefloquine, also known by its brand name Lariam, is an antimalarial drug widely prescribed to military personnel deployed to regions where malaria is a threat. While effective in preventing malaria, it has been linked to serious neurological and psychiatric side effects, including long-term sleep disturbances.

Mefloquine affects the central nervous system (CNS) by altering neurotransmitter activity, particularly in the areas of the brain responsible for sleep regulation. It is believed that the drug’s neurotoxic effects may lead to disruptions in circadian rhythm, increased nighttime arousals, and heightened dream activity, which can result in chronic insomnia, fragmented sleep, and night terrors. Some veterans also experience excessive daytime sleepiness—or hypersomnia—due to Mefloquine’s lingering impact on brain function.

One of the biggest challenges in diagnosing Mefloquine-associated sleep disorders is the overlap of symptoms with PTSD, depression, and anxiety. Many veterans experiencing chronic nightmares, hyperarousal, and difficulty sleeping are misdiagnosed with PTSD, even if they have no history of combat-related trauma. This misdiagnosis can delay proper treatment and prevent veterans from receiving VA disability benefits for the actual cause of their sleep disturbances.

Because Mefloquine toxicity is not always well-documented in military medical records, veterans need strong medical evidence to establish a connection between their sleep disorder and Mefloquine exposure. This is where a VA nexus letter becomes essential. A well-documented nexus letter from a medical professional can explain how Mefloquine affected a veteran’s sleep, providing the necessary link between military service and ongoing sleep disturbances to strengthen a VA disability claim.

How to Prove a Service Connection for Mefloquine-Associated Sleep Disorders

Proving a service connection for Mefloquine-associated sleep disorders can be challenging. Still, veterans can strengthen their VA disability claim by gathering medical evidence, documenting their exposure, and obtaining a nexus letter. The VA requires clear proof that a veteran’s sleep disorder is directly linked to their military service or an existing service-connected condition.

The first step is establishing Mefloquine exposure. Veterans should review their deployment records and medical history to confirm that they were prescribed Mefloquine during their service. Since Mefloquine was commonly given to personnel deployed to malaria-endemic regions, service records detailing deployments to these areas can support the claim. If available, prescription records or statements from fellow service members who also took Mefloquine can further validate exposure.

Next, medical documentation of sleep disturbances is essential. Veterans should seek an evaluation from a doctor or sleep specialist to diagnose conditions such as insomnia, hypersomnia, or parasomnias. A sleep study may provide objective evidence of abnormal sleep patterns.

A VA nexus letter can play a critical role in proving a service connection. A nexus letter, written by a qualified medical professional, provides a medical opinion linking a veteran’s sleep disorder to their Mefloquine use. The letter should provide research from medical journals that establishes how the use of this drug can lead to sleep disorders. The author should also conclude that it is more likely than not that a veteran’s current disability is linked to their military service.

VA Disability Ratings for Mefloquine-Associated Conditions

The VA does not have a specific diagnostic code for Mefloquine toxicity or its associated sleep disorders. Instead, conditions caused by Mefloquine exposure are typically rated under existing categories, including sleep disorders. The severity of a veteran’s condition will determine their VA disability rating, directly affecting the compensation level they receive.

Many veterans with Mefloquine-associated sleep disturbances are for mental disorders, particularly if they experience PTSD-like symptoms alongside their sleep disturbances. If insomnia or hypersomnia is the primary symptom, the VA may assign ratings under chronic adjustment disorder or a related sleep disorder category.

Typical VA disability ratings for Mefloquine-related conditions include:

• 0% Rating – Symptoms are present but do not significantly impact daily functioning or employment. The VA does not pay benefits at this level.
• 10% Rating – Mild symptoms of insomnia, nightmares, or daytime sleepiness that cause occasional interference with work or social activities.
• 30% Rating – Sleep disturbances that lead to noticeable impairment in daily life, such as chronic fatigue, moderate cognitive issues, or mood changes.
• 50% Rating – Severe symptoms, including frequent nightmares, inability to maintain employment due to excessive daytime sleepiness, or persistent cognitive deficits.
• 70% Rating – Sleep disorders significantly impact a veteran’s ability to function independently, often leading to severe emotional and cognitive instability.
• 100% Rating – Total occupational and social impairment, with symptoms preventing employment and independent daily activities.

In cases where Mefloquine has caused additional neurological or psychiatric disorders, veterans may be eligible for secondary service connections for conditions such as anxiety, depression, memory loss, or vestibular disorders. The VA will evaluate the veteran’s overall disability picture and assign ratings based on the combined severity of their symptoms.

Since many Mefloquine-associated conditions overlap with PTSD and other mental health disorders, veterans need to differentiate their symptoms in medical evaluations and ensure that Mefloquine toxicity is recognized as a contributing factor. A VA nexus letter from a medical expert can be crucial in linking sleep disturbances and other long-term health effects to Mefloquine exposure, helping veterans receive the correct rating and compensation.

Appealing a Denied VA Claim for Mefloquine-Associated Sleep Disorders

A VA disability benefits denial for Mefloquine-associated sleep disorders can be frustrating, but veterans have the right to appeal. Many claims are denied due to a lack of medical evidence, failure to establish a service connection, or misclassifying symptoms under unrelated conditions. Understanding the reasons for denial and taking the necessary steps to strengthen an appeal can improve the chances of securing benefits.

The first step in the appeals process is reviewing the VA’s decision letter, which outlines the specific reasons for the denial. If the VA states that there is no clear service connection, additional medical evidence, service records, and a VA nexus letter can help establish the link between Mefloquine exposure and chronic sleep disturbances. Veterans who did not initially submit a nexus letter can include one during the appeal process to strengthen their claim.

Veterans have several options for appealing a denied claim:

• Higher-Level Review – A senior VA reviewer will re-examine the case without new evidence. This option is useful if the denial was due to an error or misinterpretation of the existing evidence.
• Supplemental Claim – Veterans can submit new and relevant evidence, such as medical records, sleep studies, or a newly obtained nexus letter, to strengthen their claim.
• Board of Veterans’ Appeals (BVA) – If the claim is still denied, veterans can request a hearing before a Veterans Law Judge, who will review the case and consider additional testimony.

Veterans whose symptoms have worsened over time may also request a rating increase, mainly if their sleep disorder has led to additional cognitive or psychiatric conditions.

Talk to Elite Medical Research Associates About Your Nexus Letter

The thought of finding a doctor or other medical professional to author a VA nexus letter on your behalf can seem daunting, but you do not have to take on this challenge alone. At Elite Medical Research Associates, we have connections with doctors and other professionals nationwide who can evaluate your condition. Reach out today to learn more.