Parasomnias are a group of sleep disorders that cause abnormality while falling asleep, sleeping, or waking up. Many veterans struggle with parasomnias, experiencing frequent nightmares, sleepwalking, night terrors, or even acting out dreams due to disrupted sleep cycles. These conditions can severely impact daily life, leading to sleep deprivation, injuries, impaired work performance, and relationship difficulties. Despite their significant effects, parasomnias are often overlooked or misdiagnosed, making it challenging for veterans to secure VA disability benefits for these disorders.

Veterans may develop parasomnias due to military-related factors. Establishing a service connection for parasomnias can be difficult, especially if symptoms were not fully documented during active duty. To strengthen a claim, veterans often need a VA nexus letter, a medical opinion from a qualified healthcare provider linking their parasomnia to military service, or a service-connected condition.

What Are Parasomnias?

Parasomnias are a category of sleep disorders that involve abnormal behaviors, movements, emotions, perceptions, or dreams that occur while falling asleep, during sleep, or when waking up. Unlike typical sleep disturbances like insomnia or sleep apnea, parasomnias cause uncontrollable and often disruptive physical or emotional reactions, which can interfere with daily life, safety, and overall well-being. Many veterans experience parasomnias as a result of service-related stress, PTSD, traumatic brain injuries (TBI), or irregular sleep schedules from military duty.

Parasomnias are generally classified into non-REM parasomnias and REM parasomnias, depending on which stage of sleep they occur in. Non-REM parasomnias, such as sleepwalking and night terrors, happen during deep sleep and often leave the person unaware of their actions. REM parasomnias, such as REM sleep behavior disorder (RBD) and nightmares, occur during the dream stage of sleep, sometimes leading to physical movements or emotional distress.

Because parasomnias can cause serious physical and mental health consequences, including sleep deprivation, injury, or worsening PTSD symptoms, they may qualify for VA disability benefits if a service connection can be established. However, proving that parasomnias developed due to military service can be complex without medical evidence, including a VA nexus letter from a healthcare provider. A proper diagnosis, sleep studies, and expert evaluations can help veterans strengthen their claims and receive the necessary benefits.

Common Causes of Parasomnias Among Veterans

Veterans are at a higher risk of developing parasomnias due to the physical and psychological demands of military service. Factors such as combat stress, exposure to traumatic events, and irregular sleep schedules can disrupt normal sleep patterns, leading to parasomnia-related behaviors. Many of these conditions are linked to service-connected disorders, making it possible for veterans to seek VA disability benefits.

Post-Traumatic Stress Disorder

PTSD is one of the most significant contributors to parasomnias among veterans. Many individuals with PTSD experience nightmares, night terrors, and REM sleep behavior disorder, in which they physically act out their dreams. Recurrent distressing dreams can lead to fragmented sleep and hyperarousal, preventing the brain from transitioning between sleep stages properly. These disruptions increase the likelihood of sleepwalking, sleep paralysis, and violent movements during sleep. Since PTSD is a recognized service-connected condition, veterans suffering from PTSD-related parasomnias may qualify for secondary service connection through the VA.

Traumatic Brain Injury (TBI)

TBI is another major cause of sleep disturbances, including parasomnias. Head injuries sustained in combat, training accidents, or vehicle crashes can damage the brain regions responsible for sleep regulation. Veterans with TBI often report experiencing abnormal sleep behaviors such as confusion upon waking, sleep talking, and uncontrolled movements during sleep. In more severe cases, TBI-related neurological damage can lead to REM sleep behavior disorder, in which a person loses the normal muscle paralysis of REM sleep and physically enacts their dreams.

Chronic Sleep Deprivation and Irregular Sleep Schedules

Service members frequently endure extended periods of sleep deprivation due to demanding duty schedules, night shifts, and high-alert conditions. These disruptions to natural circadian rhythms can increase the risk of developing long-term sleep disorders, such as parasomnias. Sleep deprivation can also lead to a breakdown in the brain’s ability to regulate sleep properly.

Medication Side Effects

Many veterans take medications to manage service-related conditions such as PTSD, depression, chronic pain, and anxiety. Certain medications, particularly antidepressants, sedatives, and sleep aids, can trigger or worsen parasomnias by altering brain chemistry. Some medicines suppress REM sleep, leading to REM rebound when discontinued, which increases the likelihood of nightmares. In other cases, sleep aids may contribute to sleepwalking or confusion upon waking, placing veterans at risk of injury.

Neurological Conditions

Some veterans develop parasomnias due to underlying neurological disorders that affect sleep regulation. Conditions such as Parkinson’s disease, multiple sclerosis, and autonomic nervous system disorders can contribute to abnormal sleep behaviors. Veterans exposed to environmental toxins or hazardous chemicals during service may also develop neurological impairments that increase their risk of parasomnias. While these conditions may not always be directly service-connected, veterans who develop neurological disorders due to military-related exposures may qualify for VA disability benefits if they can provide medical evidence linking their condition to service.

Proving a Service Connection for Parasomnias

Veterans seeking VA disability benefits for parasomnias must establish a service connection, proving that their sleep disorder is directly related to their time in the military or a condition that was aggravated by their service. Since parasomnias are not always well-documented during active duty, many veterans face challenges in proving their condition is service-related. However, veterans can strengthen their claim with the right medical evidence, including service records, sleep studies, and a VA nexus letter.

Direct Service Connection

A direct service connection for parasomnias means that the sleep disorder began during military service and can be traced back to events or conditions experienced while on active duty. Veterans pursuing this type of claim must demonstrate that they experienced symptoms of parasomnias, such as frequent nightmares, sleepwalking, night terrors, or REM sleep behavior disorder while serving.

To establish a direct service connection, veterans should provide:

• Service medical records documenting sleep disturbances or abnormal sleep behaviors.
• Personal statements or buddy statements from fellow service members describing episodes of parasomnia.
• Medical evaluations from military or VA doctors confirming the presence of a sleep disorder during service.
• Sleep studies or neurological assessments that diagnose parasomnias and rule out other causes.

Secondary Service Connection

A secondary service connection applies when parasomnias develop due to another service-connected condition. Many veterans experience parasomnias as a symptom of PTSD, TBI, chronic pain, or medication side effects.

A nexus letter from a medical professional can play a key role in establishing a secondary service connection by explaining how the veteran’s primary service-connected condition led to the development of parasomnias.

Aggravation of a Preexisting Condition

In some cases, a veteran may have had mild parasomnia symptoms before military service, but their condition worsened due to their service environment. If military service aggravated a pre-existing sleep disorder, making it more severe or more frequent, the veteran may still qualify for VA disability benefits.

To prove aggravation, veterans must show:

• Medical records indicating that they had a history of parasomnias before enlistment.
• Evidence that symptoms became significantly worse during or after service, such as increased frequency of night terrors or new symptoms like sleep paralysis.

Proof that the condition worsened due to a service-connected event is crucial; otherwise, benefits are unavailable for a pre-existing condition.

VA Disability Ratings for Parasomnias

The VA assigns disability ratings for parasomnias based on how severely the condition impacts a veteran’s ability to function in daily life, including work, relationships, and overall well-being. Veterans with parasomnias may receive a rating based on conditions such as PTSD, anxiety, TBI, or chronic sleep disturbances. The VA evaluates these claims by considering frequency, intensity, and impact on daily activities. Below are the standard disability ratings assigned to parasomnias:

• 0% Rating – The condition is diagnosed, but symptoms do not significantly interfere with daily activities, employment, or social functioning. No compensation is awarded, but the veteran may still receive VA healthcare benefits.
• 10% Rating – Mild symptoms of parasomnia, such as occasional nightmares, minor sleep disturbances, or infrequent sleepwalking episodes that cause some sleep disruption but do not significantly impact work or relationships.
• 30% Rating – Moderate symptoms, including frequent night terrors, regular sleep paralysis episodes, or persistent sleepwalking, that cause moderate difficulty maintaining work performance, personal relationships, or routine tasks.
• 50% Rating – Severe symptoms that lead to significant impairment, such as daily sleep disturbances, physical harm from acting out dreams, or severe emotional distress related to sleep issues, making it difficult to sustain employment or engage in normal social interactions.
• 70% Rating – Major occupational and social impairment, with near-continuous sleep disturbances, violent movements during sleep, or parasomnias so severe that they lead to serious safety concerns or require supervision. Veterans at this level may have great difficulty maintaining employment or functioning independently.
• 100% Rating – Total occupational and social impairment due to uncontrollable parasomnias, requiring continuous medical supervision or rendering the veteran unable to work or live independently. This level is rare but may apply to veterans with extreme REM sleep behavior disorder or trauma-related parasomnias causing dangerous actions during sleep.

Since parasomnias can be challenging to diagnose and rate, veterans should ensure their medical records, sleep studies, and a VA nexus letter document the severity and impact of their condition. If a veteran receives a lower rating than expected, they may appeal the decision with additional medical evidence to demonstrate how parasomnias affect their daily life.

The Role of a VA Nexus Letter in a Parasomnia Claim

A VA nexus letter is critical evidence in a parasomnia claim, as it helps establish the necessary link between a veteran’s sleep disorder and their military service. However, because parasomnias are often misdiagnosed or overlooked, veterans may struggle to prove that their condition is directly connected to their service. A well-written nexus letter from a qualified medical professional can provide the medical justification needed to support a claim and increase the likelihood of approval for VA disability benefits.

A nexus letter serves as an expert medical opinion that explains how a veteran’s parasomnia was either caused by or aggravated by military service. The letter should highlight a clear diagnosis of the sleep disorder by a veteran’s treating physician, a medical explanation of how the veteran’s condition developed based on medical journals and other research, and an assessment of how it impacts daily life. Since VA disability claims must meet the standard of proof that a condition is “at least as likely as not” related to service, the nexus letter should explicitly state this conclusion. To strengthen the argument for service connection, a doctor familiar with parasomnias and VA claims can provide detailed reasoning, including references to medical studies or the veteran’s service records.

For veterans seeking a direct service connection, a nexus letter can explain how military-related stress, sleep disruptions, or environmental exposures contributed to the onset of parasomnia. In cases where a veteran is pursuing a secondary service connection, the letter can demonstrate how an existing service-connected condition, such as PTSD or TBI, led to or worsened the sleep disorder.

If a veteran had a preexisting sleep condition aggravated by military service, the letter can establish that the worsening of symptoms was beyond the normal progression of the disorder. Because VA disability claims are often denied due to insufficient medical evidence, a well-supported nexus letter can significantly improve the chances of a successful claim.

Let Elite Medical Review Associates Help

The prospect of filing a claim for disability benefits with the VA can be overwhelming for some people. Alternatively, dealing with the frustration and worry that can come with a denied claim is often worse. In either situation, help is available. A strong nexus letter could make all the difference in your case, and Elite Medical Review Associates can help you find the ideal medical professional for your case.

Finding a doctor experienced in treating parasomnias is hard enough as it is. This process only becomes more difficult when looking for a medical professional who will also prepare a VA nexus letter. Contact us to connect with the ideal nexus letter author for your claim.