REM Sleep Behavior Disorder (RBD) is a serious sleep disorder that has the potential to result in severe physical injuries. People with RBD remain physically active while asleep, leading to unintended behaviors such as kicking, punching, yelling, or even falling out of bed instead of lying still. These episodes can cause self-inflicted injuries and put bed partners at risk, significantly impacting sleep quality and overall health.

For veterans, RBD can be incredibly challenging. Many develop the disorder as a result of traumatic brain injuries, post-traumatic stress disorder (PTSD), or neurological conditions linked to military service. Chronic sleep disturbances, exposure to combat stress, and the long-term effects of service-related injuries may all contribute to the development of RBD. In some cases, RBD is an early warning sign of neurodegenerative diseases, making timely diagnosis and treatment essential.

Despite its serious consequences, RBD is often misdiagnosed or mistaken for other conditions, such as PTSD-related nightmares or mental health disorders. This can make it difficult for veterans to receive proper medical care and disability compensation. The VA requires clear medical evidence to establish a service connection for RBD, and many claims are denied due to a lack of documentation or a misunderstanding of the disorder’s impact. A VA nexus letter from a qualified medical provider can be a crucial piece of evidence in proving that RBD is linked to military service or an existing service-connected condition.

What Is REM Sleep Behavior Disorder?

RBD is a neurological sleep disorder in which individuals physically act out their dreams due to a lack of normal muscle paralysis during REM sleep. In a typical sleep cycle, the body experiences temporary paralysis during REM sleep to prevent movement. However, in people with RBD, this mechanism fails, allowing them to engage in physical activity while dreaming. This can result in movements such as kicking, punching, talking, yelling, or even falling out of bed.

RBD is classified as a parasomnia, a category of sleep disorders involving abnormal behaviors or experiences during sleep. Unlike sleepwalking, which occurs during non-REM sleep, RBD is unique because it occurs exclusively during the REM stage. For veterans, RBD can be particularly concerning, as it may develop due to service-related factors such as PTSD, brain injuries, or chronic sleep disturbances.

Common Symptoms of REM Sleep Behavior Disorder

The symptoms that are common with RBD are unusual compared to other sleep disorders. Instead of insomnia or night terrors, veterans with this condition deal with uncontrolled physical activity during REM sleep. Flailing and thrashing can put other people at risk and result in serious injuries if someone falls from their bed while asleep.

One of the most recognizable symptoms of RBD is dream enactment behavior, in which individuals engage in movements such as kicking, punching, grabbing, or jumping out of bed while still asleep. Some may also experience verbal outbursts, including shouting, talking, or laughing, in response to dream content. These episodes can occur multiple times per night and become more frequent or intense over time.

People with RBD often wake up disoriented or confused after an episode, though they may recall vivid and intense dreams that match their physical actions. Unlike sleepwalking, where individuals may not remember their actions, those with RBD typically remember their dreams in detail upon waking.

Frequent sleep disturbances are another hallmark of RBD. Many individuals struggle with fragmented sleep, frequent awakenings, and difficulty returning to sleep after an episode. As a result, they may experience chronic fatigue, excessive daytime sleepiness, and difficulty concentrating throughout the day.

RBD can also lead to self-inflicted injuries or harm to a bed partner, as sudden and forceful movements occur without conscious control. This poses a significant safety risk, particularly for veterans who may have heightened stress responses or combat-related dream content.

Since RBD often worsens over time, many veterans notice an increase in the frequency and severity of episodes, making early diagnosis and treatment essential. If left untreated, RBD can have a lasting impact on physical health, mental well-being, and overall quality of life.

Known Causes of REM Sleep Behavior Disorder Among Veterans

There are multiple known causes for RBD, each linked to disruptions in the brain’s ability to regulate muscle paralysis during REM sleep. For veterans, RBD is often associated with service-related factors such as traumatic brain injuries, PTSD, neurological conditions, and medication side effects. Identifying the cause of RBD is essential for securing VA disability benefits.

Traumatic Brain Injury

Veterans who have sustained a TBI during service are at a significantly higher risk of developing RBD. TBIs can damage the areas of the brain responsible for sleep regulation, particularly the brainstem, which controls REM sleep paralysis. Studies have shown that individuals with TBI often experience disruptions in REM sleep, abnormal dream activity, and increased movement during sleep, all of which are consistent with RBD.

For veterans who suffered blast-related concussions, head trauma from falls, or combat-related injuries, RBD may develop as a long-term neurological consequence. Because TBI is a recognized service-connected condition, veterans with RBD linked to a past brain injury may qualify for secondary service connection through the VA.

Post-Traumatic Stress Disorder and Chronic Stress

There is a strong link between PTSD and RBD, as both conditions involve heightened brain activity during sleep. Veterans with PTSD often experience recurrent nightmares, hyperarousal, and disrupted sleep cycles, which can contribute to the development of RBD. The excessive activation of the nervous system may prevent the brain from properly regulating REM sleep, leading to uncontrollable movements and violent dream enactment behaviors.

Veterans with combat-related PTSD frequently report aggressive dream activity, sleep disturbances, and episodes of physically acting out nightmares, increasing the likelihood of RBD. Since PTSD is a common service-connected condition, veterans who develop RBD as a result of PTSD may be eligible for VA benefits under a secondary service connection claim.

Neurological Disorders and Degenerative Diseases

RBD is often an early sign of neurodegenerative diseases, such as Parkinson’s disease, multiple system atrophy, and Lewy body dementia. Veterans exposed to toxic chemicals, burn pits, or Agent Orange may have a higher risk of developing these neurological disorders, potentially leading to RBD as a preclinical symptom before a formal diagnosis is made. For veterans with mild cognitive impairment, memory loss, or early signs of neurological disease, RBD may be an early warning sign of a progressive disorder.

Medication Side Effects

Certain medications prescribed to veterans for service-connected conditions may trigger or worsen RBD symptoms. Antidepressants, sleep aids, and certain neurological drugs have been linked to increased REM sleep disturbances, particularly in individuals with PTSD or anxiety. Selective serotonin reuptake inhibitors (SSRIs), commonly prescribed for depression, may increase dream intensity and REM sleep activity, leading to more significant movement during sleep and a higher risk of RBD episodes.

Chronic Sleep Deprivation and Military Sleep Disruptions

Many veterans experience prolonged sleep deprivation and irregular sleep schedules during their time in service, which can increase the likelihood of developing RBD. Night shifts, combat stress, and extended periods of high alertness may alter the brain’s sleep architecture, leading to long-term disruptions in REM sleep regulation. Over time, chronic sleep deprivation can increase neurological instability, worsen PTSD symptoms, and contribute to abnormal REM sleep behavior.

How the VA Rates REM Sleep Behavior Disorder

The VA assigns disability ratings for RBD based on the severity of symptoms and their impact on a veteran’s daily life, employment, and overall well-being. The severity of this condition is rated on a scale from 0% to 100%, with 100% representing a total disability.

Common VA Disability Ratings for RBD

• 0% Rating – The veteran has a diagnosed case of RBD, but symptoms are mild and do not significantly interfere with daily activities or employment. While no compensation is awarded at this level, the veteran may still qualify for VA healthcare benefits.
• 10% Rating – Symptoms occasionally cause minor sleep disturbances but do not significantly impact daily life or work performance. Veterans may experience mild sleep movements, occasional injuries, or brief awakenings.
• 30% Rating – RBD causes moderate impairment, including frequent episodes of dream enactment behavior that lead to disrupted sleep, daytime fatigue, and difficulty maintaining relationships or work responsibilities. Veterans may experience sleep-related injuries or require medication to manage symptoms.
• 50% Rating – Severe symptoms significantly impact the veteran’s ability to function. RBD episodes may occur multiple times per week, leading to frequent injuries, aggressive sleep movements, or inability to maintain employment due to poor sleep quality and daytime exhaustion.
• 70% to 100% Rating – At its most severe, RBD results in total occupational and social impairment. Veterans at this level may suffer from constant sleep-related injuries, require continuous medical supervision, or have an underlying neurological disorder contributing to their symptoms. This level of impairment can prevent independent living and full-time employment.

Factors That Influence RBD Disability Ratings

The VA considers several factors when determining the appropriate disability rating for RBD. They include the following:

• Frequency and severity of episodes – More frequent and severe sleep disturbances typically result in higher ratings.
• Impact on daily functioning – The extent to which RBD affects work, relationships, and independent living.
• Presence of injuries – If RBD episodes lead to self-inflicted injuries or harm to a bed partner, the condition may be rated more severely.

Secondary Ratings for RBD

Since RBD is frequently associated with other service-connected conditions, veterans may also qualify for a secondary rating if their sleep disorder is linked to PTSD, TBI, Parkinson’s disease, or medication side effects. The VA evaluates how RBD exacerbates other conditions and may increase the overall disability rating accordingly.

How VA Nexus Letters Can Help With RBD Disability Claims

A VA nexus letter is the foundation of a successful disability claim. They provide a medical expert’s opinion linking the condition to military service. 

RBD is most often a secondary condition to PTSD, TBIs, or other neurodegenerative diseases, which can make proving a service connection more difficult. In this instance, obtaining a nexus letter from a sleep specialist becomes even more critical to help exemplify how your military service contributed to the creation or advancement of RBD.

Once you have your nexus letter, you can submit it with your original claim. If your claim was denied for lack of medical evidence, you can submit your nexus letter on appeal to help strengthen your overall case. But remember, you must use either a Supplemental Claim or a Board appeal if you are going to submit new evidence.  You may want to consult an attorney if you have to file an appeal. A nexus letter is the clear medical reasoning your claim needs to improve the likelihood that you will secure VA disability benefits for your RBD.

Appealing a Denied VA Claim for REM Sleep Behavior Disorder

If your disability claim for RBD is denied, you have the right to file an appeal. We see claims denied daily because of insufficient medical evidence, lack of a clear service connection, or misclassifying RBD under another condition. When you know the reason your claim was denied, that helps you revise and submit more substantial medical documentation to improve your chances of a successful appeal. There are several appeal options:

• Higher-Level Review – A senior VA reviewer re-examines the claim without adding new evidence. (Note: Higher-level review is best if the denial was due to a legal error and not due to the absence of evidence.)
• Supplemental Claim – Veterans can submit new and relevant evidence, such as medical records, sleep studies, or a nexus letter, to strengthen their case.
• Board of Veterans’ Appeals (BVA) – Veterans can request a hearing before a Veterans Law Judge, which allows them to present additional testimony and medical documentation.

Learn How Elite Medical Review Associates Can Help With Your Nexus Letter

If you are living with this sleep disorder, securing disability benefits through the VA can be a life-changing event. Having a strong nexus letter could be enough to get you the results you deserve.

At Elite Medical Review Associates, we have relationships with expert medical care providers nationwide. Contact us immediately to learn how we can help you secure a nexus letter in your case.