Veterans’ Sleep Apnea: A Hidden Battle Beyond Service

Veterans face many challenges during service, and the provocations often follow into their lives after the military. Unfortunately, weakened health is a significant hardship that former service members have to deal with besides reintegration into civilian life.

One of the increasingly recognized and often overlooked conditions affecting veterans is sleep apnea (SA), a severe disorder characterized by repeated interruptions in breathing during sleep. It can significantly impact a veteran's health, quality of life, and mental well-being. Given its profound influence on veterans' day-to-day lives, SA is one of the most commonly claimed disabilities among veterans.

Recent studies concluded that veterans are at a higher risk of developing SA compared to the general population. The reasons are complex, ranging from the physical demands of military service to a higher prevalence of co-occurring illnesses. Yet, despite its prevalence, many veterans remain undiagnosed or struggle to get the care and benefits they deserve.

The Journal of Clinical Sleep Medicine published a study stating that veterans who were deployed face a notably higher risk of developing obstructive sleep apnea (OSA) compared to nonveterans. The study found that veterans are more than twice as likely to be diagnosed with SA, and those who served in deployed environments have a 64% higher chance of developing the condition than their non-deployed peers. Even more concerning, veterans are typically diagnosed with SA five years earlier than nonveterans. This research highlights the need for increased screening and early intervention, particularly for veterans with deployment history.

Another study published in the American Journal of Health Promotion found that OSA was diagnosed in 21% of veterans, more than double the 9% prevalence observed in nonveterans. SA is one of the most commonly claimed disabilities among veterans and is often linked to:

• exposure to toxic materials during service
• PTSD
• traumatic brain injuries

Military members encounter toxic contaminants during their service, among them asbestos, a preferred and mandated material of most branches of the armed forces. Many veterans, especially those who served aboard Navy ships or in shipyards, were exposed to asbestos before the 1980s because it was widely used for insulation, fireproofing, and engine/mechanical system components on vessels and military bases. Long-term exposure to the mineral's airborne fibers can lead to serious health problems even 30 or 40 years later. While asbestos exposure doesn't directly cause SA, in time, it can lead to or worsen underlying lung or respiratory conditions that may contribute to sleep-disordered breathing, including:

• Reduced lung capacity and oxygen exchange due to scarring from asbestos-related diseases.
• Shortness of breath (dyspnea), mainly when lying flat, which may interfere with standard sleep patterns.
• COPD-related sleep apnea is sometimes referred to as "Overlap Syndrome" when COPD and obstructive sleep apnea coexist.

SA is more than just trouble sleeping; it's a serious condition influencing a veteran's body, both during sleep and during the day. It's categorized into three main types:

• Obstructive Sleep Apnea (OSA) is what most people refer to when they say "sleep apnea. It is the most common form of SA among veterans.
• Central Sleep Apnea (CSA) is caused by the brain sending the wrong signals to the muscles that control breathing. It is less common and is usually linked to other health conditions.
• Complex (CompSA) or Mixed (MA) Sleep Apnea is a combination of obstructive and central sleep apnea.

It is possible to misdiagnose asbestos-linked diseases such as asbestosis and SA without specialized testing because of overlapping symptoms. A wrong diagnosis can lead to complications, especially since these two conditions require different treatments. Understanding that these symptoms can be subtle or develop gradually over time is essential. For veterans with asbestos-related lung conditions, respiratory issues may already be present. It can potentially mask or be confused with signs of SA:

• loud snoring
• insomnia
• start and stop breathing during sleep
• gasping for air during sleep
• waking up with a dry mouth
• headache in the morning
• excessive daytime sleepiness
• difficulty concentrating
• irritability

That's why former service members should disclose any history of asbestos exposure to their doctor. The information is essential for the correct diagnosis and management of both asbestos-related health issues and possible sleep problems. If left untreated, SA can lead to high blood pressure, heart disease, and other severe health complications.

VA Sleep Study to Diagnose Sleep Apnea

The VA diagnoses SA primarily through a sleep study, also known as polysomnography. In many cases, this test is the only way to determine whether you have conditions such as SA or other sleep problems. It records how your heart, brain, lungs, and other organs function while you sleep.

The sleep study is usually done in one night; it's easy and safe. It helps confirm SA and is often required for VA disability claims. Even if a doctor has already diagnosed you, the VA usually needs this test to approve your claim. Navy veterans who were exposed to asbestos before the 1980s and are now diagnosed with SA may apply for VA disability compensation. Still, eligibility depends on how the condition is connected to the service.

SA's direct link to asbestos exposure is difficult to prove because the disease is not medically recognized as a direct result of asbestos exposure. Moreover, there have not been any significant medical studies linking the two. Lately, according to the VA, there's been a considerable spike in disability claims related to SA, and many claims have cited both asbestosis and SA as conditions requiring financial relief. A correlative or causal link still waits for future research to confirm. Consequently, to support this kind of claim, the VA would need a strong medical opinion ( a nexus letter) stating that SA is linked to in-service asbestos exposure. However, the VA will usually not approve this type of claim unless other severe health conditions are involved.

For many veterans suffering from SA, filing for a secondary service connection is a better option. Those who already have a VA-approved respiratory condition caused by asbestos exposure may be able to claim SA as secondary to that condition. For example, asbestosis or COPD can damage the lungs to such a degree that it reduces the ability to breathe properly at night. This breathing problem can contribute to or worsen SA.

Documents to Strengthen a VA Claim for Sleep Apnea

To secure the maximum VA disability rating for SA, providing comprehensive medical evidence and clearly establishing a service connection is essential. Your documentation should include:

• official diagnosis
• a recent sleep study
• a nexus letter from the doctor
• lay statements from family and friends
• CPAP documentation

You'll need a document on the impact SA has on daily life and employment: this can be done by keeping a symptom journal and submitting employment records. You should also submit medical documentation that proves you regularly use the prescribed CPAP machine.

In case of approval of the VA claim for SA, veterans can receive a disability rating from 0% to 100%, depending on how severe the symptoms are and the needed treatments. A rating of 0% means you have a diagnosed condition but no noticeable symptoms or need for treatment. An up to 100% rating is assigned for chronic respiratory failure or more severe complications; SA claims can be submitted:

• online at va.gov
• in person at a VA regional office
• by mailing VA Form 21-526EZ

Assisting Veterans in Filing Toxic Exposure Claims

Former military personnel diagnosed with asbestos-related diseases like mesothelioma or lung cancer may qualify for both VA disability benefits and separate compensation from the asbestos trust funds.

While the VA provides benefits based on service-connected exposure, asbestos trust funds are managed outside the VA and provide financial compensation to anyone, military or civilian, who was exposed to products made by bankrupt asbestos companies and developed an asbestos-related cancer.

A lawyer specializing in toxic exposure will ensure that you file the paperwork on time after collecting all necessary documents and vital information to strengthen your case while ensuring that your claims comply with VA regulations. We can assist you in contacting experienced attorneys who are ready to represent your case.