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Veterans Law

Sleep Apnea Secondary to Asthma VA Disability Benefits

June 25, 2020
profile of man using nebulizer to treat asthma or sleep apnea

What is Asthma?

Asthma, also called bronchial asthma, is a condition in which an individual’s airways narrow and swell and produce extra mucus, thereby making breathing difficult.  For some individuals, asthma is a minor health issue.  Yet for others, asthma may interfere with daily activities and lead to life-threatening consequences.  Although asthma symptoms tend to vary, the most common ones include the following:

  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping caused by shortness of breath, coughing, or wheezing
  • A whistling or wheezing sound when exhaling
  • Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

For some individuals, asthma symptoms may flare up in certain situations including:

  • Exercise-induced asthma – symptoms triggered by physical exercise, which may be worse when the air is cold and dry
  • Occupational asthma – triggered by workplace irritants such as chemical fumes, gases, or dust
  • Allergy-induced asthma – triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (i.e., pet dander)

While there is no way to prevent asthma, there are ways to monitor the condition.  Specifically, individuals may take medication as prescribed by their doctors and using an inhaler as necessary.

Service Connection for Asthma

In most cases, veterans seeking service connection for asthma on a direct basis must show evidence of the following: (1) a current medical diagnosis of asthma; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the veteran’s asthma to the in-service event.  However, veterans may also pursue service connection for asthma on a presumptive basis under 38 CFR § 3.317.  VA created this presumption for Gulf War veterans who were returning from service in the Southwest Asia theater of operations and experiencing unexplained illness and symptoms.  The presumption includes medically unexplained chronic multisymptom illnesses (MUCMIs), undiagnosed illnesses, and certain infectious diseases.

Veterans may argue that asthma is a MUCMI under this regulation.  MUCMIs are diagnosed conditions without a conclusive pathophysiology or etiology that is characterized by clusters of symptoms.  Again, MUCMIs are medically unexplained; however, VA lists, among others, the following possible exposures:

  • Oil well fires
  • Depleted uranium
  • Sand, dust, and particulates

Health effects from exposure to these environmental hazards may produce asthma or related respiratory conditions.  As such, veterans may connect these exposures to their asthma in order to qualify for service connection under the Gulf War presumption.

What is Sleep Apnea?

Sleep apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted during the course of the night.  There are three main types of sleep apnea, including the following:

  • Obstructive Sleep Apnea – the most common form of sleep apnea; occurs when the throat muscles intermittently relax and back your airway during sleep
  • Central Sleep Apnea – occurs when your brain does not send proper signals to the muscles that control breathing
  • Complex (Mixed) Sleep Apnea Syndrome – occurs when someone has both obstructive sleep apnea and central sleep apnea

The signs and symptoms of these three types of sleep apnea tend to overlap, sometimes making it difficult to determine which type you have.  Generally speaking, the most common symptoms include: loud snoring, gasping for air during sleep, awakening with a dry mouth, morning headache, insomnia, hypersomnolence (i.e., excessive daytime sleepiness), and difficulty concentrating.

For mild cases of sleep apnea, doctors may suggest lifestyle changes such as losing weight or quitting smoking, if applicable.  In more serious cases, doctors may prescribe the use of a continuous positive airway pressure (CPAP) machine.  A CPAP machine delivers air pressure through a mask while you sleep and allows your upper airway passages to remain open, thereby preventing apnea and snoring.

Diagnosing Sleep Apnea

In order to confirm a sleep apnea diagnosis for VA disability compensation purposes, VA requires that a sleep study be conducted.  If you have been previously diagnosed with sleep apnea, but have not undergone a sleep study, VA will not consider that sole diagnosis enough evidence to verify eligibility for compensation.

Those who are already service-connected for sleep apnea, but did not undergo a sleep study, will likely be required to have one conducted in order to confirm the diagnosis to continue receiving benefits.  However, those who have been service-connected for sleep apnea for at least 10 years do not need to undergo a sleep study to maintain their rating as it is protected.

Relationship Between Asthma and Sleep Apnea

A recent study suggests that people who have asthma are more likely to develop obstructive sleep apnea.  Specifically, the risk is almost 40% greater for people with asthma as compared to those without asthma.  Again, obstructive sleep apnea has been shown to be associated with inflammation of both the upper and lower respiratory tracts, which are also affected by asthma.  The data also shows that long-term use of oral or inhaled bronchodilators (i.e., inhalers) causes the upper airway muscles to weaken resulting in impaired respiratory functioning.  Furthermore, when the throat muscles become weak due to asthma symptoms, there is a greater likelihood for the throat to collapse thereby causing obstruction of the airway.  Therefore, asthma may be directly related to sleep apnea.

Secondary Service Connection for Sleep Apnea

A secondary service-connected disability is one that results from a condition that is already service-connected.  In claims for secondary service connection, proving a medical nexus is especially important.  With regard to the conditions discussed herein, veterans may be eligible for service connection on a secondary basis for sleep apnea.  That is, if a veteran is service-connected for asthma and later develops sleep apnea, they should subsequently be service-connected for the sleep apnea if they can provide the appropriate medical evidence.

To apply for secondary service connection for sleep apnea, veterans can file a claim the same way they would file an initial claim for service-connected compensation.  They will need to demonstrate the following to VA to be granted secondary service connection for sleep apnea:

  • A diagnosis of sleep apnea
  • Medical evidence showing the relationship between their service-connected asthma and their sleep apnea