VA Disability Ratings and Benefits for Insomnia

What is Insomnia?

Insomnia is a sleep disorder marked by difficulty falling asleep or staying asleep, even when a person has the chance to do so.  People with the condition can feel dissatisfied with their sleep and experience negative outcomes related to their energy level, mood, health, work performance, and quality of life.

The two main types of insomnia are acute (short-term) and chronic (long-term).

• Acute Insomnia—This form usually only lasts for a short period of time, likely less than one month.
• Chronic Insomnia—Chronic insomnia is more complex than acute insomnia and occurs several times per week. This form can last at least one month or longer.

Symptoms

Specific symptoms of insomnia may include the following:

• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Not feeling well-rested after a night’s sleep
• Daytime tiredness or sleepiness
• Irritability, depression, or anxiety
• Difficulty paying attention, focusing on tasks, or remembering
• Increased errors or accidents
• Ongoing worries about sleep

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Causes of Insomnia

Understanding the potential causes of insomnia can be essential to your VA disability claim.  While the central cause of insomnia is not always clear, some of the most common causes include:

• Psychiatric illness, such as depression, anxiety, and/or PTSD
• Chronic pain from other disabilities
• Chronic stress
• Medications
• Life changes

Acute insomnia is typically the result of a stressful or traumatic event.  Chronic insomnia can also be the result of stress, a traumatic event, life events, or habits that disrupt sleep.  Additionally, chronic insomnia may be associated with medical conditions or the use of certain medications.

Many people experience short-term, or acute, insomnia, which lasts for days or weeks.  Acute insomnia is typically the result of stress or a traumatic event.  However, some people have long-term, or chronic, insomnia that lasts for a month or longer.  Chronic insomnia can also be the result of stress, a traumatic event, life events, or habits that disrupt sleep.  Additionally, chronic insomnia may be associated with medical conditions or the use of certain medications.

Diagnosing Insomnia

Depending on the circumstances, diagnosing insomnia may involve the following:

• Physical exam. If the cause of the condition is unknown, a doctor may perform a physic exam to look for signs of medical problems that may be related to insomnia.
• Sleep habits review. In addition to asking sleep-related questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness.
• Sleep study. If the cause of your condition is unknown or unclear, you may need to spend a night at a sleep center where tests are done to monitor and record a variety of body activities while you sleep (e.g., brain waves, breathing, heartbeat, eye movements)

Insomnia may be treated by changing your sleep habits and addressing any issues that may be associated with the condition.  However, in more severe cases, cognitive behavioral therapy, stimulus control therapy, relaxation techniques, sleep restriction, and light therapy may be used as forms of treatment.

Treatment

Insomnia may be treated by changing your sleep habits and addressing any issues that may be associated with the condition.  In more severe cases, the following treatment may be used:

• Cognitive-behavioral therapy (CBT)
• Stimulus control therapy
• Relaxation techniques
• Sleep restriction
• Light therapy

Service Connection for Insomnia

Veterans can be service-connected for insomnia on a direct basis if they can prove their insomnia resulted from or was aggravated by their military service.

Many veterans also seek service connection for their insomnia on a secondary basis.  Insomnia can often be a component of a psychological issue, and is rated as part of a psych condition under the schedule for Mental Disorders.

Secondary Service Connection

Secondary service connection refers to when an already service-connected condition causes another condition to develop.  Veterans can receive a disability rating for each condition.  Below are some examples:

• Chronic pain causing insomnia—If you developed chronic back pain (primary condition) during service and can no longer sleep through the night as a result, you could claim insomnia as a secondary condition.
• Aggravation—Previously existing insomnia made worse by military service or another service-connected disability, as long as it differs from the natural progression, qualifies as secondary service connection.
  • When it would apply: You had mild insomnia prior to military service but injured your back on active duty. This back injury causes you a lot of pain, and you now sleep less than you did before as a result.

• When it would not apply: If an injury you sustained before service caused insomnia and that injury naturally worsens, causing greater insomnia, you will not be eligible for service connection based on aggravation.

Insomnia is associated with psychiatric disorders such as depression, anxiety, and PTSD.  A veteran whose psychiatric condition causes insomnia can qualify for insomnia as a secondary service-connected condition.  If a veteran is service-connected for insomnia and then develops depression related to their lack of sleep, they may be eligible for VA disability benefits for depression on a secondary basis.

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VA C&P Exams for Insomnia

VA may require veterans to undergo a Compensation and Pension, or C&P, examination for insomnia depending on the existing evidence in their c-file.  A veteran’s c-file usually contains their service records, medical records, and any other documentation that has previously been submitted to VA.

The exam usually takes place at a VA hospital or with a VA-contracted provider.  The examiner will most likely conduct a routine exam, which may include psychological testing.  They may also ask questions about your symptoms to better understand how your insomnia connects to your service.

Importantly, VA does not give the veteran a copy of their report based on the C&P exam unless the veteran asks for it.  Therefore, it is crucial that the veteran requests a copy of the exam report.  If the veteran disagrees with this assessment, they can challenge unfavorable C&P exams.

VA Disability Ratings for Insomnia

VA will typically rate insomnia according to the Schedule of Ratings for Mental Disorders (38 CFR § 4.130).  However, VA tends to rate the condition as a component of an underlying mental health condition.

For example, if a veteran is service-connected for PTSD and suffers from insomnia as a result, it is likely that VA will consider the sleep condition in its overall evaluation of the veteran’s PTSD.

Usually, if a veteran has a psych condition and insomnia, they will only get one rating, not two.  If the veteran’s insomnia is not caused by a mental health condition, but some other condition (e.g., orthopedic condition), then VA will likely assign a separate disability rating for insomnia based on the Schedule of Ratings for Mental Disorders.

Ratings range from 0-100 percent.  Below is a breakdown of the criteria for the rating scale:

• 100%—Presents total occupational and social impairment
• 70%— Occupational and social impairment, with deficiencies in most areas
• 50%—Presents occupational/social impairment with reduced reliability
• 30% Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks
• 10%—Occupational or social impairment due to mild or transient symptoms
• 0%—If diagnosed but symptoms are not severe enough to interfere in occupational or social settings
  • Although 0% ratings often do not result in compensation, they are still important because VA recognizes service connection.

TDIU for Insomnia

If a veteran is unable to secure or maintain substantially gainful employment as a result of their sleep disorder, they may be entitled to total disability based on individual unemployability (TDIU).  Total Disability based on Individual Unemployability, or TDIU, is a benefit offered by VA that allows disabled veterans who are unable to work due to a service-connected disability(ies) to receive disability compensation equal to a 100 percent rating, even if their combined disability rating does not reach a schedular 100 percent.

If a veteran is unable to secure or maintain substantially gainful employment as a result of their sleep disorder, they may be entitled to TDIU.

Insomnia contributes to poor work performance as individuals can become too tired to function effectively during the day.

Importantly, insomnia does not need to be the only contributing factor to unemployment.  Rather, if the combination of veteran’s insomnia and other service-connected conditions contribute to their unemployment, TDIU may still be warranted.