Veterans Law

VA Disability Benefits for Sleep Disorders Secondary to Depression

March 17, 2022

Updated: February 16, 2024

VA Disability Benefits for Sleep Disorders Secondary to Depression

What is Depression?

Depression, or major depressive disorder, is a serious medical condition that can interfere with necessary activities of life, such as eating, sleeping, and working. Depression can affect how a person feels and thinks. As such, depression often takes a significant mental, emotional, and physical toll on a person.

Symptoms of Depression

Feelings of sadness, fatigue, worthlessness, guilt, or hopelessness
Loss of interest or pleasure in usual activities
Disturbances in sleep
Anxiety or restlessness
Irritability
Difficulty concentrating or remembering things
Loss of appetite and weight loss or increased appetite and weight gain
Thoughts of death or suicide

How Common is Depression in Veterans?

Depression is very common among servicemembers and veterans. A 2014 study found that nearly 1 in 4 active duty servicemembers showed signs of a mental health condition.

The Substance Abuse and Mental Health Services Administration also determined that approximately 18.5 percent of veterans returning from Iraq and Afghanistan have or have had PTSD or depression. Studies continue to be done to analyze the link between military service and depression, however, there are a variety of theories as to why so many service members and veterans experience the condition.

Why is Depression So Prevalent Among Veterans?

The nature of service can cause trauma which can have a lasting impact, long after a person’s experience is over. Depression can occur shortly after a person experiences trauma, or it may take years to manifest. Below are some examples of trauma that could lead a veteran to develop depression:

Witnessing a fellow service member be injured or killed
Experiencing an injury as the result of combat
Experiencing an IED explosion
Being part of a burial crew
Living with the fear of hostile military or terrorist activity
In-service assault or threat of assault

Female veterans are at significant risk for depression and are more than 250 percent more likely to commit suicide than their civilian counterparts. The rate of military sexual trauma female veterans face could be one of the potential reasons the rates of depression and suicide are so high among this population.

WINNING VA Disability Benefits for Depression

What Are Sleep Disorders Secondary to Depression?

As one of the symptoms of depression can be disturbances in sleep, many veterans may experience sleep disorders as a result of their depression.

Some sleep disorders that can be related to depression can include:

Sleep Apnea

Sleep apnea is sleep disorder that affects a person’s breathing during the course of the night. Generally, there are three types of sleep apnea:

Obstructive Sleep Apnea – the most common form of sleep apnea; occurs when the throat muscles intermittently relax and block your airway during sleep
Central Sleep Apnea –occurs when your brain does not send the 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

People with sleep apnea may experience loud snoring, gasping for air during the night, excessive daytime sleepiness, dry mouth, and difficulty concentrating.

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.

Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by overwhelming hypersomnolence (i.e., daytime drowsiness) and sudden attacks of sleep. Individuals with this condition often find it difficult to stay awake for prolonged periods of time, regardless of the circumstances (e.g., time of day, engagement in activities, amount of sleep obtained the night before). As a result, narcolepsy can cause significant disruptions and impairments in a person’s daily routine. There are two types of narcolepsy:

Type 1 narcolepsy – occurs with cataplexy (i.e., sudden loss of muscle tone); can be triggered by strong emotion
Type 2 narcolepsy – occurs without cataplexy

Symptoms of narcolepsy can include daytime sleepiness, sleep paralysis, and hallucinations. While depression may not necessarily cause narcolepsy, many people who have narcolepsy also experience depression. Additionally, a study published in 2018 noted that more than 50 percent of patients who were studied that had narcolepsy and comorbid depression had been diagnosed with depression prior to narcolepsy. While there is not enough evidence to make any definitive link about depression causing narcolepsy, it is clear that depression and narcolepsy do share some symptomology.

Establishing Direct Service Connection for Depression

To file a claim for VA disability benefits for depression, veterans will first need to become service connected. When seeking service connection, veterans will generally need to submit the following to VA:

A current diagnosis of depression—The easiest way to show proof of a diagnosis for depression is through medical records. Importantly, the diagnosis must be current.
An in-service event or stressor—To prove an in-service event, veterans might use service treatment records, as they will have documented any injury or illness, including depression, if it was treated during active duty. Unfortunately, not all veterans have this type of evidence available to them, as many service members do not seek treatment out of fear of stigma. In this case, lay statements from the veteran and/or their family members can be particularly effective, as they can describe both the onset and progression of the veteran’s depression, as well as how it relates to service.
A medical nexus between the depression and the in-service event—A statement from a qualified healthcare professional affirming that they believe your condition was “at least as likely as not” caused by your military service can serve as a medical nexus.

5 Ways to Establish VA Service Connection

Veterans can submit their claim using VA Form 21-526EZ. The form can be submitted to VA in the following ways:

Online – using VA’s eBenefits platform
By mail – directed to the Department of Veterans Affairs, Evidence Intake Center, PO Box 4444 in Janesville, WI 53547-4444
In person – bringing a completed VA Form 21-526EZ to a VA Regional Office near you
With a legal representative – completing the form with a Veterans Service Organization (VSO) or a VA accredited agent or attorney

Establishing Secondary Service Connection for a Sleep Disorder

Once the veteran has been service connected for depression, they may wish to file a claim for secondary service connection for their sleep disorder. Filing a claim for secondary service connection is much like filing a claim for direct service connection. Veterans can use the same form, VA 21-526EZ, to file for secondary service connection for sleep disorders secondary to depression.

When submitting a claim for secondary service connection, the veteran should submit:

A current diagnosis of a sleep disorder secondary to depression
Medical evidence showing the relationship between their depression and the sleep disorder

VA Ratings for Depression

Mental health conditions can be rated from 0 percent to 100 percent. Specifically, major depressive disorder is rated under Diagnostic Code 9434. The rating given will be based on the level of social and occupational impairment a veteran experiences and the severity of symptoms.

100%–This rating is for veterans who experience “total occupational and social impairment.” Symptoms may include gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (such as minimal maintenance of personal hygiene), disorientation to time or place, memory loss for names of close relatives, occupation, or name.

70%–Veterans rated at 70 percent experience occupational and social impairment, with deficiencies in “most” areas. Symptoms may be similar to those listed above in the 100 percent criteria. Impairment may affect the veteran’s work, school, family relations, thinking or mood. Veterans rated at this level may also experience suicidal ideation.

50%–The 50 percent rating is given to veterans with occupational and social impairment, specifically with “reduced reliability and productivity.” Symptoms can include panic attacks more than once a week, difficulty understanding complex commands, loss of memory, impaired judgement, disturbances of mood, and difficulty establishing and maintaining effective work and social relationships.

30%–To secure the 30 percent rating, veterans will experience occupational and social impairment with “occasional decrease in work efficiency” and periods of inability to perform occupational tasks. Symptoms may include depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, and mild memory loss.

10%–10 percent ratings are given to veterans with occupational and social impairment from “mild or transient symptoms” that can decrease work efficiency or the ability to perform occupational tasks during periods of stress.

0%–The 0 percent rating is non-compensable, meaning that it is not associated with any financial compensation. However, this rating is still important because it establishes service connection for the condition and can potentially help the veteran receive an increased rating in the future. With the 0 percent rating, veterans have a diagnosis, but the symptoms may not be severe enough to interfere with occupational or social functioning.

Importantly, a veteran does not need to demonstrate all the symptoms listed in each rating criteria. A Court of Appeals for Veterans Claims case, Mauerhan v. Principi, established that the symptoms listed in Diagnostic Code 9411 (i.e., post-traumatic stress disorder) are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. The same case law applies when determining a disability rating for depression. Therefore, a veteran can have any number of symptoms listed in the rating criteria for depression and still meet that level of evaluation.