Our VA Disability Lawyer Explains How to Pursue Benefits for Secondary Service-Connected Sleep Apnea
Since sinusitis affects the airways in many different ways, it contributes to some of the same physical irregularities that cause sleep apnea. Aside from sharing similar symptoms—such as snoring and difficulty breathing—recurring or chronic sinusitis also creates a long-term risk of developing sleep apnea.
Although the Department of Veterans Affairs (VA) has a duty to ensure that former members of the military receive compensation for physical disabilities sustained during service, obtaining a rating—let alone the right rating—isn’t always easy. Rejections and delays are common, as are refusals to recognize the causal relationship between conditions like sinusitis and sleep apnea.
You don’t have to put your faith in the VA’s bureaucracy. Read more to learn about sinusitis secondary to sleep apnea, or contact Sean Kendall, Attorney at Law, to find out how our team could help you obtain the rating you deserve.
An Overview of Sleep Apnea and Sinusitis
Sleep apnea and sinusitis are often connected. Chronic sinusitis can lead to nasal congestion that obstructs airflow, worsening sleep apnea symptoms. Additionally, sleep apnea can contribute to inflammation in the upper airway, potentially exacerbating sinus issues and causing a cycle of breathing difficulties.
What You Need to Know About Sleep Apnea
Sleep apnea is a common but potentially life-threatening disorder that involves regular and recurring respiratory disturbances. In general, people who have sleep apnea will stop breathing at different times throughout the night, often making them feel tired and groggy the next day.
Doctors usually diagnose sleep apnea as any one of the following three conditions:
- Obstructive sleep apnea, the most common form, occurs when the throat muscles relax and block the flow of air into the lungs.
- Central sleep apnea, which is caused by the brain’s failure to send the right signals to the muscles that control breathing.
- Treatment-emergent central sleep apnea, a complex form of sleep apnea that’s recognized as a potential side effect of receiving treatment for obstructive sleep apnea.
Sleep apnea can cause a wide range of problems, both while you’re awake and asleep. Aside from being closely associated with chronic fatigue, sleep apnea could trigger high blood pressure, diabetes, and metabolic irregularities.
The VA doesn’t distinguish between different types of sleep apnea. However, if it’s diagnosed as a service-connected condition, sleep apnea could be rated at up to 100%.
What You Need to Know About Sinusitis
Your sinus cavities are large, hollow structures inside your face. They’re normally filled with air but can become blocked if they are irritated by seasonal allergies or bacterial infections. If and when the sinuses become blocked, they can fill with fluid, generating pressure inside your skull and causing symptoms like pain and congestion. Sinusitis is an inflammation of the tissues that line your sinus cavities.
Most people who are diagnosed with sinusitis only experience discomfort between a week and 10 days. However, Veterans are believed to be at increased risk for chronic sinusitis, which can persist for longer periods of time and flare up throughout the year. In some cases, exposure to toxic chemicals—including the chemicals found in burn pits—can cause more chronic sinusitis.
Understanding the Relationship Between Sleep Apnea and Sinusitis
Sinusitis and sleep apnea are superficially dissimilar conditions. But, as referenced above, having one condition might put you at risk for the other. Specifically, you might be more likely to develop sleep apnea because:
- Sinusitis causes congestion, which can block the airways at night. Over time, intermittent difficulty breathing can eventually translate to full-blown sleep apnea.
- Sinusitis drives mucus production, another key contributor to airway blockages.
- Many service-connected cases of chronic sinusitis involve nasal polyps. These growths are not life-threatening or cancerous, but they can make it more difficult to inhale air through your nose when sleeping.
Sleep apnea and sinusitis can both affect the throat and the lungs, essentially working together to make everyday activities a veritable exercise in respiratory distress.
VA Ratings for Sleep Apnea and Sinusitis
When you’re first creating an application for service-related conditions, or you’re asking for our help because that application was denied, it’s essential to understand how the VA evaluates them and determines causation. Here’s how it works.
How the VA Rates Sleep Apnea
The VA rates all forms of sleep apnea on the following scale:
- 0% rating. A 0% rating may be selected if your diagnosis doesn’t cause any significant symptoms or doesn’t require any treatment.
- 30% rating. A 30% rating may be awarded if you experience daytime sleepiness that impairs your ability to function at work or engage in other waking activities.
- 50% rating. A 50% rating is used if you’re prescribed a CPAP machine or require other breathing assistance.
- 100% rating. A 100% rating is only awarded if your sleep apnea has caused serious complications, including chronic and potentially life-threatening heart and lung problems.
In most cases, using a CPAP machine or receiving other breathing assistance is required to obtain a rating of 50% or greater.
How the VA Rates Sinusitis
The VA usually looks for the following types of signs when rating claims for sinusitis:
- The presence of polyps inside the nose.
- A deviated nasal septum, meaning a crooked “wall” between the two nostrils.
- A history of repeated respiratory tract infections.
Depending on the severity of your symptoms, and the extent to which they impact your daily life, you could receive any of the following ratings:
- 0% rating. A 0% rating means that you have sinusitis but it doesn’t affect your daily life, work, or routine in any significant or noticeable way. In most cases, your symptoms would be akin to those of somebody with seasonal allergies.
- 10% rating. You could receive a 10% rating if you experience multiple flare-ups each year but can manage your symptoms with over-the-counter medication.
- 30% rating. 30% ratings are awarded if and when sinusitis requires regular doctor’s appointments and management with prescription medication.
- 50% rating. The highest rating for sinusitis is 50%. This rating is only awarded if sinusitis causes frequent symptoms that require multiple prescription medications or surgery.
Making Sense of the VA’s Requirements for Secondary Sleep Apnea Claims
If you’re diagnosed with sinusitis that’s service-connected, you may be entitled to obtain additional disability compensation for sleep apnea. For this “secondary service connection,” you will typically need
- A diagnosis for your primary service-connected condition of sinusitis.
- A diagnosis for your secondary service-connected condition of sleep apnea.
- Medical evidence shows that your service-connected sinusitis caused or worsened your sleep apnea.
You may or may not have to obtain additional evidence to establish a service connection. Depending on the circumstances of your service, certain overseas deployments could entitle you to PACT Act benefits. Under the PACT Act, conditions like sinusitis could be considered “presumptive,” meaning that the Department of Veterans Affairs will accept qualifying service records as sufficient evidence of a service connection. If you don’t meet the PACT Act’s criteria, you may have to submit additional evidence with your application.
Don’t let the VA deny your sleep apnea claim that’s secondary to sinusitis because of a lack of in-service medical records. The job of a unit in the military isn’t to keep medical records, and the Veteran's Court has held numerous times that a lack of in-service records isn’t a basis to deny service connection. My firm helps Veterans overcome this obstacle thrown up by the VA in their cases.