Proving Sleep Apnea Secondary to Sinusitis

Veterans may be prone to developing both sleep apnea and sinusitis due to military service, potentially qualifying them for a VA rating for sleep apnea secondary to sinusitis. For more information on sleep apnea VA ratings—including eligibility requirements, how to obtain a nexus letter for sleep apnea related to sinusitis, and achieving secondary service connection—download our complimentary eBook: VA Disability Ratings for Sleep Apnea: An Essential Guide for U.S. Veterans. 

How Sinusitis and Sleep Apnea Are Linked

Sleep apnea is a prevalent disorder among military veterans. The most common type, Obstructive Sleep Apnea (OSA), involves intermittent throat muscle relaxation that obstructs the airway during sleep.

Symptoms of OSA can include frequent nighttime awakenings, loud snoring, excessive daytime fatigue, morning headaches, and difficulty concentrating.

Sinusitis is another common condition among veterans. This condition arises when the sinuses in your nose and head become swollen and inflamed, disrupting normal mucus drainage. 

Common symptoms of sinusitis include congestion, tender eyes or facial pain, ear discomfort, postnasal drip, breathing difficulties, and fatigue. Should sinusitis persist beyond three months despite treatment efforts, it transitions into chronic sinusitis.

Sleep apnea can emerge as a secondary condition to sinusitis or be exacerbated by sinusitis in several ways. Inflammation resulting from sinusitis may impact the soft tissues of the throat and airway, thereby obstructing airflow and heightening the likelihood of developing sleep apnea.

Furthermore, sinusitis has the potential to exacerbate pre-existing airway obstructions, leading to intensified sleep apnea symptoms. Additionally, frequent sleep disturbances caused by sinusitis can aggravate existing symptoms and contribute to both the development and long-term progression of sleep apnea.

In fact, managing sinusitis is important in treating sleep apnea. Enhancing nasal airflow can significantly mitigate the severity of sleep apnea symptoms and enhance overall sleep quality.

VA Ratings: Sleep Apnea Secondary to Sinusitis

Sinusitis is evaluated by the Department of Veterans Affairs (VA) pursuant to 38 CFR § 4.97. Under the General Rating Formula for Sinusitis (Diagnostic Codes 6510 through 6514), sinusitis is rated as follows:

• 50%: Assigned following radical surgery accompanied by chronic osteomyelitis, or in cases where near-constant sinusitis manifests with headaches, pain, and tenderness in the affected areas, along with purulent discharge or crusting subsequent to repeated surgeries.

• 30%: Applicable when there are three or more incapacitating episodes per year necessitating prolonged antibiotic treatment (lasting between four to six weeks), or if there are more than six non-incapacitating episodes annually characterized by pain, headaches, and purulent discharge or crusting.

• 10%: Given for one to two incapacitating episodes per year requiring extended antibiotic treatment (four to six weeks), or for experiencing three to six non-incapacitating episodes per year marked by headaches, pain, and purulent discharge or crusting.

• 0%: Applicable when detected solely via X-ray evidence without accompanying severe symptoms.

An “incapacitating episode” refers to any occurrence that mandates bed rest and medical treatment from a healthcare professional.

Sleep apnea VA ratings fall under 38 CFR § 4.97 Diagnostic Code 6847 within the Schedule of Ratings – Sleep Apnea Syndromes.

A VA rating of 50% or higher for sleep apnea requires usage of one of the following qualified breathing assistance devices:

• Automatic airway pressure device (APAP)
• Bilevel-positive airway pressure device (BiPAP), also referred to as NIPPV or NIV
• Continuous positive airway pressure (CPAP) machine
• Implanted genioglossal nerve stimulation devices
• Nasopharyngeal appliances such as nasal dilators and nasopharyngeal stents
• Oral appliances like mandibular advancement devices (MAD) and tongue-retaining mouthpieces.

A veteran’s secondary service connection ratings for sleep apnea or sinusitis can significantly impact their overall combined disability rating. For instance, a veteran who has a primary service connection for sinusitis rated at 50 percent and an additional secondary service connection for sleep apnea rated at 30 percent would meet the criteria for Total Disability Individual Unemployability (TDIU), if they can show that they are unable to secure or maintain a substantially gainful occupation due to their service-connected disabilities.

In addition, veterans who do not satisfy the requirements for schedular TDIU may still qualify for extraschedular TDIU if they can demonstrate that their condition(s) uniquely impede their ability to sustain substantially gainful employment.

How to Get VA Benefits for Sleep Apnea Secondary to Sinusitis

To successfully secure a VA disability claim for sleep apnea secondary to sinusitis, the following criteria must be met:

• An existing service-connected primary condition (Sinusitis)
• A current medical diagnosis of the secondary VA disability (Sleep Apnea) documented in medical records as linked to the already service-connected primary disability (Sinusitis)
• Medical nexus evidence demonstrating a causal relationship between the service-connected primary condition (Sinusitis) and the secondary disability being claimed (Sleep Apnea)

Veterans diagnosed with chronic sinusitis attributable to particulate matter exposure during military service may qualify for presumptive service connection under the PACT Act.

Eligibility for presumptive service connection for chronic sinusitis under the PACT Act applies if Veterans served in one of the following locations and timeframes:

• Veterans who served on or after August 2, 1990, engaging in active military duties while assigned to stations in (including airspace above) the United Arab Emirates, Somalia, Saudi Arabia, Qatar, Oman, Kuwait, Iraq, or Bahrain.

• Veterans who served on or after September 11, 2001, fulfilling active military duties while stationed in (including airspace above) Syria, Lebanon, Jordan, Egypt, Djibouti, or Afghanistan.

Sleep Apnea Secondary to Sinusitis Nexus Letters

A nexus letter linking sleep apnea to sinusitis is crucial evidence when applying for VA benefits. Sinusitis can lead to sleep apnea by causing nasal congestion and inflammation, obstructing airways. To demonstrate this linkage to the VA, veterans must provide a medical expert opinion or nexus letter that scientifically connects the two conditions.

A nexus letter demonstrates the connection between your service-connected sinusitis and the onset or aggravation of sleep apnea by presenting a healthcare provider’s comprehensive medical reasoning and professional assessment, clearly stating that the veteran’s sleep apnea is “as likely as not” caused by or aggravated by the service-connected sinusitis.

Proving secondary service connection for sleep apnea resulting from sinusitis can be complex. A VA disability lawyer specializing in secondary service connection claims can assist you in obtaining a robust nexus letter, when appealing a denied claim. For more information on sleep apnea VA ratings—including eligibility requirements, how to obtain a nexus letter for sleep apnea related to sinusitis, and achieving secondary service connection—download our complimentary eBook: VA Disability Ratings for Sleep Apnea: An Essential Guide for U.S. Veterans.