The U.S. Department of Veteran’s Affairs (VA) is responsible for compensating military veterans who received a disability during their time in service. Depending on the effects military service has on an individual’s sleeping patterns, they may be eligible to file a VA disability claim for insomnia.
What is Insomnia?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines insomnia as a “dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms”:
- The patient has difficulty initiating sleep
- Early awakening with inability to go back to sleep
- Difficulty maintaining sleep due to frequent awakenings or problems going back to sleep after awakening
Other criteria for insomnia include:
- Trouble sleeping at least 3 nights per week
- Sleep difficulty for at least 3 months
- The insomnia is not caused by physiological effects of a drug, medication, or substance abuse
- The insomnia disorder cannot be adequately explained by other coexisting medical conditions or mental disorders
- The insomnia is not explained or caused by another sleep disorder
- Trouble sleeping occurs even when the opportunity for sleep is present
- The sleep disturbances cause significant distress or impairments in important areas of functioning throughout the patient’s life
Mood problems, low energy, and concentration issues can all be indicative of some form of insomnia.
Types of Insomnia
There are two different forms of insomnia: acute and chronic. Acute insomnia typically occurs for less than one month. When sleep difficulties begin it can be tough to distinguish between acute and chronic insomnia, but if the problem works itself out in a short period of time or is only caused by a temporary stimulus, it is acute.
If insomnia occurs consistently (at least 3 times per week) and lasts for more than one month, it will be labeled as chronic insomnia. Chronic insomnia is much more complicated and often requires some form of treatment or medication.
Causes of Insomnia
Insomnia can be caused or aggravated by a variety of triggers. Sometimes it can be difficult to identify exactly where the disorder stemmed from, which makes it important to understand some of the common causes:
- Chronic stress
- Drugs or medications
- Traumatic life changes or events
- Different mental disorders or psychiatric illnesses
- Chronic pain caused by other disabilities
Many veterans are exposed to these factors during their time serving in the military. Proving service connection between the disorder and these causes is how a veteran can receive an insomnia VA rating.
VA Service Connection: Is Insomnia a Disability?
There is a difference between struggling to fall asleep and having the sleep disorder insomnia. When it can be categorized by prolonged periods of restlessness, disturbances of daily life, and a continuous downward trend of mental and physical health, the VA recognizes sleep issues like insomnia. If a veteran has these symptoms, the next step is proving service connection.
The VA disability insomnia requires an actual diagnosis of insomnia to be present. In general, the same three pieces of evidence are expected in an insomnia claim as any other VA disability claim. To file for insomnia you must provide:
- A current diagnosis
- An explanation of an in-service event
- An official letter that connects the diagnosis and the event
The diagnosis must be from an authorized medical professional that is recognized by the VA. The event described could be anything from losing a fellow service member or experiencing a traumatic attack. The occurrence does not have to occur when the veteran is on-base either, it’s not about active duty in this case, it’s about the time of service. As long as that event can be connected to the diagnosis through a medical nexus, it can help to prove the service connection. A medical nexus is any document or statement from a medical professional that links the occurrence to the diagnosis. There are also circumstances that can change the evidence which must be provided in a VA claim for insomnia.
Aggravated Service Connection for Insomnia
You are also eligible to file a disability claim for insomnia if you already had it before you joined the military. To qualify for this type of claim, you will need to prove that the condition was aggravated, or made worse, by your time in military service. The VA regards the inability to sleep worsening after enrollment in active duty as service connection by aggravation.
This must be differentiated from the natural progress of a condition. If you are injured playing sports before joining the military and your doctor specifies that your injury will naturally worsen over time, the aggravation may not be caused by the service but by the general passage of time. One way to figure out whether or not insomnia is aggravated by service or service-connected in the first place is through a VA-ordered C&P exam.
Compensation & Pension Examinations
Compensation & Pension (C&P) exams take place in designated VA clinics. These exams allow VA-approved medical professionals to order the VA to gather evidence in support of a claim. Typically these are used as supplemental pieces to an already present diagnosis.
The exam will include psychological testing, a routine examination, and a variety of questions that help the doctor understand the severity of your disability. The doctor will not provide any sort of treatment or medication for your disability. During a C&P exam, you will likely also be required to fill out an insomnia DBQ, or disability service questionnaire. An insomnia DBQ will provide information to the doctor on symptoms you’re experiencing, details on the event you believe caused insomnia, and why you believe your insomnia is service-connected.
The examiner will then write a report to the VA for further review. If the C&P results are unfavorable, you can challenge them to earn a better insomnia VA rating. This report can be very helpful especially to veterans who develop insomnia years after their time in the military. Getting an extra opinion on service connection can help to get your claim approved. C&P examiners can also determine that the insomnia is eligible for secondary service connection compensation, meaning the insomnia was caused by another, a primary service-connected disability.
Secondary Service Connection
Secondary service connection refers to a disorder or condition that arises as a result of another disorder or condition. To qualify for secondary service connection, the first disability must already be proven to be service-connected. Seeking compensation for two disabilities can potentially increase your rating and therefore your benefits.
For example, if an individual is diagnosed with PTSD during active service and later develops insomnia due to the disorder, the veteran can include both in the claim. The veteran’s VA rating for insomnia secondary to PTSD will likely add up to be higher than the PTSD rating alone. Both mental and physical problems can contribute to insomnia. A veteran can also supplement their VA rating for insomnia secondary to back pain. If a veteran has service-connected back pain that causes difficulty sleeping, they may be entitled to a higher rating.
Secondary service claims require the same evidence that primary service claims require. An individual must get a current diagnosis and provide proof connecting the secondary condition directly to the original condition.
Insomnia VA Disability Percentage
Typically, the VA measures insomnia with Schedule of Ratings for Mental Health Disorders 38 CFR. Sleep disorders are graded as mental health disabilities, which factors into how the rating is decided. Mental health disabilities are rated as a total combination of each comorbid disorder. For example, a PTSD rating and an insomnia VA rating would combine to give one higher total score. If insomnia appears as a secondary connection from a physical condition, the veteran can receive two separate ratings (one for mental health and one for physical conditions).
The insomnia VA rating percentage depends on a multitude of factors such as severity, duration, and frequency of sleep difficulties. While it is possible for veterans to qualify for Total Disability based on Individual Unemployability (TDIU) as a result of insomnia, it is not common. TDIU is when a veteran can prove that they are unable to find and/or maintain gainful employment due to their disorder or condition. If insomnia completely prevents the veteran from being able to work a job that supplies an income above the poverty line, they will be compensated as though they have a %100 VA rating.
More often than not insomnia is not extreme enough to warrant TDIU, however, it does contribute to unemployment in combination with other mental disorders. For example, individuals who claim the VA disability tinnitus secondary insomnia and depression or PTSD are more likely to struggle to gain employment than someone who only suffers from insomnia.
VA Disability Compensation for Insomnia
Insomnia disability benefits depend on the VA’s veteran’s disability compensation chart. The 2021 VA compensation rates fluctuate depending on rating and dependents. For a 10% VA disability rating, a veteran will receive $144.14 a month. For a veteran with no dependents and a 100% disability rating, the benefits are roughly $3,146.42 a month.
Insomnia can be rated at any percentage between 0-100% which means it’s very important to include the full range of symptoms you’re experiencing and be as honest as possible about the negative effects it has had on your quality of life.
VA Disability Rating for Sleep Disturbances
The VA currently recognizes three major sleep disorder VA ratings. While other disorders may factor in, the main three are insomnia, sleep apnea, and narcolepsy.
Although not covered, some disorders still provide their own rating in these three categories. The hypersomnia VA rating, which you get when you feel excessive sleepiness during the day, is 30%. Sleep paralysis is not a disability on its own, neither is sleepwalking, but both of these are considered symptoms of the greater sleep disorder categories that can increase VA ratings.
Some disorders fit into other categories and can still increase ratings. The REM sleep behavior disorder VA disability can act as a signal for Parkinson’s, which may help you receive benefits before symptoms occur. A VA claim for periodic limb movement can also contribute to sleep difficulties due to restless legs or other body parts.
Some disorders that don’t interfere with work and other activities will not be eligible for compensation. Some people experience sleep troubles because they work night shifts or rotating shifts, this is called shift work sleep disorder. VA disability is based on the need for financial compensation, therefore this disorder doesn’t make the cut.
Getting a chronic sleep impairment VA rating can be frustrating when your condition does not match the exact symptoms. Many veterans refer to legal guidance when deciding whether or not their disability is eligible for compensation.