Veterans often face a myriad of health challenges, and two prevalent conditions among them are obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD). This article examines the intricate relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD), particularly for veterans seeking disability benefits.
Leah Bucholz offers valuable insights into the VA claims process, detailing factors influencing the relationship, research supporting the connection, and the criteria for disability ratings. By understanding how to establish a service connection for OSA and GERD, veterans can effectively advocate for their health and secure the benefits they deserve.
What Are Sleep Apnea and GERD?
Sleep apnea, particularly obstructive sleep apnea (OSA), is a disorder where the airway becomes blocked during sleep, often due to relaxed throat muscles. Those affected may experience sleep apnea symptoms such as loud snoring, daytime sleepiness, and dry mouth. They may not fully wake during these episodes, making the sleep disorder difficult to self-diagnose. Obstructive sleep apnea patients experiencing nighttime symptoms may have an ongoing cough, inflammation of the laryngitis, or asthma.
Gastroesophageal reflux disease (GERD), on the other hand, occurs when the lower esophageal sphincter fails to close properly, allowing stomach acid to rise into the esophagus. Common GERD symptoms include heartburn, chest pain, and a sour taste in the mouth, though some individuals may experience “silent” GERD without noticeable symptoms.
Risk Factors and Complications
Common risk factors that increase both GERD and sleep apnea include obesity, smoking, and certain chronic health conditions like diabetes and high blood pressure. Individuals with these risk factors should monitor for signs of both conditions, as developing one can increase the likelihood of the other.
The complications of untreated acid reflux include esophageal inflammation, Barrett’s esophagus, and an increased risk of esophageal cancer. Sleep apnea can lead to cardiovascular issues, including high blood pressure and stroke. Therefore, it is crucial to diagnose and manage both conditions promptly.
Treatment Options
Treatment for GERD typically involves medications such as H2 blockers, proton pump inhibitors, and lifestyle changes like weight management and dietary adjustments. Sleep apnea treatments often include the use of a continuous positive airway pressure (CPAP) machine, oral devices, and positional therapy, where individuals sleep on their side to keep the airway open.
Lifestyle changes can be beneficial for patients with GERD and sleep apnea. Maintaining a moderate weight, avoiding alcohol and smoking, and adopting specific sleeping positions such as sleeping on the left side can help reduce symptoms. Elevating the head during sleep can also relieve GERD symptoms.
The Intersection of OSA and GERD
The connection between obstructive sleep apnea and GERD is significant yet often overlooked. OSA can cause pressure changes during apneic episodes, which weaken the lower esophageal sphincter, allowing stomach acid to flow back into the esophagus, especially at night. This acid reflux irritates both the esophagus and airways, worsening symptoms of GERD and contributing to breathing issues in OSA. Conversely, GERD can worsen chronic acid reflux by inflaming the airways, leading to more frequent disruptions in breathing.
Leah Bucholz highlights the importance of recognizing this bidirectional relationship, particularly in cases where OSA is considered a secondary condition in disability claims. A comprehensive approach is crucial for proper management, as these conditions often coexist and exacerbate each other. Treating one condition often leads to improvements in the other, making simultaneous management essential.
Lifestyle factors like obesity, smoking, and alcohol consumption further complicate both GERD and sleep apnea, making lifestyle changes an important part of treatment. Addressing these factors improves health outcomes and sleep quality.
Factors Influencing the Relationship
Leah emphasizes the importance of a comprehensive assessment when examining the link between obstructive sleep apnea and gastroesophageal reflux disease. Key factors influencing the relationship include:
- Obesity and BMI: Body mass index (BMI) and obesity can contribute to both conditions. In cases where obesity is a significant factor, attributing sleep apnea solely to GERD might be a stretch. The collapse of the upper airway, a common cause of OSA, is often linked to weight gain.
- Airway Pressure: Sleep apnea may create negative pressure in the chest during apneas, pulling stomach acid into the esophagus and worsening GERD symptoms.
- Lifestyle Factors: Smoking, alcohol consumption, and sedentary habits increase the likelihood of developing both conditions and exacerbate their symptoms. For example, smoking weakens the lower esophageal sphincter, promoting acid reflux, while also contributing to airway inflammation, making OSA worse.
- Sleeping Position: Lying flat on the back can exacerbate acid reflux by allowing stomach acid to more easily reach the esophagus and can worsen airway obstruction in OSA. Sleeping on the left side or with the head elevated can help alleviate symptoms.
- Shared Risk Factors: Conditions like diabetes and hypertension contribute to the severity of both GERD and sleep apnea, making holistic evaluation crucial for effective treatment.
Leah advocates for a holistic evaluation that takes into account all relevant risk factors that increase sleep disorder or acid reflux symptoms, both positive and negative.
Crafting Comprehensive Letters for VA Claims
Leah Bucholz highlights the significance of crafting well-rounded letters when supporting veterans’ claims. Rather than focusing solely on one condition, she recommends including all pertinent risk factors for developing GERD and acid reflux, providing an objective assessment of the veteran’s health. A thorough examination of the evidence, including both helpful and non-helpful factors, forms the foundation of a compelling letter in support of disability claims.
Medical Opinions and VA Disability Claims
Leah clarifies that she is not an accredited claims agent, VSO, or attorney. However, she collaborates with accredited legal representatives and offers medical opinions for their cases. Veterans pursuing disability benefits can obtain medical opinions from their treating providers or seek assistance from professionals like Leah, who can forensically review records and offer expert opinions based on the available evidence.
Research Supporting the Connection of Obstructive Sleep Apnea & Gastroesophageal Reflux
Leah shares insights from various research articles that delve into the relationship between obstructive sleep apnea syndrome & gastroesophageal reflux disease. A meta-analysis published in “Sleep and Breathing” in 2019 explores the connection between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease. This meta-analysis, based on 2600 patients from seven articles, provides direct evidence of GERD’s involvement in the pathogenesis of OSA.
Noteworthy Research Articles on the relationship between Obstructive Sleep Apnea & Gastroesophageal Reflux
- “The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Gastrosoph Reflux Disease: A Meta-analysis” (2019) – Sleep and Breathing.
- “Gastroesophageal Reflux Disease and Sleep Disorders: Evidence for a Causal Link and Therapeutic Implication” (2010) – Journal of Neurogastroenterology and Motility.
- “Is the Severity of Obstructive Sleep Apnea or the Magnitude of Respiratory Effort Associated with Gastroesophageal Reflux?” (2005) – World Journal of Gastroenterology.
- “Association Between Obstructive Sleep Apnea Severity and Endoscopically Proven Gastroesophageal Reflux Disease” (2018) – Sleep and Breathing.
Insights from Research Articles
These articles reveal a positive correlation between the severity of OSA and the presence of GERD. Endoscopic findings of GERD were found to be worse in patients with more severe OSA. Additionally, GERD symptoms were associated with deteriorated sleep quality, highlighting the comorbid nature of these conditions.
Empowering Veterans to Explore Research
Leah encourages veterans to explore these research articles to gain a better understanding of the intricate relationship between Obstructive Sleep Apnea & Gastroesophageal Reflux. Armed with knowledge, veterans can engage in informed discussions with their treating providers, facilitating a collaborative approach to healthcare and disability claims.
VA Rating for GERD and OSA
Veterans suffering from GERD and OSA may be eligible for VA disability benefits. GERD is rated under Diagnostic Code 7346, with ratings based on symptom severity. A 60% rating is assigned for severe symptoms such as persistent heartburn, vomiting, and weight loss. A 30% rating is given for more moderate symptoms like recurrent heartburn and regurgitation. A 10% rating covers mild symptoms, while veterans with controlled or occasional symptoms may receive a 0% rating.
For OSA, ratings are based on the need for CPAP therapy and symptom severity. A 50% rating applies if the veteran requires a CPAP machine. A 30% rating is assigned for OSA causing daytime hypersomnolence, while a 0% rating applies if symptoms are mild without serious disruption to daily life.
To achieve a 100% rating, veterans must show that their combined disabilities are severe enough to prevent them from maintaining gainful employment, qualifying them for a Total Disability Individual Unemployability (TDIU) rating.
Service Connection for GERD and OSA
Veterans suffering from Obstructive Sleep Apnea (OSA) and Gastroesophageal Reflux Disease (GERD) can file for disability benefits through the VA. Establishing a service connection for GERD or OSA requires proving that military service caused or aggravated the condition. Here’s how veterans can navigate the process:
- Veterans must provide medical evidence, including service treatment records or a medical nexus linking the condition to their time in service.
- If your claim is based on a secondary service connection, you’ll need proof that a service-connected disability, such as PTSD or diabetes, contributed to developing sleep apnea or GERD.
- GERD and OSA can also be claimed as secondary conditions to each other. Medical evidence demonstrating this link can help establish a secondary service connection.
- Submit a claim via the VA.gov website, a Veterans Service Organization (VSO), or a VA office.
The VA may schedule a Compensation & Pension (C&P) exam to assess the severity of your condition. Veterans may report symptoms such as chest pain, nocturnal GERD symptoms, and sleep-disordered breathing from obstructive sleep apnea. Veterans can appeal unfavorable decisions or seek assistance from VA-accredited representatives to help navigate the complex claims process.
Conclusion
In conclusion, the connection between obstructive sleep apnea & gastroesophageal reflux disease is a nuanced aspect of veterans’ health that deserves attention. Leah Bucholz’s insights and the research articles mentioned provide a foundation for veterans to navigate the complexities of disability claims related to these conditions. By understanding the multifactorial nature of the connection between GERD and sleep apnea, veterans can advocate for their health and pursue the disability benefits they rightfully deserve., veterans can advocate for their health and pursue the disability benefits they rightfully deserve.
Also read: VA Appeals to the Board (BVA) Explained by an Accredited Claims Agent
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
Our purpose is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
Understanding the unique challenges veterans face, our commitment lies in delivering exceptional service and support.
Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
Prestige Veteran Medical Consulting is not a law firm, accredited claims agent, or affiliated with the Veterans Administration or Veterans Services Organizations. However, we are happy to discuss your case with your accredited VA legal professional.
