Veterans who suffer from tinnitus often experience more than just persistent ringing in their ears. Insomnia, a common secondary condition, can also develop, complicating daily life. This article explains how to service connect insomnia as a secondary condition to tinnitus, the VA rating process, and tips for filing a successful claim.
How Does VA Rate This Condition?
Insomnia does not have its own diagnostic code and is rated as a mental disorder under VA’s mental health criteria, based on the severity of its impact on a veteran’s occupational and social functioning. The ratings range from 0% to 100%, depending on the frequency and intensity of symptoms.
The challenge for many veterans is to prove that their insomnia is related to tinnitus. Veterans who experience chronic insomnia linked to tinnitus should maintain thorough documentation of their symptoms, including the frequency of sleepless nights and how insomnia affects their ability to function in daily life and at work.
How to Prove Insomnia Secondary to Tinnitus
To establish a service connection for insomnia secondary to tinnitus, veterans need to present compelling medical evidence demonstrating that their insomnia is either caused or aggravated by their tinnitus. Once this link is proven, VA may grant a separate disability rating for insomnia in addition to the rating for tinnitus.
Successfully filing for VA disability for insomnia secondary to tinnitus involves three key steps:
1. Service-Connecting Tinnitus
Veterans must already have a service-connected tinnitus rating. This initial connection proves that the tinnitus is directly linked to their military service. Without this foundational service connection, it will be difficult to establish a secondary connection for insomnia. Learn more about how VA rates tinnitus.
2. Obtaining a Medical Diagnosis of Insomnia
A current diagnosis of insomnia must be established. Veterans should provide detailed medical records documenting the severity and frequency of their sleep disturbances and how insomnia impacts their daily life. Studies have shown a strong correlation between tinnitus and insomnia. For instance, a study published in The Hearing Journal found that insomnia and tinnitus often create a cycle, where tinnitus disrupts sleep, leading to chronic insomnia. This research showcases the connection between these conditions, helping to support the claim.
Additional research from the National Institutes of Health also found a significant relationship between tinnitus and insomnia, highlighting that up to 76% of tinnitus patients suffer from insomnia.
3. Nexus Letter Backed with Research
A key component in proving secondary service connection is obtaining a nexus letter from a qualified healthcare provider. This letter must explain how the veteran’s tinnitus is either causing or worsening their insomnia. The nexus letter can reference scientific studies to strengthen the claim.
For example, research published by the National Center for Biotechnology Information (NCBI) has shown that tinnitus can exacerbate sleep disorders, while other studies link the severity of tinnitus to the intensity of insomnia symptoms. The ongoing exploration of the role of sleep for managing tinnitus, as highlighted by the University of Oxford’s research, further supports the connection between these conditions.
By following these steps and incorporating well-documented research into their claim, veterans can improve their chances of receiving the VA disability benefits they deserve for insomnia secondary to tinnitus.
Case Example: Winning VA Disability Claim for Insomnia Secondary to Tinnitus
Note: These case examples are pulled from the VA’s database as a way for us to understand and showcase how claims are won in various cases. Not all of the cases are Hill & Ponton’s cases, and it will be indicated if they were represented by our firm. This information is meant to assist veterans with understanding factors and potential strategies for winning their VA disability claims.
A Vietnam veteran, who served in the U.S. Army from 1968 to 1970, initially filed a claim for disability benefits due to tinnitus. The veteran received a 10% disability rating for tinnitus but later developed chronic insomnia, which they believed was secondary to their service-connected tinnitus. After their initial claim for insomnia was denied, the veteran appealed the decision to the Board of Veterans’ Appeals, seeking an increased rating for insomnia as a secondary condition.
After reviewing the veteran’s appeal and supporting evidence, the Board granted service connection for insomnia secondary to tinnitus. The veteran’s overall disability rating was increased to reflect the severity of their insomnia, which significantly impacted their daily functioning, especially regarding their ability to maintain consistent sleep patterns and mental health.
Key Factors That Contributed to Winning the Claim:
- Establishing Service Connection for Tinnitus: The veteran already had an established service-connected disability for tinnitus, which provided a strong foundation for their secondary claim. This initial 10% rating for tinnitus was crucial in linking the insomnia as a secondary condition.
- Medical Evidence of Insomnia Diagnosis: The veteran’s medical records detailed a clear diagnosis of chronic insomnia. Regular sleep evaluations showed significant impairment in the veteran’s ability to fall and stay asleep, which was thoroughly documented by healthcare providers.
- A Nexus Letter from a Qualified Medical Professional: A well-supported nexus letter from the veteran’s healthcare provider played a pivotal role. This letter detailed the connection between the veteran’s tinnitus and insomnia, explaining how the persistent ringing in the ears disrupted the veteran’s sleep patterns, causing or aggravating insomnia.
- Scientific Research Supporting the Tinnitus-Insomnia Link: The appeal referenced multiple studies showing the correlation between tinnitus and insomnia. This research helped strengthen the veteran’s claim by providing a scientific basis for the connection between the two conditions.
By thoroughly documenting the impact of both tinnitus and insomnia on the veteran’s daily life, and providing strong medical and scientific evidence, the veteran successfully won the appeal, securing a higher disability rating. This case highlights the importance of a well-prepared appeal with comprehensive documentation and medical support when filing for secondary conditions.
Filing a Claim for Insomnia Secondary to Tinnitus
Veterans seeking to file a claim for insomnia secondary to tinnitus should carefully follow these steps to ensure the best chance of success:
- Gather Medical Evidence: Ensure that both your tinnitus and insomnia diagnoses are well-documented. This includes medical records from VA healthcare providers or private physicians that detail the onset, duration, and severity of your tinnitus and insomnia. Include any sleep studies, hearing tests, or records of how insomnia has affected your daily life and occupational functioning. It’s crucial to show that insomnia developed or worsened due to your service-connected tinnitus.
- Request a Nexus Letter: A nexus letter is a critical piece of evidence when establishing a secondary service connection. This letter must be written by a qualified healthcare provider, such as a doctor or a specialist, who can provide a professional medical opinion that your insomnia is “at least as likely as not” caused or aggravated by your tinnitus. The nexus letter should also reference relevant medical research or studies to strengthen the claim. This letter connects the dots between your service-connected tinnitus and your current insomnia diagnosis.
- Submit the Claim: File the claim with all the necessary medical documentation, including your medical records and nexus letter. Veterans can submit their claims through VA’s online portal, by mail, or in person at a regional office. Be sure to complete all necessary forms, including the VA Form 21-526EZ for disability benefits. It’s helpful to track your submission and follow up with VA to ensure all evidence is reviewed.
By following these steps and providing comprehensive medical evidence, veterans can build a strong case for receiving a disability rating for insomnia secondary to tinnitus.
How Secondary Conditions Can Influence VA Ratings
VA caps tinnitus at a 10% disability rating, but veterans who can link additional conditions (such as insomnia) to their service-connected tinnitus may significantly increase their overall disability rating. Demonstrating that insomnia is a secondary condition tied to tinnitus can lead to additional compensation, depending on the extent of the insomnia’s effects on daily life, work, and social interactions. This connection can meaningfully raise the veteran’s disability rating and provide vital financial relief.
However, establishing secondary conditions doesn’t just impact the rating; it allows a more comprehensive understanding of how the veteran’s overall health has been affected by service. For many veterans, tinnitus is just one piece of a larger health puzzle, often associated with a range of interconnected conditions that continue to affect their quality of life long after their military service. By acknowledging these secondary conditions, veterans can ensure they and their families receive the full scope of benefits and compensation they’re entitled to.
Example: Vietnam Veteran with Combat-Related Injuries
Consider fictitious example of a Vietnam veteran who served in combat zones and was regularly exposed to loud gunfire and explosions. This veteran may develop several conditions, including tinnitus, insomnia, and even PTSD. In this case:
- Tinnitus: The veteran is awarded a 10% rating for persistent tinnitus caused by constant exposure to gunfire and explosions during service.
- Insomnia Secondary to Tinnitus: The veteran has trouble sleeping due to the persistent ringing in their ears, they file a claim for secondary service connection for insomnia. If insomnia leads to chronic sleep issues and impacts the veteran’s daily life and work performance, they could receive a 30% or higher rating depending on the severity.
- PTSD and Anxiety: The psychological toll of combat, combined with the stress of dealing with tinnitus and insomnia, may exacerbate the veteran’s PTSD or anxiety. These conditions can be connected to the initial tinnitus, leading to further compensation.
- Physical Injuries: The veteran may also have suffered physical injuries during combat, which, when combined with insomnia and tinnitus, create a complex picture of their overall health. Each condition contributes to VA’s assessment of their total disability rating.
By connecting tinnitus and insomnia as part of a broader set of service-related conditions, VA can more accurately reflect how the veteran’s service has impacted their life. This holistic view of the veteran’s health also ensures they receive the appropriate benefits, which can extend to their dependents, providing the needed support for their family.
Seek Help with Your VA Claim
Navigating the VA disability claims process for secondary conditions like insomnia can be challenging. Veterans may benefit from working with a VA-accredited attorney like Hill & Ponton to help file an appeal or resolve a denied claim. Click here for a free case evaluation today.
Content Reviewed by
Shannon Brewer, a senior attorney with Hill & Ponton, reviewed the information provided in this post.
