Studies show that people with asthma are more likely to develop obstructive sleep apnea. If you have been granted service-connected disability compensation for bronchial asthma and have been diagnosed with obstructive sleep apnea, you may be entitled to receive compensation for this condition as well.
During the Iraq and Afghanistan war ‘burn pits’ were used on military bases to dispose of waste materials. The military burned a slew of materials, including human waste, dead animals, plastics, IEDs, appliances, batteries, and anything that was found during the raids that was considered dangerous or hazardous. The burn pits were kept burning using jet fuel as the accelerant. Some of these burn pits were as close as 20 feet from where the service members slept.
Many soldiers returning from multiple tours in this region were severely ill. The term ‘Gulf War Syndrome’ was a description of the multitude of symptoms the veterans returning from the war in Iraq and Afghanistan were experiencing. Some of the symptoms had a definitive diagnosis such as fibromyalgia, irritable bowel syndrome, or chronic fatigue syndrome. However, the veterans were experiencing symptoms that did not have a clear etiology. Because of this, the VA issued a regulation related to veteran’s service in the Gulf region.
The VA regulation calls these other conditions “undiagnosed illnesses”. These illnesses that have become chronic and exhibit multiple symptoms include respiratory problems and should, according to the regulation, allow the VA to grant service connection as a result of exposure to environmental hazards experienced by veterans during service in Southwest Asia.
A recent survey conducted by the U.S. Department of Veterans Affairs demonstrates that over 15,000 out of 28,426 Afghanistan and Iraq veterans have been provider-diagnosed with emphysema, chronic bronchitis, COPD, asthma, chronic bronchitis, lung disease, or constrictive bronchiolitis, or idiopathic pulmonary fibrosis.
I would like to focus on one particular condition that has not only affected veterans that served in Iraq and Afghanistan, but also many other veterans who may already have had the condition as a result of it being incurred in or related to military service – asthma.
Asthma is a condition affecting the lungs and causes shortness of breath, wheezing, and coughing. Most people with asthma are treated with inhaled corticosteroids as well as periodic use of oral steroids during periods of exacerbation. During an asthmatic exacerbation, the coughing and wheezing is so bad that the affected person has difficulty speaking as a result of coughing fits. These exacerbations impose significant limitations in a person’s occupation causing speech difficulty. They also cause severe effects on exercise, sports, recreation, and even affect the person’s ability to perform their daily chores.
A veteran who has been granted service connection for bronchial asthma is likely to be on at least one or more type of inhalation or oral bronchodilator therapy. That is, one or more medication such as an inhaler to help reduce or maintain the symptoms. Most people are prescribed bronchodilators. Bronchodilators relax the muscles around the airways (breathing tubes). When the airways are more open, it is easier to breathe. You can also be prescribed an anti-inflammatory to help reduce the swelling and mucus production inside the airways. These medicines also are called corticosteroids or steroids. These can be in the form of inhaled medications, but some corticosteroids come in pill form and usually are used for short periods of time in special circumstances, such as when the asthma symptoms are getting worse. One type of steroid is called Prednisone and is widely prescribed in the U.S.
When you have asthma, you have to take these medicines all the time, even when you feel well, to avoid an exacerbation. However, despite compliance, many people with asthma suffer frequent exacerbations that may or may not depend on the weather, environmental hazards, such as smoke, and air pollution.
A person with asthma, especially those that have had asthma for a prolonged period of time and has been on inhaled or oral bronchodilator therapy is more likely to develop obstructive sleep apnea (OSA) as a result of the medication.
Research has shown that asthma patients face an almost 40% greater risk for sleep apnea than asthma-free patients. As noted earlier, the inflammation caused by asthma constricts the bronchial airways. Data has shown that chronic or intermittent use of systemic steroids may increase upper airway collapsibility. In other words, long-term use of oral or inhaled bronchodilators causes the upper airway muscles to weaken resulting in impaired upper airway dilator muscle function. This is directly related to OSA, because sleep apnea is a state-dependent condition that is characterized by intermittent obstruction of the upper airway during sleep. When the muscles of the throat become weak because of asthma symptoms, there is a greater tendency for the throat to collapse causing obstruction of the airway. That is why people with OSA frequently wake up in the middle of the night gasping for air or choking in their own saliva.
To determine if you have OSA, your physician may need to schedule an overnight polysomnography. This is the study used in the diagnosis of OSA. If your partner tells you that you stop breathing at night, or have excessive snoring, it may be time to inquire about this test. Remember that the standard of proof to determine whether or not a veteran’s disability is linked to service or a service-connected condition is “at least as likely as not”, or a 50/50 chance that it is true. There is abundant research to show a casual effect between the symptoms of OSA related to asthma and the VA should evaluate these two conditions in favor of the veteran.