Citation Nr: 21030586 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-55 010 DATE: May 19, 2021 ORDER Entitlement to service connection for a disability manifested by sleep impairment, to include insomnia, is denied. FINDING OF FACT The Veteran is service-connected for generalized anxiety disorder with major depressive disorder, which includes symptoms involving chronic sleep impairment and insomnia. CONCLUSION OF LAW The criteria for service connection for a disability manifested by sleep impairment, to include insomnia, are not met. 38 U.S.C. §§ 1110, 5107(b) (2018); 38 C.F.R. §§ 3.102, 3.303, 4.14 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1997 to July 1997, from August 2001 to March 2002, from September 2004 to November 2005, from October 2009 to September 2010, and from September 2012 to March 2013. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In March 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. Separate Rating Sleep Impairment In a December 2015 rating decision, the RO denied service connection for a sleep disability, noting that the Veteran was already receiving compensation for sleep impairment in a 30 percent rating assigned for his service-connected psychiatric disability. The Veteran appealed, seeking a separate rating. During the March 2021 Board hearing, the Veteran stated that he had issues sleeping regardless of whether he felt depressed or anxious. He reported that he had difficulty sleeping and would sometimes be awake for days at a time and had difficulty functioning as a result. He stated that he believed his sleep issues were totally separate from his mental health issues and resulted in different impairment. He indicated that when he had trouble sleeping, he had more inflammation, and had difficulty sleeping because of joint pain. The Veteran's representative argued that the Veteran had insomnia, which should be considered a separate disability. An August 2014 VA treatment record noted that during a psychological evaluation, the Veteran complained that he had too many things on his plate and was having trouble sleeping, concentrating, and focusing. The assessment was generalized anxiety disorder and attention deficit hyperactivity disorder, and a note was made to rule out depression. A June 2015 VA examiner (for mental health) indicated that the Veteran reported symptoms consistent with generalized anxiety disorder and major depressive disorder, including chronic sleep impairment. A July 2015 VA treatment record indicated that the Veteran requested a traumatic brain injury (TBI) consultation for ongoing headaches, insomnia, increased irritability, and difficulty focusing. In August 2015, the TBI clinic referred him to neurology for treatment of headaches, and the mental health clinic for treatment of depression, anxiety, and insomnia. In August 2015, he reported experiencing nightmares and having difficulties staying asleep. A September 2015 VA examination report for TBI noted that the Veteran's subjective symptoms included insomnia. During a December 2016 VA examination for fibromyalgia, the Veteran reported experiencing musculoskeletal pain, overall fatigue, and sleeping 12 to 14 hours per day with daytime grogginess and overall lack of energy. The Board notes that the Veteran is service-connected for fibromyalgia and is receiving a 40 percent rating for widespread musculoskeletal pain and tender points with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms. 38 C.F.R. § 4.71a, Diagnostic Code 5025. A January 2017 VA treatment record noted that the Veteran reported experiencing posttraumatic stress disorder (PTSD) symptoms, including sleep disturbance and difficulty concentrating. Diagnoses included PTSD and insomnia. VA treatment records indicated the Veteran was prescribed zolpidem (Ambien) for sleep/insomnia. In September 2017, he reported using medical marijuana and having improved sleep. In an October 2017 letter, A.S., a social worker from a Vet Center, indicated that the Veteran reported difficulty sleeping due to pain and anxiety. An October 2017 VA treatment record indicated that during a psychosocial pain assessment, the Veteran reported that he slept 12 hours per day. He stated that he noticed increased pain when he felt fatigued. In November 2017, he stated that Ambien was not helping his sleep and that he felt anxious at night. In December 2017, he requested more sleep/anxiety medication. In this case, the Veteran receives a 30 percent rating for his service-connected generalized anxiety disorder with major depressive disorder, which includes symptoms involving chronic sleep impairment. See 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. To separately compensate the Veteran for insomnia/sleep impairment would violate the rule against pyramiding. 38 C.F.R. § 4.14. Therefore, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a disability manifested by sleep impairment, to include insomnia, is not warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mishalanie, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.