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How the VA Rates Obstructive Sleep Apnea

Sleep Apnea

 

What is sleep apnea? Sleep Apnea is a common, potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted, or ceases, during the course of a night’s sleep. These sleep disturbances can occur from tens to hundreds of times per night. The causes of these disturbances may vary depending on which form of the condition you have: obstructive, central, or a mixed form of both.

Obstructive sleep apnea is one of the more common forms which occurs when the upper airway repeatedly becomes blocked throughout the night. This blockage is caused when the soft tissue in the back of the throat relaxes, impairing the airflow. Central sleep apnea occurs when the brain either does not send signals to the muscles that control breathing or those signals are interrupted. The VA refers to mixed sleep apnea is a combination of the obstructive and central forms of the condition.

How Does the VA Rate Sleep Apnea

Sleep apnea is rated under 38 CFR § 4.97, Diagnostic Code 6847. This diagnostic code falls under the Sleep Apnea Syndromes. The VA assigns the following ratings for Veterans based on the severity of their sleep apnea:

  • 100 percent: chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy or the enlargement or failure of the right side of the heart due to lung disease. This is the most severe and the highest rating available.
  • 50 percent: the Veteran requires the use of a breathing device, such as a CPAP machine.
  • 30 percent: the Veteran is experiencing hypersomnolence, or excessive daytime sleepiness, that does not improve with sufficient sleep or even with naps during the day.
  • 0 percent: the Veteran’s condition does not produce any symptoms but has a documented sleep disorder. This rating is a non-compensable rating, however, a Veteran may be entitled to other benefits, such as VA health care.

Establishing Service Connection

In order to establish direct service connection for sleep apnea, a Veteran must show that they have a current, diagnosis of sleep apnea, an in-service event or illness/injury, and a medical nexus or link that shows the Veteran’s sleep apnea is related to their in-service event, injury/illness.

A Veteran can also establish service connection for sleep apnea on a secondary basis. This means that a Veteran has an already service-connected disability that caused the Veteran to have sleep apnea. In this case, there must be a medical nexus to link the sleep apnea to their already service-connected disability. Some conditions that can be secondary to sleep apnea may include but are not limited to heart conditions, mental health conditions, and diabetes. If you have a service-connected condition that you believe is causing your sleep apnea, it may be a good idea to start to talk to your doctors about it.

How Does the VA Diagnose Sleep Apnea?

The VA will usually order a sleep study to be performed in order to confirm a diagnosis of sleep apnea. As a part of the VA’s duty to assist Veterans in obtaining evidence to help prove their claim, the VA has a duty to assist Veterans in scheduling the examination for a sleep study. For Veterans who have already been diagnosed with sleep apnea without a sleep study by the VA, the Veteran may have to undergo a sleep study done by the VA in order to confirm the diagnosis for benefit purposes.

Denied for Benefits?

If you have a previous denial for sleep apnea, please give us a call to see how one of our experienced attorneys can help you! Get started here!

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