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How the VA Rates Sleep Apnea

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VA Rates Sleep Apnea


Understanding The VA Disability Ratings for Sleep Apnea

Sleep apnea is a common condition that affects about 22 million people nationwide. If you are among these individuals living with sleep apnea, you may be eligible for Veterans’ disability compensation. This guide will outline the basics of sleep apnea, how the VA disability rating works for this condition, and how you can prove service connection.

What Is Sleep Apnea?

Sleep Apnea is a 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 as a combination of the obstructive and central forms of the condition.

Some of the most common symptoms of sleep apnea include:

  • Episodes in which you stop breathing during sleep — which another person would notice and report
  • Gasping for air while sleeping
  • Loud snoring
  • Waking up with a dry mouth
  • Headaches in the morning
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty paying attention while awake
  • Irritability

Veterans who are experiencing the above symptoms should consider seeking a diagnosis and pursuing sleep apnea disability benefits. This generally requires a sleep study. If left untreated, sleep apnea can lead to conditions like:

  • High blood pressure
  • Stroke
  • Heart failure, irregular heartbeats, and heart attacks
  • Diabetes
  • Depression
  • Worsening of ADHD
  • Headaches

How Does the VA Rate Sleep Apnea?

The VA sleep apnea ratings are based on the severity of the Veteran’s Obstructive 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.

How Can You Establish Service Connection For VA Disability?

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 current 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. This study will serve as medical evidence for the Veteran’s case.

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.

Is There a Connection Between PTSD & Sleep Apnea?

Research has shown that their Veterans with post-traumatic stress disorder, also known as PTSD, may be at risk for sleep apnea. There are factors that overlap in both disorders which affect and aggravate each other. Some of these factors are issues that Veterans may have experienced in active duty, such as disturbed sleep in combat, excessive sleep deprivation, fragmented sleep, hyperarousal, and chronic stress.

Although all of these symptoms contribute to the interaction between sleep apnea and PTSD, the main culprits seem to be sleep deprivation and chronic stress. Studies have shown that patients exhibiting these symptoms tend to have increased frequency and length of apneic events.

Research has also shown that as the severity of PTSD increases in a person, the chances of developing sleep apnea increases as well because of the interplay between the shared factors of the two disorders. Sleep apnea and other mental illness are also associated with each other. Click here to learn more about that topic.

The important takeaway message is that if you are a Veteran suffering from PTSD, it is important to get a screening for sleep apnea. You may be eligible for additional VA disability benefits based on that diagnosis.

What If You’re Denied for Benefits?

If your obstructive sleep apnea VA claim, or other sleep apnea claim, was originally denied, you may be able to appeal the rating and receive VA disability compensation. The law professionals at Hill & Ponton are available to help. You can call our law firm at 1-888-373-9436 to discuss your VA disability claim. You can also click the red button in the corner free case evaluation.

see how one of our experienced attorneys can help you! Get started here!


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