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Your Sleep Apnea VA Rating — A Guide to Getting a VA Disability Rating for Sleep Apnea

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Sleep Apnea Rating

 

Many Veterans are diagnosed with obstructive sleep apnea, and therefore—with an effective claim that includes the right evidence—should be eligible for a sleep apnea VA rating. Since this condition is nearly epidemic among Veterans, it’s important to learn what it takes to get a VA disability for sleep apnea, as well as how the condition may affect you.

What is sleep apnea?

Sleep apnea is a serious sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. This can occur from ten times to hundreds of times per night. The constant interruption of breathing can lead to reduced sleep quality, short-term memory loss, irritability and even mood disorders, as well as major metabolic diseases such as diabetes and heart disease.

Sleep apnea often is thought of as a mild annoyance, but it is a significant condition that can lead to health issues ranging from hypertension, stroke and heart attack to depression, anxiety and headaches.

How do I know if I have sleep apnea?

Symptoms of obstructive sleep apnea include:

  • Loud snoring
  • Episodes where you stop breathing during sleep
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Daytime sleepiness (hypersomnia) or insomnia
  • Lack of focus or difficulty concentrating
  • Irritability or anger

If you experience many of these symptoms, we recommend seeing a doctor as soon as possible and seeking a diagnosis. If you meet the requirement of having a current diagnosis, you can obtain a service connection and VA rating for sleep apnea and receive disability benefits.

It’s likely your doctor will need to order a sleep study to determine if you have sleep apnea. A doctor’s diagnosis will be one of the keys to getting a sleep apnea VA rating.

Why do so many Veterans have sleep apnea?

Research shows a strong correlation between deployments and sleep disorders, and sleep apnea is extremely common among Veterans. The Office of the Inspector General found that 1.3 million Veterans enrolled in VA Healthcare have a sleep apnea diagnosis.

As a Veteran, you’re four times more likely than other Americans to develop sleep apnea. According to the VA, 1 in 5 Veterans has obstructive sleep apnea. Since 2009, the number of Veterans’ claims for sleep apnea has increased by over 150%, according to USA Today.

Why do so many Veterans have sleep apnea? There are many factors during and after service that make Veterans vulnerable to this condition. There are also many service-connected conditions that can result in sleep apnea. It can also work in reverse: sleep apnea can lead to other disabilities.

Sleep apnea can be aggravated by PTSD (secondary to PTSD), also an extremely common disorder for Veterans. The same goes for depression and anxiety—or any of the 33 mental health conditions rated by the VA—which can be highly disruptive to sleep.

Traumatic brain injury and physical pain are also conditions that affect many Veterans and can lead to sleep apnea. Exposure to materials such as dust and fumes, and the resulting rhinitis or sinusitis, is also a common issue for Veterans that’s associated with sleep apnea.

What is the current VA rating for sleep apnea?

There isn’t a single rating for sleep apnea, but a range of ratings depending on the severity of your condition (as is true for other disability ratings). A disability rating at any given percentage (e.g., 30%, 50%, 100%) pays based on that percentage, no matter what condition(s) gives you that rating.

Your sleep apnea rating will compensate you based on your condition’s severity. The disability rating you’re given for sleep apnea is combined with any other disability ratings you have, if any, to give you an overall rating based on VA math.

Sleep apnea is classified by the VA as sleep apnea syndromes (diagnostic code 6847). The VA awards disability ratings for sleep apnea at the 0 percent, 30 percent, 50 percent, and 100 percent levels. The most common VA rating for sleep apnea is 50 percent.

The sleep apnea VA rating criteria are as follows:

  • 100%: Chronic respiratory failure with carbon dioxide retention or cor pulmonale (a condition that causes the right side of the heart to fail), or requires tracheostomy
  • 50%: Requires use of breathing assistance device such as a CPAP machine
  • 30%: Persistent daytime hypersomnolence
  • 0%: Asymptomatic but with documented sleep disorder breathing

If you feel groggy during the day, you may be rated at 30 percent. If you use a CPAP machine to address your sleep apnea, you’re likely to be rated at least at 50 percent. To be rated at 100 percent, you must experience chronic respiratory failure.

Can sleep apnea be service-connected?

Yes, sleep apnea can be service-connected—and will need to be service-connected in order for you to get a disability rating for sleep apnea.

Sleep apnea can be service-connected in two ways: either direct service connection or secondary service connection.

Direct service connection for sleep apnea can be difficult to obtain, as most successful cases require a diagnosis while on active duty. This would mean you had a sleep study conducted while on active duty and received a medical diagnosis of sleep apnea as a result of the study.

This is rare, because most Veterans don’t realize they have sleep apnea until after they’ve left military service. Many Veterans don’t even know what sleep apnea is while on active duty, let alone that they need a sleep study to prove they have it! For this reason, a secondary service connection for sleep apnea is much more common.

Sleep apnea and secondary service connection

A disability with a secondary service connection is a condition that was caused or made worse by an already existing service-connected condition.

If you have a service-connected disability aggravating or causing your sleep apnea, you may be eligible to get service connection for sleep apnea on a secondary basis. This is especially relevant for Veterans diagnosed with sleep apnea long after leaving the military.

With over 50 conditions that can be medically linked to sleep apnea, it’s important to understand the three elements required by law that must be satisfied in order for sleep apnea to be service-connected secondary to another service-connected disability.

  1. A medical diagnosis of sleep apnea confirmed by a sleep study in VA medical records or private records
  2. Evidence of a service-connected primary disability, such as musculoskeletal conditions or mental health conditions (PTSD, depression, anxiety, sinusitis, rhinitis), AND
  3. A nexus (link) shown via medical evidence establishing a connection between the service-connected disability and the current disability (in this case, sleep apnea)

The three most common conditions resulting in a secondary service connection for sleep apnea and therefore a are:

Sleep apnea secondary to PTSD

Research shows that combat Veterans with PTSD may be at higher risk for sleep apnea than the general population. Both disorders have risk factors that affect both sleep apnea and symptoms of PTSD, and the conditions can aggravate each other.

A study conducted by the VA Healthcare System for San Diego and National Center for PTSD found that between 40 percent and 98 percent (!) of Veterans with PTSD also have a co-occuring sleep disturbance, including obstructive sleep apnea (OSA). If you’re dealing with sleep apnea as a secondary condition to PTSD, you aren’t alone!

Sleep apnea also ranks #2 on our List of the Top 5 Secondary Conditions to PTSD.

PTSD—and the side effects of medications taken to address PTSD—can lead to the development of sleep apnea in a few different ways. PTSD is well-known for causing sleep deprivation, chronic stress, and an increase in body mass or obesity due to prescribed medications. All of these can contribute to sleep apnea.

In order to prove a secondary service connection, you’ll need three things:

  • A medical diagnosis of sleep apnea confirmed with a sleep study
  • A service-connected PTSD disability rating (or another service-connected mental health condition)
  • A medical nexus establishing a connection between your PTSD and sleep apnea

PTSD doesn’t have to be the main cause of your sleep apnea, but it does have to be connected. You can link these two by detailing the side effects of PTSD that impact your sleep apnea, with the doctor writing your nexus letter.

Also see our post on receiving a VA rating for sleep apnea secondary to PTSD.

What kind of CPAP machine does the VA use?

A Continuous Positive Airway Pressure (CPAP) machine helps treat sleep apnea by delivering a stream of air into your airways through a mask and a tube.

The VA prescribes several different types of CPAP machines. These include:

  • A basic CPAP, which keeps pressure constant all night long
  • A bilevel device (BiPAP), which provides two levels of pressure—more when you breathe in and less when you breathe out
  • An auto-CPAP device, which changes pressure throughout the night based on your body position, sleep stage, and snoring

As you’re gathering medical evidence to file your VA claim for sleep apnea, remember that just having a CPAP alone doesn’t meet the VA’s requirements for service connection. You must have a medical statement from a doctor detailing how your sleep apnea is service-connected.

Is a CPAP machine the only treatment for sleep apnea?

Sleep apnea treatment depends on the type and severity of the condition. Before or in addition to CPAP therapy, lifestyle changes such as diet, exercise, and stress reduction may be recommended. Some Veterans with sleep apnea may experience improvement with lifestyle changes, but CPAP therapy is still among the most common treatments.

Why would a VA claim for sleep apnea be denied?

A VA claim for sleep apnea can be denied for many reasons. One common scenario is when a Veteran tries to claim sleep apnea as a primary condition when there was no diagnosis during active-duty service. Even if you have a medical diagnosis during active-duty service, without a sleep study this is difficult to claim successfully.

If you’re claiming sleep apnea as a secondary condition, make sure you already have a medical diagnosis before you make your claim. The most common reason for denial of secondary claims is not establishing a strong enough connection between the service-connected disability and the sleep apnea. Including a nexus letter for sleep apnea can be an important part of your claim to strengthen your case for a sleep apnea VA rating.

In addition, during the C&P exam for a sleep apnea VA rating, it’s important to make the case for how your sleep apnea impacts your ability to work, your daily life, and your social life.

Sleep apnea is proven to significantly reduce a person’s quality of life (in one study, the reduction in quality of life was equivalent to that observed with diabetes or hypertension). Obstructive sleep apnea can cause daytime sleepiness, snoring, depression, difficulties with concentration, and loss of memory.

Here are a few examples of how sleep apnea could be impacting your life, which you’ll want to clearly state and demonstrate in your C&P exam and in your claim:

  • You have difficulty working and lose productivity during the day due to napping
  • You have to use a CPAP or other breathing machine at night
  • Your depression or anxiety, exacerbated by loss of sleep, affect your relationships and work
  • Your inability to focus or concentrate or loss of memory affects your job or your safety

Do I need a nexus letter for sleep apnea?

We recommend a nexus letter from a medical professional to connect your condition to your military service (or secondary to a service-connected disability) in order to improve your chances of receiving a rating for sleep apnea as a secondary condition.

In our experience, a well-crafted nexus letter for sleep apnea is the single most crucial document you can provide to help prove service connection on an “at least as likely as not” basis. Having a doctor connect your sleep apnea to your secondary service-connected disability will greatly improve your chances of winning a sleep apnea VA rating.

(If you need an independent medical opinion in the VA’s language, take a look at our VA Claims Insider Elite program. Membership gives you your very own Veteran coach to walk you through the VA claim process from start to end, and access to proprietary resources. It also connects you with Vetted medical professionals in our independent referral network for medical examinations and credible medical nexus letters. It’s free to join and we don’t win unless you win.)

Can the VA take away my sleep apnea rating?

A sleep apnea VA rating can be reduced by the VA.

When you’re granted a sleep apnea VA rating, you may also be assigned a re-evaluation period (unless the condition is classified as static). Typically the re-evaluation period is anywhere from two to five years after your initial examination. At that time, the VA may schedule a re-examination to verify if your sleep apnea symptoms still exist, and if they’ve changed.

If your initial rating decision letter says that future examinations are scheduled, or you don’t have a 100% permanent and total rating, then your disability rating is not considered permanent or static by the VA.

There are cases in which your VA rating for sleep apnea would not be re-evaluated. These would include situations in which:

  • Your disability is considered permanent by the VA
  • Your disability is considered static by the VA
  • Sleep apnea symptoms persist without material improvement for five or more years (this is known as a stabilized rating)
  • You’re over age 55
  • You have a continuous sleep apnea rating for 20 years or more

According to 38 CFR § 3.105(e), a rating reduction (for any condition) may only take place in cases where:

  • The VA has reviewed your entire medical history
  • You’ve undergoes a thorough examination
  • The VA has found sustained improvement in your ability to function under the ordinary conditions of life,

The VA is also required to issue a Veteran notice of a proposed reduction and give you 60 days to submit evidence and 30 days to request a hearing (unless the reduction would not change your compensation).

Get service-connected, get compensated and get the care you need!

By covering all the bases in your sleep apnea VA claim process—having your sleep apnea diagnosed with a sleep study and connecting your sleep apnea to a service-connected condition with medical evidence—you’ll set yourself up for success to get a service-connected VA rating for sleep apnea. Also make sure to seek the care you need to get relief from the effect of sleep apnea on your health and life.

Want More Help with Your Sleep Apnea VA Claim?

At VA Claims Insider, we can help you win your claim and get the highest VA rating for sleep apnea.

At VA Claims Insider, we help Veterans understand and take control of the claims process so they can get the rating and compensation they’re owed by law. Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim (FDC).

If you’ve filed your VA disability claim and have been denied or have received a low rating, or you’re not sure how to get started, reach out to us for a FREE VA Claim Discovery Call—so you can FINALLY get the disability rating and compensation you deserve. We’ve supported more than 15,000 Veterans to win their claims. NOW IT’S YOUR TURN.

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