Compensation and Pension (C&P) Exams for Sleep Apnea

CCK Law: Our Vital Role in Veterans Law

What is Sleep Apnea?

Sleep apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted during the course of the night.  VA uses C&P exams to determine the severity of a Veteran’s sleep apnea. There are three main types of sleep apnea, including the following:

• Obstructive Sleep Apnea – the most common form of sleep apnea; occurs when the throat muscles intermittently relax and block your airway during sleep
• Central Sleep Apnea – occurs when your brain does not send proper signals to the muscles that control breathing
• Complex (Mixed) Sleep Apnea Syndrome – occurs when someone has both obstructive sleep apnea and central sleep apnea

The signs and symptoms of these three types of sleep apnea tend to overlap, sometimes making it difficult to determine which type you have.  Generally speaking, the most common symptoms include: loud snoring, gasping for air during sleep, awakening with a dry mouth, morning headache, insomnia, hypersomnolence (i.e., excessive daytime sleepiness), and difficulty concentrating.

For mild cases of sleep apnea, doctors may suggest lifestyle changes such as losing weight or quitting smoking, if applicable.  In more serious cases, doctors may prescribe the use of a continuous positive airway pressure (CPAP) machine.  A CPAP machine delivers air pressure through a mask while you sleep that is somewhat greater than that of the surrounding air.  This allows your upper airway passages to remain open, thereby preventing apnea and snoring.

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What is a Compensation and Pension Examination (C&P Exam)?

A Compensation and Pension examination (C&P exam) is a medical examination of a veteran’s disability, performed by a VA healthcare provider, or a VA contracted provider.  VA uses C&P exams to gather more evidence on a veteran’s claimed condition before issuing a decision and assigning a rating.  Most commonly, C&P exams are used to (1) confirm or deny service connection, and/or (2) establish the severity of a veteran’s disability.  Before the exam, the examiner should review your entire claims file, which contains previously submitted evidence and medical treatment records.  The exam itself usually only lasts about 15-20 minutes, but can range anywhere from 5 minutes to several hours.

How Does VA Diagnose Sleep Apnea?

In order to confirm a sleep apnea diagnosis for VA disability compensation purposes, VA requires that a sleep study be conducted.  If you have been previously diagnosed with sleep apnea, but have not undergone a sleep study, VA will not consider that sole diagnosis enough evidence to verify eligibility for compensation.

What Happens During C&P Exams for Sleep Apnea?

During the C&P exam for sleep apnea, the examiners will ask questions about your condition and how it affects you.  VA examiners might complete a Disability Benefits Questionnaire (DBQ) for sleep apnea as well.  This DBQ is formatted for examiners to “check a box” next to descriptions that most accurately depict the severity of your sleep apnea.  For example, examiners might check off whether you use a CPAP machine.  It is important for you to be honest about your symptoms so that they can be properly documented.  Bringing a friend or family member to your exam may be beneficial so that they may serve as a witness to the symptoms that impact your daily life.

Re-Examinations for Sleep Apnea

In some cases, VA will schedule veterans for a re-examination of their sleep apnea to determine if the condition has improved.  If it has, VA may be able to propose a rating reduction.  However, there are certain rules VA must follow when proposing to reduce a veteran’s rating.  Specifically, the proposed rating must be based on a review of the veteran’s entire medical history.  Furthermore, VA must show that there has been material improvement in the veteran’s ability to function under the ordinary conditions and stressors of life and work.  If this is the case, veterans have a chance to submit argument and evidence against the proposed rating reduction.

In some cases, VA cannot schedule veterans for re-examinations for their sleep apnea.  Typically, VA will not re-evaluate your sleep apnea under the following conditions; however, there may be exceptions on a case-by-case basis:

• You are over the age of 55
• You have a stabilized rating (5 years or more). Any rating that has remained at the same level for 5 years or longer is considered “stabilized.”  In order to re-evaluate stabilized ratings, VA must show sustained improvement.  VA cannot use just one re-examination to show sustained improvement.  Rather, it must show through medical records as well as the re-examination that you are not just temporarily experiencing improvement.  Or, VA must show that the evidence in your file predominately demonstrates sustained improvement with regard to your sleep apnea.
• You have a total disability rating (100%). Here, VA must provide evidence that your condition has improved such that there has been an observable change in your ability to function under the ordinary conditions of daily life.
• You have a permanent disability. If your sleep apnea is considered permanent in nature, this means that VA is reasonably certain, based on medical evidence, that the level of impairment will continue for the rest of your life with zero or close to zero chance of improvement, you should not be scheduled for a re-examination.
• You have a continuous rating for 20 years or more. VA cannot re-evaluate or reduce a continuous rating below the original level it was assigned.

If any of the above situations apply to you, you may not be subject to new C&P exams for sleep apnea for reevaluation purposes.

Tips for Attending C&P Exams for Sleep Apnea

It is important for veterans to be completely honest with their examiners.  Do not downplay any of your symptoms that are resulting from sleep apnea.  It is also important to assume that the examiner is observing everything that you are doing and writing down all of the comments you are making.  Therefore, being as honest as possible about the severity of your symptoms will hopefully produce accurate results and capture your full disability picture.

Furthermore, veterans must attend their scheduled C&P exams.  If you do not attend, it is possible that VA will deny or reduce benefits without much deliberation.  If you cannot attend, you must notify VA right away and work to re-schedule.