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Veterans Law

How Does VA Rate Sleep Apnea?

March 8, 2018
va disability ratings for sleep apnea

What is Sleep Apnea?

Sleep apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted throughout the night.  There are three main types:

  • Obstructive- the most common form of sleep apnea, occurs when the throat muscles intermittently relax and block your airway during sleep.
  • Central- occurs when the brain doesn’t send proper signals to the muscles that control breathing.
  • Complex (Mixed)- occurs when someone has both obstructive and central sleep apnea.

Sleep Apnea Symptoms and Treatment

The signs and symptoms of these three types of sleep apnea tend to overlap, sometimes making it difficult to determine which type a person has.  The most common symptoms include:

  • Loud snoring
  • Gasping for air during sleep
  • Waking with a dry mouth
  • Morning headaches
  • Insomnia
  • Hypersomnolence (i.e. excessive daytime sleepiness)
  • Difficulty concentrating

For mild cases, 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 a person sleeps.  The air pressure is somewhat greater than that of the surrounding air, allowing upper airway passages to remain open, thus preventing apnea and snoring.

How to WIN Your Sleep Apnea VA Disability Claim

How Does VA Diagnose Sleep Apnea?

VA requires that a sleep study be conducted before confirming a sleep apnea diagnosis.  Even if a medical professional has previously diagnosed a veteran with sleep apnea, VA will not consider this sufficient evidence without a sleep study.

Veterans who have already been granted VA disability for sleep apnea based on their service connection, but did not undergo a sleep study, will likely be required to undergo one to maintain their benefits.  On the other hand, those who have maintained a VA rating for at least 10 years do not need to partake in a sleep study as their diagnosis and disability rating are protected.

How Do You Prove Sleep Apnea is Service Connected?

Generally, if a veteran’s disability was incurred during or aggravated by their military service, VA will grant service connection.  To prove service connection for sleep apnea on a direct basis, veterans must show evidence of the following:

  • A current diagnosis of sleep apnea, as confirmed by a sleep study;
  • An in-service event, injury, or illness; and
  • A medical nexus, or link, between their sleep apnea and the in-service event, injury, or illness.

Secondary Service Connection for Sleep Apnea

Veterans may also be able to establish service connection for sleep apnea on a secondary basis.  A secondary service-connected disability is one that resulted from a condition that is already service-connected.  In cases of secondary service connection, the medical nexus opinion must link a veteran’s secondary condition to their already service-connected disability.

Examples of Service Connection

Current research shows that post-traumatic stress disorder (PTSD) can aggravate sleep apnea.  If veterans are service-connected for PTSD and later develop sleep apnea, they may be able to establish secondary service connection.

Additionally, VA issued an opinion from its Office of General Counsel stating that while veterans cannot receive disability benefits for obesity, it can be used as an intermediary step.

For example, say a veteran has a service-connected orthopedic condition preventing them from exercising and thereby , causing weight gain.  Subsequently, the veteran develops sleep apnea due to their obesity.  In this case, while there is not a direct connection between the service-connected orthopedic condition and sleep apnea, they are linked together by obesity.

Since the service-connected orthopedic condition caused obesity that then caused the sleep disorder, VA should grant service connection for on a secondary basis.

VA Rating for Sleep Apnea Secondary to PTSD

Sleep Apnea VA Disability Ratings

Sleep apnea is rated under 38 CFR § 4.97, Diagnostic Code 6847 – Sleep Apnea Syndromes (Obstructive, Central, Mixed).  Veterans are assigned a 0, 30, 50, or 100 percent VA rating based on the severity of their condition.  The current VA rating criteria for sleep apnea are as follows:

  • 100 percent: The veteran has chronic respiratory failure with carbon dioxide retention, requires a tracheostomy, or has cor pulmonale (i.e., the enlargement or failure of the right side of the heart due to lung disease.)
  • 50 percent: The veteran requires the use of a breathing assistance device, such as a CPAP machine.
  • 30 percent: The veteran is experiencing persistent daytime hypersomnolence (i.e. a condition characterized by chronic daytime sleepiness that does not improve even with sufficient sleep).
  • 0 percent: The veteran has a documented sleep disorder but their condition is currently asymptomatic (i.e., not producing symptoms).  Although considered non-compensable, the veteran may still qualify for other benefits, such as VA health care.

How Does VA Rate Sleep Apnea? Sleep apnea is rated under 38 CFR § 4.97, Diagnostic Code 6847 – Sleep Apnea Syndromes (Obstructive, Central, Mixed).  Veterans are assigned a 0, 30, 50, or 100 percent sleep apnea VA rating based on the severity of their condition.  The current VA rating criteria for sleep apnea are as follows: 100 percent: The veteran has chronic respiratory failure with carbon dioxide retention, requires a tracheostomy, or has cor pulmonale (i.e., the enlargement or failure of the right side of the heart due to lung disease.) 50 percent: The veteran requires the use of a breathing assistance device, such as a CPAP machine. 30 percent: The veteran is experiencing persistent daytime hypersomnolence (i.e. a condition characterized by chronic daytime sleepiness that does not improve even with sufficient sleep). 0 percent: The veteran has a documented sleep disorder but their condition is currently asymptomatic (i.e., not producing symptoms).  Although considered non-compensable, the veteran may still qualify for other benefits, such as VA health care.

Current VA Disability Rates

Once assigned a sleep apnea VA disability rating, the veteran will receive monthly compensation from VA based on their rating.

As of December 1st, 2020 the VA disability rate benefit amounts are as follows:

  • 0 percent disability rating: $0.00 per month
  • 10 percent disability rating: $144.14 per month
  • 20 percent disability rating: $284.93 per month
  • 30 percent disability rating: $441.35 per month
  • 40 percent disability rating: $635.77 per month
  • 50 percent disability rating: $905.04 per month
  • 60 percent disability rating: $1,146.39 per month
  • 70 percent disability rating: $1,444.71 per month
  • 80 percent disability rating: $1,679.35 per month
  • 90 percent disability rating: $1,887.18 per month
  • 100 percent disability rating: $3,146.42 per month

 

TDIU Benefits for Sleep Apnea

Certain symptoms of sleep apnea, such as excessive daytime sleepiness, fatigue, and difficulty concentrating, may impact a veteran’s ability to work.  Veterans unable to find and keep substantially gainful employment due to their service-connected conditions may be entitled to total disability based on individual unemployability (TDIU).

TDIU is another avenue to securing VA disability compensation at the 100 percent level.  Importantly, veterans do not need to be rated at the 100 percent level for sleep apnea itself; VA must simply acknowledge that the veteran’s service-connected sleep apnea, along with any other conditions, prevents them from working.

Veterans can qualify for TDIU under 38 CFR § 4.16(a), provided they meet the following schedular requirements:

  • A veteran must have one service-connected disability rated at 60 percent disabling or higher; or
  • More than one service-connected disability, with one disability rated at least 40 percent, and a combined rating of 70 percent or higher.

Total Disability based on Individual Unemployability TDIU Infographic

Is Sleep Apnea a Permanent VA Disability?

Generally, sleep apnea is not automatically rated a permanent disability by VA, but if a veteran meets certain qualifications, they may be able to secure lifelong compensation.

If VA considers your sleep apnea permanent in nature, meaning they are reasonably certain that the condition will continue with zero or close to zero chance of improvement, veterans will not be scheduled for a re-examination.  If this is the case, VA cannot propose a rating reduction.

Did VA Deny Your Disability Benefits Claim?

If VA denied your disability claim, there are still options for appealing the decision.

The team of veterans (VA) disability attorneys at Chisholm Chisholm & Kilpatrick LTD may be able to help secure benefits for your condition.  We have years of experience handling veterans’ disability appeals for sleep apnea.

Call us today at 800-544-9144 to get started.