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How Does VA Rate Sleep Apnea?

March 8, 2018
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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.  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 doesn’t 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.

How does the 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.

Those who are already service-connected for sleep apnea, but did not undergo a sleep study, will likely be required to have one conducted in order to confirm the diagnosis to continue receiving benefits.  However, those who have been service-connected for sleep apnea for at least 10 years do not need to undergo a sleep study to maintain their rating as it is protected.

Service Connection for Sleep Apnea

Generally speaking, service connection or service-connected means that a veteran’s disability was incurred during or aggravated by his or her military service.  In order to establish service connection for sleep apnea on a direct basis, veterans must show evidence of:

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

However, 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 disability to their already service-connected disability.

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 obesity is not a disability that you can get benefits for, but it can be used as an intermediary step.  For example, you are service-connected for an orthopedic condition that prevents you from exercising and causes you to gain weight.  Subsequently, you develop sleep apnea as a result of your obesity.  In this case, there is not a direct connection between your service-connected orthopedic condition and non-service-connected sleep apnea, but they are linked together by obesity.  Since your service-connected orthopedic condition caused your obesity that then caused your sleep apnea, service connection should be awarded.

VA Disability Ratings for 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 rating depending on the severity of their condition.  The rating criteria is as follows:

      • 100% – chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy, or cor pulmonale. Cor pulmonale is the enlargement or failure of the right side of the heart due to lung disease.
      • 50% – if a veteran requires the use of a breathing assistance device, such as a CPAP machine
      • 30% – 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% – if the veteran’s condition is asymptomatic (i.e. condition that is not producing symptoms) but has a documented sleep disorder

TDIU Benefits for Sleep Apnea

Certain symptoms of sleep apnea, such as excessive daytime sleepiness, fatigue, and difficulty concentrating, may impact a person’s ability to work.  If you are unable to secure and follow substantially gainful employment as a result of your service-connected sleep apnea, you may be entitled to total disability based on individual unemployability (TDIU) – a benefit that provides compensation at the 100 percent level.  Importantly, veterans do not need to be rated at the 100 percent level for sleep apnea itself.  Instead, VA must simply acknowledge that their service-connected sleep apnea prevents them from working.

Was Your VA Disability Benefits Claim for Sleep Apnea Denied?

If your VA Disability claim for Sleep Apnea has been denied, do not give up the fight. The skilled VA disability attorneys at Chisholm Chisholm & Kilpatrick LTD may be able to help. We have years of experience handling veterans disability appeals for Sleep Apnea. Contact us today at (800) 544-9144.

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