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How Does VA Rate Sleep Apnea?

How Does VA Rate Sleep Apnea?

What is Sleep Apnea?

Sleep Apnea is a common, 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 potentially occur tens to hundreds of times per night. The causes of these disturbances vary, depending on which form of the condition you have: obstructive, central, or a ‘mixed’ form of both.

Obstructive sleep apnea, the more common form, occurs when the upper airway (the throat) repeatedly becomes blocked throughout the night. This blockage is caused when soft tissue (muscle) in the back of the throat relaxes, impairing air flow. Central sleep apnea occurs when the brain either does not send signals to the muscles that control breathing, or those signals are interrupted. Complex sleep apnea, referred to by VA as ‘mixed,’ is a combination of the obstructive and central forms of the condition.

How does the VA diagnose sleep apnea?

To begin, let’s first discuss what makes a sleep apnea diagnosis valid in the eyes of the VA. In order to confirm a sleep apnea diagnosis for compensation rating 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 for benefit purposes. There is, however, an exception to this rule; 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.

Note: VA has a duty to assist veterans in obtaining necessary evidence to prove their claim. This means that if no sleep study has been conducted to confirm your diagnosis, VA has a duty to assist you in scheduling an examination.

How does VA rate sleep apnea?

Sleep apnea is rated by the VA under 38 C.F.R. § 4.97, Code 6847 as Sleep Apnea Syndromes (Obstructive, Central, Mixed). Veterans are assigned 0%, 30%, 50% and 100% ratings for sleep apnea, depending on the severity of their condition. Below are the criteria listed in VA’s rating schedule for sleep apnea:

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 use of a breathing assistance device, such as a continuous airway pressure (CPAP) machine.”

30%: The veteran is experiencing “persistent daytime hypersomnolence.” Hypersomnolence is a condition similar to insomnia, characterized by chronic daytime sleepiness that does not improve even with sufficient sleep.

0%: If the veteran’s condition is Asymptomatic but has “documented sleep disorder breathing.” An asymptomatic condition is one that is diagnosed, but may not be producing symptoms.

Keep in mind that sleep apnea can be a secondary service-connected disability, or can cause a secondary service-connected disability. For example, a veteran who developed Parkinson’s Disease (PD) after being exposed to Agent Orange may develop sleep apnea as a result of their Parkinson’s. This means VA can rate you for PD, as well as for sleep apnea.

Category: Veterans Law

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