How Sleep Apnea Affects Your Va Rating
May 2, 2020 By Rich Frankel
For individuals with sleep apnea, every day can be a struggle. A lack of sleep can make it difficult to focus or to complete basic tasks. If you have sleep apnea that is either the result of your military service or was caused by a different service-connected disability, you may be eligible for disability benefits from the Department of Veterans Affairs .
The VA provides benefits to veterans with a range of service-connected disabilities. The amount of benefits that you may receive is based on your level of disability, as determined by the VA rating system. Individuals with multiple disabilities related to their service may receive a combined rating.
If you have been diagnosed with sleep apnea as a veteran, you may be entitled to VA benefits. An experienced New Jersey veterans disability attorney can help you understand your right to benefits.
Why Is Sleep Apnea Considered A Disability
Awareness is on the rise, and increasing numbers of people are learning about sleep apnea and how vital it is to be treated and appropriately diagnosed. Since the patient can stop breathing anywhere from a few seconds to a few minutes numerous times per hour during the sleep cycle, many are unable to perform regular work duties where they draw a paycheck.
Related Conditions That May Qualify You For Disability
There are three conditions that people with sleep apnea commonly have that could qualify them for disability benefits. These conditions include chronic pulmonary hypertension, chronic heart failure, and chronic depression. Each of these conditions has its own set of criteria that must be met for an affected person to qualify for disability benefits. Of course, there is always a chance that an affected person could get denied for benefits.
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Proving You Lack The Capacity To Work
To determine if you are able to work, the SSA will prepare an assessment of your “residual functional capacity,” or “RFC.” Your RFC is what you are capable of doing despite your impairment. Your RFC assessment is used by the Social Security Administration to determine what kind of work you are still capable of doing.
To prepare your RFC, the SSA will look at how your fatigue affects your ability to work and whether you have any other impairments, such as a documented heart condition, that limit your ability to exert yourself physically. Key to having a proper RFC assessment done is having your doctor write an opinion of your capabilities and restrictions. For example, if you suffer from extreme fatigue that causes you to fall asleep during the day, your doctor may restrict you from driving or operating dangerous equipment. Or, if you have heart failure caused by pulmonary hypertension, your doctor may limit you to lifting only a few pounds. Your doctor should also comment on how the sleep apnea affects your mental abilities, if you have documented trouble with your memory, concentration, pace, or social functioning.
Do I Get A Sleep Apnea Rating When Va Gives Me A Cpap
Unfortunately, VAs disability rules are not easy to understand. This often means that veterans are not sure whether VA is handling their claim correctly or not.
Many veterans have questions about VAs rules, and I try to answer many of those in the articles I write on this blog. In this article, I would like to discuss an issue that pops up quite frequently when I talk to veterans about sleep apnea.
Here is a fairly common situation. A doctor at a VA medical center recommends a sleep study for a veteran. After the sleep study, the doctor prescribes a CPAP. But, VA does not assign a rating.
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Related Case: Cpap Recall
On June 14, 2021, Philips announced a recall notification for some of their CPAP and other machines. Philips is one of, if not the, largest manufacturers of CPAP/Auto CPAP/BiPAP devices and therefore many people who use these devices will likely be affected by the recall.
Philips has determined from testing that the polyester-based polyurethane sound abatement foam used to reduce the noise of the machine may be harmful to those who use it.
If you use a Philips brand machine and have had adverse side effects, you may be eligible for compensation due to this recall.
Sleep Apnea Disability Rating For Veterans Claims
Veterans may qualify for disability compensation for sleep apnea. However in the past year, VA has changed a few rules.
As of April 18, 2016, a veteran must now show that a qualifying breathing assistance device is medially required. This is to show the severity of the sleep apnea, and documentation must be given by a qualified medical professional. Previously, all you needed to submit was medical proof of a diagnosis of sleep apnea.
You will need to have a diagnosis of sleep apnea for compensation rating purposes. Your rating is based on the severity of the condition. The scale goes from 0 to 100% and is awarded in 10% increments.
To meet a 50-percent rating criteria, the main consideration is whether use of a qualifying breathing assistance device is required by the severity of the sleep apnea.
- 100 percent:chronic respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy
- 50 percent:requires use of breathing assistance device such as continuous airway pressure machine
- 30 percent: persistent daytime hypersomnolence
- 0 percent:asymptomatic, but with documented sleep disorder breathing
If your veterans claim for disability compensation has been denied, or you are not satisfied with your rating, please get in touch with our law firm. It is critical that you have qualified legal counsel who is committed to fight for you.
Contact Our Ohio Disability Benefits Lawyers Today
Diagnosing and treating sleep apnea can be highly expensive. It can also be costly in terms of losing the ability to work and earn a living. For this reason, you should seek help from an experienced disability benefits attorney as early as possible if you suffer from this condition and need help with your claim for SSD benefits.
If you or a loved one has been struggling to obtain SSD benefits while battling sleep apnea, we are here to help at Heller, Maas, Moro & Magill, Co., L.P.A. With five offices conveniently located throughout northeastern Ohio, we can meet with you immediately to discuss your case.
Our goal is to make sure all of our clients receive compassionate and skilled legal representation when they need it the most. We can bring more than 200 years of combined legal experience to your case and a determination to do everything we can to help you, whether it involves assisting with your initial application for SSD benefits or with your appeal of a denied claim.
The last thing we want to do is to add to your stress. That is why our law firm will never charge you costs or legal fees unless we are successful in helping you to obtain benefits. Every case starts with a free consultation. to discuss your case today.
About the Author
Social Security Disability For Sleep Disorders
If you have a sleep disorder, you may be eligible for Social Security disability benefits. The most common sleep disorders are insomnia and sleep related breathing disorders such as sleep apnea.
Insomnia is a condition characterized by an inability to sleep. In some cases, people with insomnia have trouble falling sleep at all. In others, they are unable to sleep long enough to get adequate rest. Chronic insomnia is insomnia which lasts more than one month, whether there is an outside cause or the insomnia itself is the primary disorder. Common causes of chronic insomnia are stress, drug use , chronic pain and hormonal imbalances. One common effect of insomnia is the sensation of seeing things in slow motion. Some of the other common effects of insomnia are:
- Double vision
- Digestive problems
There are a wide variety of treatment options available, depending on the cause of insomnia. Treatment options include medications, psychotherapy, and relaxation techniques. Chronic insomnia is often accompanied by other mental disorders such as ADHD, clinical depression, PTSD, OCD, dementia, and bipolar disorder.
- Lack of memory
- Daytime sleepiness
- Disturbance of cognitive abilities due to fatigue
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How The Va Assigns Disability Ratings For Sleep Disorders
Once a veteran proves that their sleep disorder is related to military service, the VA will determine the veterans monthly compensation amount based on a complex series of rating criteria set forth in VA regulations.
The most common sleep disorder we see in veterans is obstructive sleep apnea. Disability ratings for sleep apnea are assigned at 0, 30, 50, or 100 percent.
If sleep apnea causes disordered breathing but no other symptoms, the veteran will be assigned a 0 percent rating, meaning the veteran will not receive any monthly payment amount for sleep apnea.
If the veteran experiences persistent excessive sleepiness during the day, he or she will receive a 30 percent rating.
Use of a continuous positive airway pressure device will entitle a veteran to an automatic 50 percent rating.
And finally, if the veterans sleep apnea causes chronic respiratory failure with carbon dioxide retention or cor pulmonale, or if their sleep apnea requires tracheostomy, then a 100 percent rating will be awarded.
Click here to learn more about how to increase your disability rating.
Most Applicants Will Find It Difficult To Qualify For Social Security Disability Benefits Automatically With A Diagnosis Of Sleep Apnea Unless They Can Prove Their Disability Is Related To Heart Failure Chronic Pulmonary Hypertension Or A Neurocognitive Disorder
If you have sleep apnea, but your disability does not match one of Social Securitys impairment listings, you may still be eligible for Social Security Disability benefits if you have another impairment for example, high blood pressure or diabetes. Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Securitys Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicants ability to hold a job and perform necessary daily tasks. In any case, you must have an actual diagnosis confirmed by a polysomnogram and statements by medical providers detailing your capabilities and limitations. For example, because of sleepiness during the day, you may not be able to operate machinery. Social Security will also evaluate how your limitations affect your ability to work , taking into account whether or not you are able to drive, your age, and level of education. They will test your residual functional capacity which is a measure of how the disease affects your everyday job performance. The fatigue associated with sleep apnea, particularly chronic or severe sleep apnea, can lead to physical and cognitive impairment.
The first category is the Work Requirements which has two tests.
The second category is the Medical Eligibility Requirement.
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How The Va Rates Sleep Apnea
There are several categories under which sleep apnea may be defined during a VA review of your health to determine what conditions you may have and which are considered by the VA to be service-connected. They include:
- Conditions that require a tracheostomy due to chronic respiratory failure with carbon dioxide retention or cor pulmonale
- Conditions that require the use of a breathing assistance device such as a CPAP machine
- Persistent day-time hypersomnolence
- Asymptomatic but with documented sleep disorder-type breathing
These ratings range from 100% disability all the way down to 0% .
The breakdown is as followsremember that the VA rates all such cases individually but using a guide to qualifying conditions that include:
- 100 percent VA rating: awarded in cases of chronic respiratory failure with carbon dioxide retention or cor pulmonare, or requires tracheostomy
- 50 percent rating: awarded in cases where the use of a CPAP machine is required
- 30 percent rating: awarded for persistent day-time hypersomnolence
- 0 percent rating: awarded for asymptomatic sleep apnea with documented sleep disorder breathing
No Matter What Type Of Sleep Apnea A Person Has They Stop Breathing For Short Periods Of Time During Sleep
When a person stops breathing, the brain and rest of the body do not get enough oxygen. These stoppages occur repeatedly, sometimes hundreds of times and often for one minute or longer. If untreated, sleep apnea can cause daytime fatigue, memory problems, weight gain and headaches. The condition can also adversely impact job performance and carries the risk of heart disease, diabetes, liver problems and auto accidents. Sleep apnea can affect anyone, even children, but men and people who are overweight are more at risk than others.
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Diagnosing And Treating Sleep Apnea For Better Health
Its important to treat sleep apnea, because it can have long-term consequences for your health. While there have been some high-profile deaths linked to sleep apneasuch as with Judge Antonin Scalia Jun says that the true risk is from damage done over time.
Obstructive sleep apnea can range from mild to severe, based on a measurement system called the apnea-hypopnea index . The AHI measures the number of breathing pauses that you experience per hour that you sleep.
Obstructive sleep apnea is classified by severity:
- Severe obstructive sleep apnea means that your AHI is greater than 30
- Moderate obstructive sleep apnea means that your AHI is between 15 and 30
- Mild obstructive sleep apnea means that your AHI is between 5 and 15
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Whether or not you need treatment for sleep apnea depends on its severity, whether or not you have symptoms such as sleepiness and other health conditions. For example, if you have risk factors for heart disease, your doctor might opt to treat you even for mild sleep apnea. On the other hand, if you have a severe case of sleep apnea, your doctor might insist on treatment even if youre not sleepy.
Not very relaxing, right? Luckily, its treatable.
Va Disability Rating For Sleep Apnea
What kind of VA disability rating is possible for sleep apnea? This is a condition that, like all other VA-compensated disabilities, must have an established connection to military service in order to get an award for VA disability compensation.
Service-connected medical issues including sleep apnea may be deemed to be directly caused by military service, there may be a presumptive condition that includes sleep apnea, or you may experience sleep apnea as a secondary condition associated with some other VA rated issue.
The key is to understand how the VA defines sleep apnea, and under what conditions it may justify a VA disability percentage rating.
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There Are Three Types Of Sleep Apnea: Obstructive Sleep Apnea Central Sleep Apnea And Mixed Or Complex Sleep Apnea
Obstruction sleep apnea, or OSA, is the most common and is caused by a blockage of the airway when soft tissue at the back of the throat collapses during sleep. When the muscles relax, the airway narrows or closes and the person cant get enough air. The brain senses this inability to breathe and wakes the person so they can begin breathing normally again. These occurrences are so brief the person doesnt even remember them.
Getting A Secondary Service Connection For Sleep Apnea
It is possible to establish aconnection on a secondary basis. In which case the link must be established between a previously accepted service-connected condition. A couple of conditions sleep apnea has been secondarily rated for are PTSD and asthma, for example. There are quite a few conditions that have been proven to lead to the development of sleep apnea, so this might be a good course for you to choose.
Studies have shown that there is an especially significant link between PTSD and sleep apnea. Many factors overlap in both disorders that can aggravate each other. Some of these may have begun during active duty, such as excessive sleep deprivation, hyperarousal, and chronic stress.
These studies have shown that if PTSD increases in severity, the chances of sleep apnea increase as well. So if you have PTSD, it is recommended that you get screened for sleep apnea.
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Three Elements Of A Successful Va Sleep Apnea Rating Claim
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Va Disability Ratings And Sleep Apnea
To qualify for VA benefits for sleep apnea, veterans must first be diagnosed with the condition. This is typically done through a sleep study, either at a clinic or at your home. In addition, there must be evidence that this diagnosis either began during active military service or was made worse during service. In other words, there must be a current diagnosis, an onset, event or cause in service, and a link or nexus between those two.
Even if Sleep Apnea did not specifically begin in service, other conditions may be related. For example, some studies have found a link between Post-traumatic stress disorder and sleep apnea. Other conditions may also be related, but ultimately, only a doctor can offer a medical opinion to link a separate service-connected condition with sleep apnea.
An individual with sleep apnea may be eligible for VA benefits. Under the VA Ratings Schedule, a veteran with sleep apnea may be entitled to 0%, 30%, 50% or 100% benefits for sleep apnea, as follows:
- 0% Sleep Apnea Rating: asymptomatic, but with documented sleep disorder breathing
- 30% Sleep Apnea Rating: persistent daytime hypersomnolence
- 50% Sleep Apnea Rating: requires use of breathing assistance device such as continuous airway pressure machine
- 100% Sleep Apnea Rating: respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy.
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