Tougher Standards Expected For Va Sleep Apnea Rating
Are you one of the 25,000 veterans awarded service connection for obstructive sleep apnea just last year? Are you one of the 13 percent of approximately 427,000 post 9/11 veterans who draw compensation benefits and have service-connected sleep apnea? If you are, you are among the more than 114,000 veterans that are already drawing compensation for sleep apnea. If you are rated at 50 percent, you likely are well aware that simply your use of a CPAP machine is the sole reason for that rating. A change in the standards for VA sleep apnea rating, however, is setting out to change that.
How Are Va Ratings Assigned
The Veterans Affairs Schedule for Rating Disabilities is designed to assign ratings based what the functional impairment is of a service-connected condition. Take for example a service-connected knee condition that has resulted in a replacement. After successful surgery the highest possible rating is usually 30 percent because the VA estimates that the surgery fixes your pre-surgery problem by providing you with a new joint, yet they acknowledge you will still have functional loss because the artificial knee will never be the same as the natural knee you were born with. Therefore, based on how the VASRD is supposed to work, people are starting to ask what could possibly be the functional impairment of using a CPAP machine that warrants a 50 percent rating.
Va Sleep Apnea Denial
VA almost always denies claims for sleep apnea on initial submission. Weve seen dozens of VA examiner reports that all say the same thing: Either there was no diagnosis during service, or, that sleep apnea is caused by excess tissue in the throat and not caused by mental disorders. So you probably shouldnt be surprised if you apply for it and get one of those responses. VA almost never disputes that the Veteran in fact has sleep apnea. Current technology includes sleep studies, and the results are almost indisputable. If VA denies your sleep apnea claim, it almost certainly wont be on the basis that you dont have sleep apnea.
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Va Ratings For Sleep Apnea
The VA rates and evaluates sleep apnea under Diagnostic Code 6847, also called sleep apnea syndromes. The VA rates sleep apnea based on its severity and symptoms from 0% to 100%.
A 0% rating qualifies the Veteran for no disability benefits, although other standard benefits like healthcare may be available. A rating of 100% allows a Veteran to claim total disability and receive the highest potential amount of monthly compensation.
- A rating of 0% is given for asymptomatic sleep apnea or documented sleep-disordered breathing.
- A rating of 30% is given to Veterans who experience persistent daytime hypersomnolence.
- A rating of 50% is given to Veterans who have to use a Continuous Positive Airway Pressure machine or other breathing assistance device.
- A rating of 100% is only given to Veterans who experience chronic respiratory failure with carbon dioxide retention or cor pulmonare or Veterans who require a tracheostomy.
In the last case, a Veteran may retain their 100% disability rating for some time after their tracheostomy procedure while they recover. After the procedure, they will eventually have to attend a C& P exam to see how their symptoms have progressed before receiving a new disability rating.
Sinusitis & Sleep Apnea
Veterans with obstructive sleep apnea have a heightened risk of chronic sinusitis. There are studies linking the conditions, which means veterans may be able to service-connect the two conditions together. Sinusitis can aggravate obstructive sleep apnea and vice-versa. For this reason, disabled veterans regularly receive both a VA sinusitis rating and a VA sleep apnea rating concurrently.
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Service Connection And Va Ratings For Sleep Apnea
To establish 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 between their sleep apnea and the in-service event, injury, or illness
Once service connection is awarded, sleep apnea is then rated under 38 CFR § 4.97, Diagnostic Code 6847 Sleep Apnea Syndromes . Veterans are assigned a 0, 30, 50, or 100 percent rating depending on the severity of their condition. The rating criteria are as follows:
- 100% chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy, or cor pulmonale
- 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
- 0% if the veterans condition is asymptomatic but has a documented sleep disorder
Sleep Apnea Rating Schedule For 2020
Sleep apnea is becoming a bigger problem in the United States Armed Forces.
According to the Veterans Benefits Administration , the three types of sleep apnea lead the way in terms of service-connected respiratory disabilities.
Sleep apnea VA disability claims account for nearly 1 in 4 respiratory claims.
According to the VBA, there were over 282,300 service-connected sleep apnea claims that were awarded in 2017.
The number of VA disability ratings that are awarded for sleep apnea is on the rise, however, it still fails to address the entire issue.
The U.S. Armed Forces utilize VA disability ratings to determine the severity of sleep apnea and these types of claims are notoriously hard to receive approval.
Consequently, the VA denies the majority of sleep apnea claims.
Part of the problem is the VA has altered its rules for assigning sleep apnea disability ratings and providing benefits over the years.
Therefore, many service members are subject to misinformation or interpretation when filing a VA disability claim.
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Contact Veterans Law Attorneys Today
If you believe your sleep apnea is due to your tinnitus or vice versa, you may be able to see an increase in your disability benefits. However, it can be difficult to gather the right evidence and file a successful claim by yourself.
Fortunately, you dont have to go it alone. Instead, you can contact Berry Law for a free consultation and case evaluation.
We are experienced Veterans law attorneys who are standing by to help you connect your sleep apnea to your tinnitus as a secondary condition. We can help you through the benefits application process and, if needed, through the benefits appeals process as well.
Contact Berry Law today to get started!
Are Asthma And Sleep Apnea Related
Yes. Although asthma does not cause sleep apnea or vice versa, the two conditions are more linked than previously thought.
Researchers now believe that there is a bidirectional relationship between asthma and sleep apnea, meaning both conditions worsen each other. So, if you have sleep apnea, your asthma symptoms might worsen, and vice versa.
Furthermore, asthma may cause or aggravate obstructive sleep apnea in some cases. Its possible to develop asthma independently, then develop sleep apnea symptoms because of how asthma affects your airways and lung tissue over time.
Because of this, you may be able to acquire an increased disability rating for your asthma benefits if you have sleep apnea.
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Why Would A Va Claim For Sleep Apnea Be Denied
A VA claim for sleep apnea can be denied for many reasons. One common scenario is when a veteran tries to claim sleep apnea as a primary condition when there was no diagnosis during active-duty service. Even if you have a medical diagnosis during active-duty service, without a sleep study this is difficult to claim successfully.
If youre claiming sleep apnea as a secondary condition, make sure you already have a medical diagnosis before you make your claim. The most common reason for denial of secondary claims is not establishing a strong enough connection between the service-connected disability and the sleep apnea. Including a nexus letter for sleep apnea can be an important part of your claim to strengthen your case for a sleep apnea VA rating.
In addition, during the C& P exam for a sleep apnea VA rating, its important to make the case for how your sleep apnea impacts your ability to work, your daily life, and your social life.
Sleep apnea is proven to significantly reduce a persons quality of life . Obstructive sleep apnea can cause daytime sleepiness, snoring, depression, difficulties with concentration, and loss of memory.
Here are a few examples of how sleep apnea could be impacting your life, which youll want to clearly state and demonstrate in your C& P exam and in your claim:
Va Cpap Machines For Sleep Apnea Treatment
Since sleep apnea can correlate with conditions like heart disease and obesity, its important to seek treatment options. Physicians will treat sleep apnea depending on the type and severity of the condition. This can range from CPAP therapy, lifestyle changes such as diet, exercise, and others.
While some individuals with breathing disorders may show improvement from lifestyle changes, breathing assistance devices such as CPAP machines , BiPap machines, etc. are still among the most common treatments. These machines create airway pressure to help the individual breathe throughout the night.
Note: Millions of Philips CPAP Machines have been recalled due to toxic chemical seeping into mask and unknowingly being inhaled by sleep apnea patients. Check out our Philips CPAP Recall page here!
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Want More Help With Your Sleep Apnea Va Claim
At VA Claims Insider, we can help you win your claim and get the highest VA rating for sleep apnea.
At VA Claims Insider, we help veterans understand and take control of the claims process so they can get the rating and compensation theyre owed by law. Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim .
If youve filed your VA disability claim and have been denied or have received a low rating, or youre not sure how to get started, reach out to us for a FREE VA Claim Discovery Callso you can FINALLY get the disability rating and compensation you deserve. Weve supported more than 15,000 veterans to win their claims. NOW ITS YOUR TURN.
Why Would A Va Claim Be Denied Sleep Apnea
VA may deny a sleep apnea claim based on different aspects, whether theres not enough medical evidence of sleep apnea or perhaps no logical connection between your military service and your current sleep apnea. If your obstructive sleep apnea VA claim, or other sleep apnea claim, was originally denied, you may be able to appeal the rating and receive VA disability compensation.
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Contact A Veterans Benefits Attorney Today
If you are a Veteran with sleep apnea who needs help applying for benefits, contact the office of Sean Kendall, Attorney-at-Law for a free, no-obligation consultation. We will work to protect your legal rights and help maximize the benefits you deserve. Call us today at 877-629-1712 or use our online contact form to find out more.
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Va Disability Ratings For Sleep Apnea
Under the VA Ratings Schedule, a veteran may qualify for VA benefits, which are grouped into 0%, 30%, 50%, or 100%. These benefits can be further broken down as follows:
- 0% Sleep Apnea Rating: no symptoms apart from breathing difficulty while sleeping.
- 30% Sleep Apnea Rating: excessive daytime sleepiness, though a CPAP machine is not required at night.
- 50% Sleep Apnea Rating: requires the use of a breathing assistance machine to sleep at night .
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100% Sleep Apnea Rating: sleep apnea causes chronic respiratory failure with carbon dioxide retention or heart conditions that may require tracheostomy.
Currently, service-related sleep apnea with a 50 percent rating is the most common for veterans seeking VA disability benefits. Studies show that 9 out of 10 veterans with service-connected sleep apnea have a 50% rating and are under CPAP therapy.
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How Can I Prove My Sleep Apnea Resulted From An In
Sleep apnea is not considered a presumptive condition for veterans exposed to Agent Orange or ionized radiation, or contaminated water at Camp Lejeune. However, veterans of the Persian Gulf War may be entitled to presumptive service connection for their sleep apnea. Under the VAs regulation concerning Persian Gulf War veterans, 38 § C.F.R. 3.17, sleep apnea falls under sleep disturbances as an undiagnosed illness and medically unexplained chronic multisymptom illness.
Veterans can also prove service connection for sleep apnea by showing that their sleep apnea began in service using service medical records, or by providing a nexus opinion from a medical professional that links their current diagnosis of sleep apnea to signs or symptoms they experienced in service.
Additionally, veterans can service connect their sleep apnea on a secondary basis. Establishing a secondary service connection involves proving that your sleep apnea is a secondary or residual effect of another condition one that does have a direct service connection such as chronic rhinitis, asthma, a deviated septum, or diabetes mellitus type 2.
Establishing Service Connection For Sleep Apnea
In order to establish direct service connection for sleep apnea, a claimant must show that they have:
- a current, diagnosis of sleep apnea
- an in-service event or illness/injury
- a medical nexus or link that shows the veterans sleep apnea is related to their in-service event, injury/illness.
A veteran can also establish service connection for sleep apnea on a secondary basis. This means that a veteran has an already service-connected disability that caused the veteran to have sleep apnea. In this case, there must be a medical nexus to link the sleep apnea to their already service-connected disability.
Some conditions that can be secondary to sleep apnea may include but are not limited to:
- heart conditions
- mental health conditions
If you have a service-connected condition that you believe is causing your sleep apnea, it may be a good idea to start to talk to your doctors about it.
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Success With Va Sleep Apnea Appeals
The good news is we have experience with these claims and have helped many Veterans obtain sleep apnea benefits on either a direct or secondary basis. These benefits can be desirable. VA rates sleep apnea 50% if the Veteran was assigned to use a C-PAP machine, regardless of whether it is actually used. Veterans who are already service-connected for a mental disorder may be sitting at 70%, 80%, or 90% overall, and a 50% rating may be just whats needed to reach 100%. It is our pleasure to try to help you get there.
Tdiu Benefits For Sleep Apnea
Certain symptoms of sleep apnea, such as excessive daytime sleepiness, fatigue, and difficulty concentrating, may impact a veterans ability to work. If you are unable to find and maintain substantially gainful employment due to your service-connected sleep apnea, you may be entitled to total disability based on individual unemployability .
Veterans can qualify for TDIU under 38 CFR § 4.16, 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.
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Is A Cpap Machine The Only Treatment For Sleep Apnea
Sleep apnea treatment depends on the type and severity of the condition. Before or in addition to CPAP therapy, lifestyle changes such as diet, exercise, and stress reduction may be recommended. Some veterans with sleep apnea may experience improvement with lifestyle changes, but CPAP therapy is still among the most common treatments.
Sleep Apnea Va Rating Changes Are Coming Learn How You Can Protect Your Benefits
Do you need help or advice? Contact us now.
Sleep apnea is one of the most common disabilities affecting veterans. Its also one of the most misunderstood. Some see it as a nuisance, others as a life-threatening condition.
A soon-to-retire service member described his sleep apnea this way:
I was diagnosed with sleep apnea about 2 years ago and I have to say that I love my CPAP, it is awesome to embrace the feeling of your skull being crushed while you attempt to sleep for four hours if Im lucky!
Even with the CPAP machine delivering some relief, this individual is not going to be anywhere near 100% at work the next day. Sleep apnea is a chronic condition that can sap you of energy and affect your ability to work.
It may not surprise you to learn that some veterans are receiving over $1,000 a month in VA disability compensation for the condition. The reality is, sleep apnea has a wide range of severity and, as a chronic condition with no cure, it tends to get worse over time.
Though the CPAP machine is far from a silver bullet, it is central to the way sleep apnea VA ratings currently work. That could be changing. This article looks at how the proposed changes could impact tens of thousands of veterans and what you can do about it.
First, we take a deep dive into what sleep apnea is, who tends to be affected by it, and how the VA currently rates it. Feel free to skip ahead to the changes if you already know this stuff.
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