If you are a veteran and you feel exhausted during the day and/or are having trouble sleeping, you could have sleep apnea, and if it is connected to your active service in the U.S. military, you could be entitled to VA disability benefits. To learn how to put together the evidence you need to have your VA benefits claim for sleep apnea approved, and to ensure you receive an accurate sleep apnea VA rating, connect with a VA benefits lawyer from our law firm.
Sleep Apnea: Briefly Explained
You may have heard the term sleep apnea before, but it can be helpful to briefly cover it as you could be suffering from sleep apnea and not know it. If you are tired during the day and experience difficulty concentrating, irritability, and other changes to your ability to function while awake, you could be suffering from sleep apnea. It is something that happens while you are asleep. When sleep apnea is not severe enough to wake you, and you do not have a partner to notice, you might not know why you feel so tired.
Sleep apnea involves difficulty breathing while asleep and takes one of the following three forms:
- Central sleep apnea – is when your brain does not send the necessary signals to the muscles in your body that control breathing, resulting in a gap in oxygen that can lead to brief waking moments
- Treatment-emergent central sleep apnea, or complex sleep apnea – this is when a person who has been diagnosed with obstructive sleep apnea (OSA), the most common type, has been diagnosed through a sleep study and it converts to CSA after receiving OSA therapy
- Obstructive sleep apnea (OSA) – this is the most common type of sleep apnea, in which the tensing and relaxing of muscles in your throat obstructs the flow of air into your lungs
Common symptoms of sleep apnea include:
- Loud snoring
- Waking with a headache in the morning
- Experiencing insomnia, or difficulty sleeping
- Experiencing hypersomnia, or excessive tiredness during the day
- Difficulty concentrating
Some of the causes of sleep apnea that a veteran may develop as a result of a primary condition or disability that, in turn, could cause sleep apnea as a secondary disability include:
- Use of sedatives or tranquilizers, which can make the muscles of the throat relax and cause OSA
- Excess weight, which can be caused by medications, disabling conditions, and other service-related causes
- Narrowed airways – can be caused by genetics or other reasons
- Medical conditions including type 2 diabetes, high blood pressure, and other diseases
Sleep apnea is best identified through a sleep study, as many of the symptoms of sleep apnea are not readily observable by the veteran suffering from it.
Is It Hard to Get VA Disability for Sleep Apnea?
Collecting VA disability benefits for your sleep apnea has the same general requirements you will encounter when applying for compensation from the VA for any current conditions linked to your active service.
To collect VA disability compensation for a current condition such as sleep apnea, the veteran must demonstrate that:
- The veteran has a current diagnosis of the condition they are disabled or otherwise impacted by.
- The condition was caused by an event, injury, or illness that happened when the Veteran was on qualifying active duty in the U.S. Armed Forces or other designated organizations.
- A medical review of the veteran’s condition determines that there is a link between their current condition and an event, injury, or illness during active duty.
While this may sound relatively straightforward, gathering evidence and filing your claim can be time-consuming and complex. A VA benefits lawyer can assist in accurately measuring your sleep apnea VA rating by helping you collect the evidence you need to prove sleep apnea to the VA and that it was linked to your service.
Sleep apnea can impact your ability to live everyday life and can also be detrimental to your overall health. Due to the ongoing cycle of oxygen deprivation associated with sleep apnea, individuals who suffer from sleep apnea may develop high blood pressure and other cardiovascular issues. Some individuals are also at greater risk of heart attacks and other fatal events due to the lack of oxygen to the brain that results from sleep apnea.
How Do I Prove VA Disability for Sleep Apnea?
Proving that you qualify for VA disability benefits requires that you demonstrate your current condition with recent medical records, that your current condition is linked to your active service, and that something happened in service to cause the condition. Additionally, the VA requires that your diagnosis of sleep apnea is confirmed by a sleep study.
You Must First Prove that Your Sleep Apnea is Service-Connected
The first step in receiving VA disability benefits for your sleep apnea is proving a link between your condition and your active service. This is supported by a nexus letter, which is an expert medical opinion that demonstrates that your sleep apnea was a primary or secondary condition that resulted from an event, injury, or illness that happened while you were under qualifying active duty.
The purpose of the nexus letter is to present the VA with an expert opinion that finds a connection between the veteran’s active duty and the current condition for which they are applying for VA benefits. The VA benefits you are applying for are meant to provide coverage for the drop in earnings your disability causes. For example, when your sleep apnea causes tiredness and difficulty concentrating, it can be dangerous to work or drive. This would entitle you to compensation for the lost earnings.
The Criteria for a Sleep Apnea VA Rating
Sleep apnea syndromes are listed under 38 CFR 4.97, DC 6847 (sleep apnea syndromes(obstructive, central, mixed) under the respiratory conditions category. To qualify for a rating under the VA ratings schedule, you must:
- Have medical evidence diagnosing sleep apnea, confirmed by a subsequent sleep study
- Once you have that evidence, you can schedule an examination with the VHA to determine if you might meet the criteria for your sleep apnea VA rating
- Keep in mind that evidence from a sleep study that you have sleep apnea does not confirm service-connection for your condition, which still requires evidence and supporting documentation like a nexus letter
When you can prove your sleep apnea was connected to your service and back it up with a sleep study, you will likely qualify for VA compensation and can process your filing and move forward.
A Sleep Study is Essential
As the VA notes, your diagnosis of sleep apnea must be confirmed by a sleep study for you to qualify for VA Disability. The National Institute of Health explains that a sleep study, also referred to as a polysomnography, is a painless test that is employed to:
- Measure the quality of your sleep
- To determine how your body responds to sleeping problems
- To help doctors in the diagnosis of your sleeping disorder
The sleep study generally involves you going to a facility and sleeping in a controlled environment. Your brain waves are recorded alongside your heart rate, breathing, and blood oxygen level, over the course of a full night of sleeping. The information gathered allows medical experts to determine if you have sleep apnea or other sleeping disorders, and if so, to what extent. While there are home sleep tests available, it is important to ensure that the test you take is accepted by the VA.
Can I Get a 100% VA Disability Rating for Sleep Apnea?
So long as your sleep apnea is related to your active service, you will qualify for VA disability benefits. A 100 percent disability rating for sleep apnea is generally awarded to veterans who have extremely serious symptoms, like chronic respiratory failure, cor pulmonale, or require a tracheostomy. But sleep apnea rated at less than 100 percent can be a factor in a claim for TDIU when it contributes to you being incapable of working, and also incapable of performing basic daily tasks without assistance. Sleep apnea in its more severe forms that qualifies for the 100 percent disability rating are rare. In my more than 25 years of practicing law, I have seen the extreme versions of sleep apnea, such as tracheostomy, only a few times.
A veteran who has a 100 percent disability rating qualifies for the maximum amount of monthly tax-free compensation, which is presently $3,106.04. Other factors are taken into consideration to increase that amount, including the need for aid or special monthly compensation, and any dependents the veteran might have.
The amount that you receive depends upon your sleep apnea VA rating. The VA explains that disability ratings “are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule).” Your sleep apnea VA rating is determined by considering the medical evidence you have in support of your condition, and how the criteria outlined in the VA Rating Schedule applies to your situation.
Sleep Apnea VA Ratings
The purpose of collecting VA disability benefits is to compensate a veteran “as far as can be practicably determined” for the average impairment of their earning capacity that results from their service-related condition. In addition to tax-free monthly payments for lost earnings compensation, qualifying veterans also generally receive coverage for their medical needs through the Veterans Health Administration (VHA) and their network of healthcare facilities.
The VA disability ratings for sleep apnea are as follows:
- 0 percent – you have a documented sleep disorder, but do not have any of the symptoms of sleep apnea
- 30 percent – you are regularly overtired during the day (hypersomnolence), which does not improve even when you seem to have had a sufficient amount of time sleeping
- 50 percent – you need a sleeping device such as CPAP, BiPAP, MAD, APAP, or other machines to assist your breathing while you sleep as a result of sleep apnea
- 100 percent – you are suffering from chronic respiratory failure, including carbon dioxide retention; or, cor pulmonale; or, the need for a tracheostomy
It is necessary to note that to qualify for 50 percent disability for your sleep apnea:
- You must use a qualifying breathing device
- The use of the qualifying device must be proven with evidence as being necessary
While a 0 percent rating may not entitle you to tax-free monthly compensation, the VHA will still cover your medical bills. When you reach 30 percent disability or greater for sleep apnea, you do become eligible for monthly tax-free payments, depending upon VA rating, number of dependents, and other factors the VA will take into account. The rating criteria jumps from 0 to 30 percent and there is nothing in between. The most common sleep apnea rating is 50 percent. But be advised that as of the publication of this article, VA is proposing to revamp the rating code for sleep apnea, making it more difficult to obtain the easy 50 percent rating that comes with use of the CPAP machine. So, file any sleep apnea claims now before VA changes the regulations.
Your sleep study will be an important piece of information in support of establishing your condition and making sure that any devices you are prescribed qualify under VA guidelines so that you can collect the benefits you are entitled to.
Discuss Your Sleep Apnea VA Rating with a Veterans’ Benefits Attorney
Determining your sleep apnea VA rating requires the collection of evidence to prove your diagnosis, and its connection to your service, as well as a sleep study to prove it to the VA. You’ll need to file VA Form 21-526EZ with all the necessary information and evidence, and ideally, your claim will be approved and you receive an accurate VA rating for your sleep apnea.
The process of collecting evidence can be time-consuming, and you might not know exactly what the VA is looking for. Working with our veteran’s VA benefits law firm once you receive an initial denial is the best way to increase the chances of a successful outcome, and so that you do not have to worry about doing things correctly and completely throughout the process. We take over the paperwork on your behalf, provide reviews with our in-house physician and network of medical experts to generate evidence, and will advocate for the best possible outcome with the VA on your behalf.
To learn how our VA benefits lawyers can help, give us a call at 888-495-5774, or visit our site to schedule a free case evaluation.