How the VA Rates Sleep Apnea: CPAP vs. Non-CPAP Cases Explained

Sleep apnea is a very common condition that Veterans suffer from. Those with sleep apnea often struggle to stay awake during the day and gasp for air at night. As a result, the symptoms routinely disrupt your life, career, relationships, and ability to take care of yourself. Unfortunately, many Veterans believe that “it’s just snoring” and are unaware of the stress that sleep apnea places on the brain and cardiovascular system. The truth is that sleep apnea can potentially result in a 100 percent disability rating.

What Is the VA Diagnostic Code for Sleep Apnea?

The VA evaluates sleep apnea under Diagnostic Code 6847. The federal regulations list the exact criteria for assigning a 0, 30, 50, or 100 percent rating based on (1) the severity of your respiratory impairment and (2) whether you need a continuous airway pressure (CPAP) machine.

Through the Code of Federal Regulations, the VA recognizes three distinct types of sleep apnea syndromes:

• Obstructive Sleep Apnea (OSA). This is the most common form of sleep apnea, occurring when throat muscles relax and block your airway during sleep.
• Central Sleep Apnea (CSA). CSA occurs when your brain fails to send the proper signals to the muscles that control your breathing.
• Mixed Sleep Apnea. This is a complex combination of both obstructive and central sleep apnea events occurring during the same sleep cycle.

No matter what type of sleep apnea you are diagnosed with, the VA will use the same four-tier rating schedule to determine the benefits you have earned. This rating system is based on your functional impairment and the necessity for medical equipment and surgeries. They do not consider how loud you snore or how many times you wake up. Instead, the VA assesses how much your sleep apnea affects your ability to function and what medical interventions are required to ensure you can breathe safely at night.

How Does the VA Rate Sleep Apnea Without a CPAP Machine?

If you require a CPAP machine, you are automatically assigned a minimum rating of 50 percent. If you do not require a CPAP machine or a similar breathing-assistance device, the VA will typically assign either a 0 percent or a 30 percent rating. A 30 percent rating is granted for persistent daytime hypersomnolence, while a 0 percent rating is assigned if your condition is documented but asymptomatic.

A 0 percent rating means your medical records and sleep study confirm you have a sleep-disordered breathing condition, but you do not exhibit symptoms that impair your daily life, or your symptoms are fully controlled without medical intervention. Even though a 0 percent rating does not pay monthly compensation, it is incredibly valuable for your future. It formally establishes a service connection for the respiratory condition. If your symptoms worsen years down the road, you can simply file for an increased rating rather than having to prove service connection all over again. It also guarantees you access to VA healthcare for the condition.

A 30 percent rating is assigned when a Veteran experiences persistent daytime hypersomnolence. This medical term refers to excessive daytime sleepiness that is not relieved by a full night’s rest. Veterans with a 30 percent rating often struggle to stay awake during the day, which significantly affects their ability to maintain steady employment. Evidence for this rating often includes:

• Medical records detailing chronic daytime fatigue.
• High scores on the Epworth Sleepiness Scale, a standard questionnaire used by doctors to measure daytime sleepiness.
• Lay statements from spouses or coworkers describing instances of you falling asleep at work, requiring frequent naps, or suffering from severe concentration issues.

What Qualifies a Veteran for a 100 Percent Sleep Apnea Rating?

Veterans suffering from sleep apnea can acquire a 100 percent rating. However, this rating is reserved for the most significant and life-threatening cases.

Very few Veterans meet the criteria for a 100 percent rating under Diagnostic Code 6847. The conditions required for this level of rating indicate massive respiratory and cardiac impairment:

• Chronic respiratory failure. This means your lungs are unable to move oxygen into your blood and/or remove carbon dioxide (CO2). This often causes significant shortness of breath and tiredness, so much so that even basic tasks can be undoable.
• Cor pulmonale. This is a condition where high blood pressure in the lungs causes the right side of the heart to grow, which ultimately causes heart failure.
• Tracheostomy. A surgical opening in the neck to place a tube into the windpipe to allow air to enter the lungs.

Furthermore, if your sleep apnea is rated at 50 percent, but the intense daytime fatigue and cognitive impairment prevent you from holding a steady job, you may qualify for Total Disability Based on Individual Unemployability (TDIU). TDIU allows the VA to pay you at the 100 percent rate if your service-connected conditions make substantial gainful employment impossible. To qualify for TDIU, you generally need one disability rated at 60 percent, or a combined rating of 70 percent with at least one condition rated at 40 percent or higher.

What Medical Evidence Do You Need to Win a Sleep Apnea Claim?

The evidence required to win a sleep apnea claim is similar to most other conditions. You need (1) evidence of a current condition that (2) can be medically linked to (3) something that happened while you were in service. You need to prove all three of these elements in order to win your claim. If even one element is lacking in evidence, the VA will likely deny your claim.

The most important thing to remember is that you need significant amounts of evidence to prove each element. The VA is notorious for refusing to “fill in the blanks” or use common sense when assigning ratings. For example, if you have evidence of an in-service event and a letter that says your current condition is linked to that event, the VA can still deny your claim if your current condition is not sufficiently elaborated upon.

To win your claim and get a Sleep Apnea VA Rating, you will need:

• A Current Sleep Study. The VA requires a formal polysomnogram (sleep study) to diagnose sleep apnea. A doctor’s physical exam or your own reports of heavy snoring are insufficient without the objective data generated by a sleep study.
• In-Service Documentation. If you developed sleep apnea during your service, you need military medical records showing complaints of sleep issues or daytime fatigue, etc. Buddy statements from fellow service members who witnessed your snoring or choking in the barracks can be highly effective here. However, in-service documentation is not needed to establish service connection on a secondary basis, as explained further below. 
• A Medical Nexus Opinion. This is a detailed, scientifically backed letter from a qualified medical professional explaining exactly how your military service caused your sleep apnea.

Many Veterans file for sleep apnea as a secondary service-connected disability. This means a condition you already have a rating for caused or aggravated your sleep apnea. Common primary disabilities that lead to secondary sleep apnea include Post-Traumatic Stress Disorder (PTSD), traumatic brain injuries (TBI), chronic sinusitis, and asthma. If you are filing a secondary claim, your nexus letter must focus on the precise physiological links between your primary injury and the collapse of your airway during sleep.

Frequently Asked Questions (FAQs)

Does a sleep study from a private doctor count for a VA claim?

Yes. The VA will accept a private sleep study, as long as it meets their standards. As a result, you do not have to worry about waiting for a VA hospital to conduct a study.

Will the VA lower my rating if I struggle to use my CPAP machine?

No. Under current regulations, if you are required to use a continuous positive airway pressure (CPAP) machine, you are entitled to a minimum rating of 50%. It does not matter if you do not use it routinely or struggle to sleep with the mask on your face. The key issue the VA will look at is whether the CPAP machine is deemed “medically necessary,” not whether you actually use it.

Why did the VA deny my sleep apnea claim?

When a Veteran’s claim for sleep apnea is denied, the most common reason is the absence of a nexus letter. The letter must be from a qualified medical provider (usually a physician) who can explain how your in-service event is directly linked to your sleep apnea. If the letter is based on speculation and does not get into the specifics of your case, the VA will likely deny your claim.

How Our Firm Can Help You Get a Sleep Apnea VA Rating 

An experienced Veterans disability attorney can evaluate your military records, coordinate with independent medical experts to secure strong nexus opinions, and appeal unfair denials or improperly low ratings. Our team has many years of experience helping Veterans with sleep apnea obtain the VA rating they deserve. We have helped Veterans across the country, and we can leverage our experience to help you too.

To get the dedicated legal representation you deserve, contact our offices for a free consultation today.