Sleep Apnea VA Rating for Disability and Compensation
Veterans who experience a service-related condition or disability qualify for benefits through the U.S. Department of Veterans Affairs (VA), alongside medical coverage through the Veterans Health Administration (VHA). Benefits generally include tax-free monthly compensation based upon your percentage for service connected sleep apnea VA rating assigned by the VA, healthcare coverage, as well as coverage for education, job training, and other benefits depending upon your circumstances.
If you are a veteran suffering from service-related sleep apnea, you could be missing out on significant benefits. To collect the benefits you are entitled to, you must fill out an application, provide evidence of your current condition, and a nexus letter from a medical professional that links your current condition to your active service. The process can be difficult, and working with a VA benefits lawyer to help you through the process of appealling for VA disability benefits for your sleep apnea will support the outcome and provide you with all the assistance you need along the way.
What is Sleep Apnea?
The condition known as sleep apnea is a sleep disorder that can range in severity and involves the repeated stopping and starting of breathing. Individuals who snore loudly or are still tired despite having had a full night’s sleep and may suffer from sleep apnea. The repeated stopping of breathing associated with sleep apnea wakens the person with the condition, limiting their ability to achieve restful and restorative sleep at night.
There are 3 main types of sleep apnea:
- Obstructive sleep apnea (OSA) – the more common form of sleep apnea that happens when the muscles of the throat relax and block the flow of air into your lungs.
- Central sleep apnea (CSA) – happens when the brain fails to send the proper signals to the muscles that control your breathing.
- Treatment-emergent central sleep apnea – sometimes called complex sleep apnea- happens when an individual has OSA that has been diagnosed with a sleep study, which then converts to CSA after receiving therapy for OSA.
Identifying which type of sleep apnea you have can be difficult, as the symptoms are known to overlap.
Determining which type of sleep apnea you suffer from can be difficult as the different types have many of the same symptoms. In general, the most common symptoms experienced by individuals suffering from obstructive and central sleep apneas include:
- Periods during which you stop breathing during sleep, which can be reported by another person or confirmed through a sleep study
- Gasping for air while sleeping
- Waking up with a dry mouth
- Loud snoring
- A headache in the morning
- Having a hard time staying asleep (insomnia)
- Being excessively sleepy during the day (hypersomnia)
- Being irritable
- Having a hard time paying attention when awake
You may not know when to seek medical attention for your sleep apnea symptoms, especially if you are unaware of them.
Obstructive sleep apnea happens when the muscles in the back of your throat relax, blocking your breathing pathways. These muscles support the soft palate, which is the triangle-shaped piece of tissue below the soft palate called the uvula, the tonsils, and the side walls of the throat and tongue. The relaxing of the muscles causes a narrowing of the airway that lowers oxygen in your blood and can lead to you briefly awakening 5 to 30 times or more an hour for the entire night.
Individuals suffering from central sleep apnea experience periods where their body makes no effort to breathe for a short period of time. This can lead to awakening with shortness of breath, and can also lead to difficulty sleeping or maintaining sleep.
The following factors increase the risk of sleep apnea and may be caused by a service-related condition:
- Excess weight – persons who are obese have a significantly increased risk of obstructive sleep apnea, as fat deposits around the upper airway can lead to constriction in breathing
- Narrowed airways – this can be something an individual is born with or other reasons
- Neck circumference – having a thicker neck can lead to having a narrower airway
- Being a male – as men have a 2-3 times greater likelihood of having sleep apnea than women
- Use of sedatives or tranquilizers – these can relax the muscles of the throat
- Medical conditions, including high blood pressure, type 2 diabetes, congestive heart disorder, and other diseases, can increase the risk of developing sleep apnea
The symptoms can have a significant impact on how a veteran suffering from sleep apnea can live.
Impact on Your Daily Life
Those who suffer from obstructive sleep apnea often experience difficulty maintaining focus and staying awake during the day. The pattern of awakening from a lack of oxygen results in difficulty reaching deep, restful phases during sleep. Some of the most common complications from OSA include:
- Daytime fatigue – the ongoing awakenings from sleep apnea can make traditional, restorative sleep impossible, which can lead to a greater likelihood of daytime fatigue, irritability, and drowsiness.
- Difficulty concentrating – the lack of restorative sleep can lead to difficulty concentrating while performing daytime tasks.
- Falling asleep – individuals with sleep apnea may find themselves falling asleep while at work while driving, or while watching television, resulting in an increased risk of workplace and motor vehicle accidents.
- Behavior and mood changes – persons suffering from sleep apnea may feel more depressed, moody, or quick-tempered than normal.
These impacts can negatively influence your ability to work, maintain employment, and get around in your own vehicle. Such factors are carefully taken into account when determining your sleep apnea VA rating, especially when your claim for sleep apnea coincides with a claim for total disability.
Impact on Your Overall Health
Health issues that are more significant than fatigue and tiredness can develop from sleep apnea. Significant health issues that may develop from sleep apnea include:
- High blood pressure – the sudden decreases in blood oxygen levels that happen with OSA sleep apnea result in an increase in blood pressure and strain on the cardiovascular system, which can lead to hypertension or high blood pressure
- Heart attack – OSA can also increase the risk of a recurrent heart attack, as well as stroke and irregular heartbeats, while individuals with heart disease who experience multiple episodes of low blood oxygen can experience sudden death from an irregular heartbeat
- Type 2 diabetes – sleep apnea increases the risk of insulin resistance and type 2 diabetes
- Metabolic syndrome – this disorder is comprised of abnormal cholesterol levels, high blood pressure, high blood sugar, and an increased waist circumference, resulting in an increased risk of heart disease
- Complications with surgery and medicines – sleep apnea can lead to complications with surgery, and also when using certain medicines
- Depression – research shows that sleep apnea can cause depression
When your capacity to live an independent life is limited, then your VA disability rating is generally higher, and sleep apnea can also result in costly medical necessities that your VA benefits would also cover if your application is approved.
Sleep Apnea VA Rating Criteria
The VA will generally require you to complete a sleep study to have the evidence needed to begin collecting VA disability compensation for sleep apnea. You’ll need to demonstrate a current diagnosis of sleep apnea confirmed by a sleep study, in addition to an in-service event, injury, or illness linked to your sleep apnea.
It is possible to receive a sleep apnea VA rating of 0, 30, 50, or 100 percent for sleep apnea, as follows:
- 0 percent – you do not have any symptoms of sleep apnea, but you do have a documented sleep disorder
- 30 percent – you experience persistent daytime hypersomnolence, which means daytime sleepiness that does not improve even when you have had sufficient sleep
- 50 percent – you must use a breathing assistance device to address your sleep apnea symptoms, such as a CPAP machine, BiPAP, MAD, APAP, and others. This criterion requires the use of a qualifying breathing device, in addition to two related considerations, whether the device qualifies and whether the use of the qualifying device is necessary
- 100 percent – you suffer from chronic respiratory failure with carbon dioxide retention; or cor pulmonale; or, requires a tracheostomy
Under the VA Rating Code, sleep apnea syndromes are listed under 38 CFR 4.97, DC 6847 (sleep apnea syndromes – obstructive, central, mixed). It falls under respiratory conditions, and the VA clarifies that it is necessary that they:
- Receive medical evidence diagnosing sleep apnea, with confirmation by a sleep study.
- This in turn allows you to schedule an examination to determine if you might meet the criteria.
- It is important to note that evidence from a sleep study is not sufficient to prove a service connection for sleep apnea.
When clinical examinations determine that the symptoms of sleep apnea are present, the following diagnosis of sleep apnea must be confirmed through a sleep study for the purposes of compensation.
The VA will accept a home sleep study as proof of your sleep apnea in limited circumstances, only if:
- The clinical review has determined that the veteran can be appropriately evaluated through a home sleep study, and,
- A competent medical provider evaluated the results of the sleep study.
How VA Rating Percentages are Assigned
In general, VA disability ratings are determined based on the impact on the overall health and ability of the veteran to engage in gainful employment. When a condition impacts a veteran’s ability to perform daily tasks or requires that they be provided assistance to complete these tasks, disability ratings begin at 10. They increase by increments of 10 until they reach 100, which is defined as total disability. With respect to Sleep apnea, the most important factor is whether the veteran is using the CPAP machine. It is extremely rare to see a veteran with chronic respiratory failure with carbon dioxide retention, cor pulmonale, or needing a tracheostomy. The vast majority of cases are ones involving a CPAP machine and the assignment of a 50 percent rating.
Filing a Sleep Apnea Claim
To be approved for VA disability benefits for your sleep apnea claim, it is required that you prove the same three elements as with any other VA disability claim:
- You experienced an event during active service that caused or aggravated a condition or illness.
- You have a present-day diagnosis of that same condition or illness.
- You have a medical opinion that links numbers 1 and 2.
However, the most common scenario for winning a sleep apnea claim usually involves secondary service connection. This means an existing service-connected disability causes you to develop sleep apnea after service. Common examples are PTSD or other psychiatric disabilities leading to sleep apnea, physical disabilities that lead to excessive weight gain that in turn causes sleep apnea, or service connected breathing problems like sinusitis or rhinitis that cause sleep apnea.
Sleep apnea can then cause other problems, such as hypertension that can lead to a stroke and debilitating symptoms.
To file your sleep apnea claim, you’ll need to complete several steps, starting with gathering evidence. Your claim can only be approved if you prove that you suffer from a condition caused by or worsened by your active service. The nexus letter explored in the section below is how you provide the VA with evidence to connect your current condition to your active service.
Once you have gathered sufficient evidence, you must begin submitting your claim by filing VA Form 21-526EZ, which must be completed and signed. The VA provides a significant amount of information and guidance to help you understand how to obtain and include the kind of evidence you need to be approved, listed on pages 2-8 in the link provided to the form.
There are two pathways to submit your VA Form 21-526EZ, the FDC Program (Optional Expedited Process) or the Standard Claim Process. You are required to submit substantially more records, as available, under the FDC Program, while under the Standard Claim Process, you may provide the VA with information about relevant evidence so that they may request it to review within your application. To support your claim, you’ll usually need a nexus letter unless the sleep apnea was diagnosed in service.
Nexus Letters and Medical Evidence from Healthcare Professionals
As mentioned in the introduction, a “nexus letter” is an essential piece of your VA benefits application and will often determine whether or not you are approved and can help to address what rating your disability receives. The nexus letter is the vital piece of evidence a medical professional provides that links your current condition or disability to your active service.
The nexus letter will determine whether your current condition is linked to your service on a scale as follows: “not likely,” “at least as likely as not,” “more than likely,” and “highly likely.” When the medical opinion determines that your current condition is at least as likely not to have been caused or aggravated by an event during your active service, your VA disability benefits claim will be approved.
Sleep Study Results Support the Success of Your VA Benefits Application
To collect VA disability benefits for sleep apnea, you must prove that you have the condition. Given that many sleep apnea symptoms happen while you are unconscious or near-unconscious, gathering evidence through observation is essential. A sleep study places you in a controlled environment and allows for your condition to be observed by medical professionals.
As explained by the National Institute of Health, a sleep study, also called polysomnography, is a painless test that is used to:
- Measure how well you sleep
- How your body responds to problems with sleeping
- To assist doctors in diagnosing a sleep disorder
Generally, a sleep study will record brain waves while monitoring your heart rate, breathing, and the oxygen level in your blood over a full night’s sleep.
Other ways to help study and measure the quality of your sleep are through:
- Multiple sleep latency tests, which measure how fast you fall asleep over a series of daytime naps, using sensors that record your brain activity and the movements of your eye.
- Activity monitors allow doctors to record and review how well you sleep, which are worn in the home for several days or even weeks.
- The maintenance of wakefulness tests, which measures during the daytime your ability to stay alert and awake.
Sleep tests such as these can assist your doctor in diagnosing sleep-related breathing disorders, including sleep apnea, narcolepsy, sleep-related seizure disorders, and other sleep-related movement disorders. These tests can provide essential evidence in support of your VA benefits claim.
Secondary Service Connection and VA Disability Coverage
As noted above, a secondary service connection can be when a primary condition causes the secondary condition or when a pre-existing condition was aggravated during service. For example, a wound to the neck, a primary condition, could impact the trachea area, leading to the development of sleep apnea, a secondary condition. As noted above, any service connected condition that causes excessive weight gain could be used as a factor to link your sleep apnea to service. In addition, even if sleep apnea was not noted in service, but the service records document the onset of weight gain during service (such as being placed in the weight control program), this can often be the evidence needed to link the sleep apnea to service.
Get Help With Your Sleep Apnea VA Rating and Appeal from Our VA Benefits Law Firm
If you have developed sleep apnea after your service, or it has worsened because of your service, you could be entitled to compensation. For help gathering evidence and filing or appealing for your VA benefits for sleep apnea, give us a call at 888-495-5774, or contact us online.