What To Know Before Filing A Sleep Apnea Claim As A Veteran
If you are a veteran suffering from any form of sleep apnea as a direct result of your active-duty military service, you may be entitled to compensation from the Department of Veterans Affairs . Understanding whether your sleep apnea qualifies for VA disability benefits and how to get the information needed to prove entitlement to service-connection can be challenging.
For information on what you need to know before filing a sleep apnea claim as a veteran, do not hesitate to contact our firm. Our VA disability attorneys can help you better understand what you could be entitled to for service-connected sleep apnea.
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The Va Disability Rating Schedule
Under the Rating Schedule, benefits increase as a veterans level of disability increases (from 0 to 100%. If a veteran is deemed totally disabled exclusively due to service-connected impairments, then the benefits are paid at 100%. In some situations, veterans may receive additional compensation for very serious injuries.
The Rating Schedule groups disabilities into broad categories, such as the musculoskeletal system, the skin, and mental disorders. Each category contains a schedule of ratings for specific diagnoses, with specific symptoms that are required for various ratings of disability. An individual must suffer from those particular symptoms to qualify for a given rating.
To rate a disability, the VA will first look at the broad category and find your diagnosis such as sleep apnea. From there, the VA will find the diagnostic code that best matches your symptoms, which will result in your rating.
Working With A Va Disability Lawyer
Although sleep apnea is a fairly common condition with the potential to be destructive to an individuals well-being, the VA does not make it easy to receive compensation. Even with all the necessary evidence, it can be difficult to convince the VA that your sleep apnea developed as a direct result of your time in the military. The way in which information is structured and presented can make a significant difference.
VA disability lawyers can also help in cases where an appeal is needed. If the VA denies your original disability claim or assigns you a lower rating than you believe you deserve, a lawyer can help to appeal the claim and try again for a more favorable decision.
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Factors That Influence Sleep Apnea Disability Claims
In summary, you need to prove the following three factors to receive a disability rating for sleep apnea:
An in-service diagnosis of sleep apnea is the clearest path toward approval for VA disability.
However, most service members do not receive a diagnosis while in the military which makes proving that sleep apnea is service-connected much more difficult.
As a result, scheduling a sleep study through a certified clinic is the best means to getting an indisputable diagnosis.
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:
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Understanding The Va Disability Rating For Sleep Apnea
First and foremost, a sleep apnea diagnosis via a sleep study is required by the VA. A medical professionals previous diagnosis of sleep apnea without a sleep study is not sufficient evidence for the VA.
The VA rating of sleep apnea assigns veterans a 0, 30, 50, or 100 percent rating under 38 CFR § 4.97, Diagnostic Code 6847. The number ratings are based on severity:
- A 0 percent rating means a veteran has a sleep disorder documented, but they are not showing symptoms. This rating is considered non-compensable.
- A 30 percent rating involves the veteran experiencing chronic daytime sleepiness that is not improved by sufficient sleep.
- A 50 percent rating means the veteran experiences sleep apnea and requires a breathing assistance device like a CPAP machine.
- A 100 percent rating involves the veterans diagnosis of chronic respiratory failure with carbon dioxide retention or is diagnosed with cor pulmonale .
Va Rating For Sleep Apnea Common Symptoms In Veterans
Sleep Apnea Symptoms in Veterans
Many veterans have or develop Sleep Apnea and common signs and symptoms include:
- Difficulty concentrating
- Anger and irritability
If you suffer from any of these symptoms, its highly recommended to see a doctor right away.
You may need to undergo a Sleep Study to determine if you have Sleep Apnea.
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Is Sleep Apnea A Permanent Va Disability
Generally, sleep apnea is not automatically rated a permanent disability by VA, but if a veteran meets certain qualifications, they may be able to secure lifelong compensation.
For example, if your sleep apnea VA rating has been in place for a certain period of time, VA may assume based on medical evidence that the level of impairment will continue for the rest of your life. It is also generally more difficult for younger veterans to be considered permanently disabled, as VA is allowed to take age into account.
If VA considers your sleep apnea permanent in nature, meaning they are reasonably certain that the condition will continue with zero or close to zero chance of improvement, you will not be scheduled for a re-examination. If this is the case, VA cannot propose a rating reduction.
Va Disability Rating For Sleep Apnea
The VA rates all cases individually, but usually follow a guide of qualifying conditions. The most documented VA percentages for sleep apnea are as follows:
- 0% Sleep apnea with documented sleep disorder breathing that is currently asymptomatic. The symptoms have disappeared or are not severe enough to cause any issues.
- 30% This rating is given when an individual experiences consistent hypersomnolence, or daytime sleepiness, as a result of sleep being interrupted.
- 50% – Given in cases when the diagnosed individual requires the use of a CPAP machine.
- 100% The max rating, awarded in cases when a tracheostomy is required, or when an individual experiences chronic respiratory failure with carbon dioxide retention This rating implies that the individual cannot carry out daily activities.
It is important to note that VA disability ratings are decided based on a combination of all the conditions an individual is experiencing. If sleep apnea leads to other conditions or is the result of a different primary condition, an individuals VA rating may be increased.
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What Evidence Do I Need With Veteran Disability Benefits For Sleep Apnea Claim
Since sleep apnea can be difficult to diagnose, it is essential that you document symptoms and evidence to submit. This includes having a sleep study done , a buddy letter from your spouse, and medical records from your doctor about your symptoms. Keeping a list of your symptoms and treatments can be beneficial evidence to submit.
In fact, even if you have been previously diagnosed with a form of sleep apnea it is highly likely the VA will ask you to have another study conducted.
Remember, you cannot expect the VA to take you just at your word. Many veterans have submitted claims without providing enough proof, resulting in most sleep apnea claims being rejected . This means that it is key to provide as much evidence as possible, leaving very little room for the VA to speculate about anything.
Sleep apnea has continued to be one of the harder disability claims for veterans to win, meaning you must do your due diligence to get the benefits you deserve for this condition.
While there is a preparation you need to do to get your claim approved, it is worth it!
Although sleep apnea claims have spiked considerably in recent years, especially with veterans of Iraq and Afghanistan, the VA does not consider sleep apnea presumptive to a service connection.
Even though sleep apnea has been a difficult claim for veterans to win in the past, with the right amount of evidence your sleep apnea claim could be an easy win with the right materials.
Va Ratings For Disability
The VA is responsible for compensating veterans for disabilities earned during their time in the service. To determine how much money an individual will receive, they use a percentage-based rating system ranging from 0-100 using increments of 10 . VA ratings depend on the severity of a disability, which part of the body is affected, and how much of a hindrance the disability is to an individuals daily duties.
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Beware This Pitfall In Va Sleep Apnea Claims
One of the two changes makes it a little easier for the Regional Office to deny your VA sleep apnea claim at the 50% disability rating level. The diagnostic criteria for a VA sleep apnea claim, found in the Code of Federal Regulations, have not changed. For a 50% rating, the diagnostic criteria still Requires use of breathing assistance device such as continuous airway pressure machine.
But, with these changes in the VA playbook, VA is placing a greater emphasis on what is meant by the word required. Look at this new language in the m21-1MR:
- When determining whether the 50-percent criteria are met, the key consideration is whether use of a qualifying breathing assistance device is required by the severity of the sleep apnea.
A little bit later on, the manual now says,
- Use absent a medical determination that the device is necessary does not qualify. The regulation requires that the device be necessary and this is a medical question.
That last phrase should be a warning and a clue to you. In the past, if you presented evidence that your doctor prescribed a CPAP machine to help with your sleep apnea that was sufficient evidence in the eyes of VA for a 50% VA sleep apnea rating. VA personnel were like me they assumed doctors did not prescribe anything that was not medically necessary.
So, a prescription for a CPAP was proof that it was required for treatment of sleep apnea. Now, you need more than that because VA refuses to assume anything.
Secondary Basis Proof For Va Disability Claims
Additionally, service members may attempt to prove their sleep apnea is service-connected through a secondary basis.
The VA accepts disability claims that connect sleep apnea with another medical condition that developed or worsened during service.
For example, medical experts already have found links between asthma, mental health disorders, TBI, and PTSD with sleep apnea.
Therefore, you may be able to prove sleep apnea is service-connected through a secondary condition/basis.
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To Prove Sleep Apnea You Need Medical Evidence
Only medical evidence can satisfy the eligibility criteria for these ratings. It is not enough for the veteran to say I meet the criteria for a 50% rating. Fortunately, VAs website provides rating tools such as Disability Benefits Questionnaires . Specifically, VA provides a Sleep Apnea DBQ that focuses on the symptoms described in the Schedule. Veterans seeking a higher rating for sleep apnea should have their doctors complete the DBQ. If the criteria for a 100% rating for Sleep Apnea is noted on the DBQ, then VA will likely grant that rating.
Filing For Va Sleep Apnea Benefits Consult With A Va Disability Attorney
The Veterans Affairs Administration recognizes sleep apnea as a debilitating condition that warrants disability support. However, navigating the requirements of the claims and appeals process is challenging at best.
If you are a veteran suffering from sleep apnea, you need help to file a successful VA disability claim.
Reach out to our legal team today to speak with an experienced VA disability attorney for assistance with your VA sleep apnea claim or appeal.
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Mental Health Conditions Secondary To Sleep Apnea
Anxiety and depression can interfere with a persons sleep patterns, as well as cause symptoms of hyperarousal or hypervigilance. As such, a veteran with anxiety and depression faces a higher risk of sleep apnea.
If a veteran is service-connected for anxiety or depression, they may be able to receive secondary service connection for their sleep apnea. Veterans may also receive secondary service connection for anxiety and depression if they are already service-connected for sleep apnea.
Types Of Sleep Disordersand Their Symptoms
Sleep disorders can be caused by blunt trauma to the head or psychological and mental disorders. Sometimes they can also be caused by physical disabilities. Types of sleep disorders include:
- Insomnia: Sufferers have trouble falling asleep or staying asleep for more than a few hours. This can lead to drowsiness, irritability and a depressed mood.
- Obstructive Sleep Apnea: This condition causes breathing to stop during sleep, either for a few seconds or several minutes. Sleep apnea causes fatigue, slow reflexes and eventually can impact the heartleading to heart problems such as arrhythmia and cardiac arrest.
- Narcolepsy: Those suffering from this condition are extremely fatigued during daytime hours, no matter how many hours they slept the night before. This disorder causes abrupt daytime unconsciousness and cataplexy, an episodic loss of muscle function ranging from sagging facial muscles to physical collapse.
- Daytime somnolence or excessive daytime sleepiness : This condition is linked to each of the disorders listed above, but can be diagnosed on its own. Persons with EDS feel very drowsy during the day and often feel compelled to take naps at inappropriate times.
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Faq: Your Va Sleep Apnea Rating
What is sleep apnea?
Obstructive sleep apnea is a condition that occurs when the upper airway becomes blocked repeatedly during sleep. Sometimes the airflow is completely stopped or just reduced. Central sleep apnea occurs when the brain does not send the body signals to breathe.
Should I have a sleep apnea study done?
If you suspect that you suffer from sleep apnea, we highly suggest you get a sleep study. First we recommend a sleep study for your own health. Secondly, you are going to need evidence of your condition to obtain a VA sleep apnea rating. A sleep study can diagnose you with sleep apnea and is the a great way to figure out what medical precautions you need to take.
Can sleep apnea be service-connected?
Yes. Sleep apnea can be service-connected in many different ways. While most veterans dont have a diagnosis while serving, they can use buddy statements to prove their condition existed at the time of service. For example, you can use a statement from someone you served with to show you snored really loudly and that you stopping breathing in your sleep for periods of time. During your active duty service, you slept very close to many other people and they may be able to show your sleep patterns developed or worsened from service.
Can I secondarily service-connect sleep apnea?How does the VA rate sleep apnea?What VA ratings are available for sleep apnea?What does a 0% VA sleep apnea rating mean?Can veterans get a VA sleep apnea rating of 100%?
Related Articles And Blogs
- National Institute of Health: Respiratory Failure
- National Heart, Lung and Blood Institute: Tracheostomy
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