Sleep Apnea & Disability Benefits From The Department of Veteran Affairs (VA)
Sleep apnea is a common disorder among veterans as it makes it difficult to focus on tasks during the day. The lack of sleep occurs as a result of military service or a situation from service. If you have a similar condition or symptoms, you may be eligible for disability benefits from the Department of Veteran Affairs(VA). In this guide, we’ll look at sleep apnea in veterans and how the VA gives ratings to different levels of sleep apnea.
Here are some of the key takeaways from this VA ratings and sleep apnea article:
- Sleep apnea related to service is a disability eligible for VA benefits
- The VA ratings for disability orders are calculated in percentages (0%,30%, 50%, and 100%)
- Claiming a VA disability benefit requires the help of a professional
- Most service-related conditions may trigger sleep apnea and VA rating.
- PTSD is a common secondary disability related to sleep apnea.
What Is Sleep Apnea?
Sleep apnea is a challenging condition that affects plenty of Americans. It is a sleep disorder where one fails to breathe constantly during sleep. Sleep apnea has three main types; complex, central, and obstructive.
A person with sleep apnea may have difficulties focusing during the day, experience repeated headaches and other complications. They may also develop a few complications such as high blood pressure, heart problems, and diabetes.
A veteran with sleep apnea may be eligible for disability benefits if they can show that their sleep apnea is connected to the service. U.S military veterans are as much as four times more likely to develop sleep apnea compared to those who didn’t serve in the military.
If you’re a veteran, it is vital to ask the following questions to determine whether you have sleep apnea or not: Do you snore during sleep? Are you tired during the day and take frequent naps? Do you have breathing difficulties while sleeping?
If you answered yes to all these questions, chances are you might have sleep apnea.
VA Rating for Sleep Apnea: Common Symptoms in Veterans
Most veterans with sleep apnea have reported the following signs and symptoms:
- Moments where you stop breathing during sleep
- Morning headache
- Waking up with a dry mouth
- Anger and irritability
- Lack of concentration
- Air gasps during sleep
If you have any of these symptoms, it is recommended to visit a doctor and get diagnosed with sleep apnea. You have to go through several tests and sleep studies to diagnose if you have a sleep disorder.
Connection Between Sleep Apnea And Other Medical Conditions
Although we may assume sleep apnea causes veterans directly related to their service, there are some cases where it is a result of another condition. In such instances, the veteran may have to claim sleep apnea on a secondary basis if the underlying condition is service-related.
Sleep apnea may be triggered by many problems. For instance, a certain study in 2015 found that Afghanistan and Iraq veterans with PTSD had a high risk of getting sleep apnea. The worse the PTSD symptoms, the higher the chance of testing positive for sleep apnea symptoms.
There are several conditions related to sleep apnea, including:
- Muscle diseases
- Post-traumatic stress disorder (PTSD)
Other main causes of sleep apnea include:
- High blood pressure
- Deviated septum
Various medications, like sleep medicines, sedatives, and narcotic pain medication
Veterans with sleep apnea resulting from a medical condition related to service may have to claim sleep apnea as a secondary disability. This means they have to show enough evidence that they have been diagnosed with sleep apnea and that the sleep apnea is either related to a service-connected disability or caused by it.
So, a sleep apnea diagnosis alone is not enough to qualify for VA benefits unless you have sufficient evidence to show it was related to your time in service. It is a process that requires medical help and your doctor can assist you to form an admissible medical opinion.
However, the VA has medical professionals who would review your personal condition, analyze the background, and decide if your sleep apnea is most likely caused by a service-related condition.
For instance, let's say you were diagnosed with type 2 diabetes due to your service and were given a VA rating for benefits. If you later develop sleep apnea due to diabetes, you could apply for an updated VA rating based on your recent disability. For this, you’ll need to show evidence of your sleep apnea diagnosis and its connection to diabetes.
According to law, three factors must be satisfied for any sleep apnea secondary VA claims:
A medical diagnosis of sleep apnea was shown in a sleep study in private records or VA medical records.
Nexus evidence shows that there is a connection between the service-connected disability to sleep apnea.
Evidence of a primary disability such as a fractured leg, mental health conditions, etc.
Proving that sleep apnea was caused by a service-connected illness such as asthma or diabetes can be difficult. But as long as you have evidence such as a letter from your physician showing a strong medical opinion that your sleep apnea was caused by primary disability.
The two most common ways to connect sleep apnea to your military service are through direct service connection or secondary service connection.
Direct Service Connection
For a direct service connection to sleep apnea, one must show that they were diagnosed with sleep apnea during military service. Or, they must prove that the sleep apnea symptoms were triggered while you were in service.
If you were diagnosed with sleep apnea during your service, it is easier to get VA disability benefits and the VA practitioners don’t need more evidence. But it is rarely the case. When most veterans experience sleep apnea symptoms, they assume it is fatigue from the rigorous training and demands of military service. They feel the exhaustion is caused by staying awake for long hours.
This means they don’t get diagnosed during service and the symptoms escalate once they leave the military.
If you never had a diagnosis and would like to file a VA claim for sleep apnea, then you need to prove you had symptoms during your time in service. This is the most popular way veterans use to file for a VA disability claim for sleep apnea.
Secondary Service Connection
As mentioned earlier, you may have sleep apnea due to a primary disability that is service-related. Such situations occur once you’re discharged and are commonly associated with conditions like PTSD, facial injury, or any other disability that causes sleep apnea.
Providing these claims requires full knowledge and understanding of the medical evidence that acts as a nexus with sleep apnea.
How The VA Assigns Disability Ratings for Sleep Disorders
Once the veteran can prove that they have sleep apnea, the VA continues to determine the veteran’s monthly compensation based on a rating system set in the VA regulations known as a Rating Schedule.
In the Rating Schedule, the veteran's severity of sleep apnea is calculated in percentages (0% to 100%) which determines how much the VA should compensate. So, for instance, if a person is deemed totally disabled due to service-connected damage, all the benefits are paid 100% and in some instances, they may get extra compensation for critical injuries.
The Rating Schedule places disabilities into groups or categories like “the musculoskeletal system,” “mental disorders,” and “the skin.” Each group has a defined rating for certain diagnoses with critical symptoms that are used for the disability ratings.
So, you must have these specific symptoms to qualify for the given rating. A VA will first assess your symptoms and find a diagnostic code that best pairs with them.
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 (e.g CPAP machine).
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.
Proposed Changes to Sleep Apnea Rating Schedule
Back in February 2022, VA posted a blog post proposing updates to the current rating schedules for several disabilities, including sleep apnea. In the post, VA suggested that a veteran under a CPAP machine would not immediately qualify for a 50% sleep apnea rating. They would only do so if the CPAP were proven to be ineffective based on several tests, or if they could not undertake the treatment due to another condition.
Looking at the number of veterans using the CPAP machine, it is clear that the department is looking at cutting down costs. The new change might prove to be difficult for the following reasons:
- Sleep apnea rarely gets better if not treated as it is a chronic condition.
- Most of the diagnosis is done at night and does not account for daytime symptoms, which mostly affect veterans, particularly when doing regular jobs.
The effectiveness of CPAP is not as high, especially in veterans who have PTSD.
Consequently, if these rules take effect, the ratings will also change significantly.
First, you would not get any compensation for asymptomatic sleep apnea. A ten percent rating will only be awarded if the veteran’s treatment gives partial relief. A fifty percent rating will be given if the veteran’s treatment was ineffective or they can’t use the prescribed treatment due to medical conditions. And a hundred percent rating would only apply if the treatment is ineffective or not possible due to organ damage as a result.
Although the changes seem a bit harsh for many veterans, they serve the purpose of relieving veterans from any loss of potential earnings due to service-related disability. So, if you’re getting sleep apnea treatment that is effective, then your earnings are not affected by that disability.
Combined VA Disability Rating
If you suffer from more than one disability related to your service, the VA will give you a combined disability rating. The VA has a Combined Ratings Table to determine the rating for veterans with multiple service-connected disabilities.
The disability ratings are not additions to each other but instead a combined reading of the two. This involves assessing each disability in terms of severity and using a chart to locate the best-combined rating.
For instance, assume you have a 50% rate for asthma due to military exposure and you receive a 20% disability rating for your sleep apnea. Using the chart, your combined rating would be 68%, which is then rounded off to give a combined rating of 70%.
Obtaining a combined disability rating for your condition is not an easy task and you might want to consult the right practitioners and VA legal attorneys to help you get the best disability benefits.
How To Get Benefits For Sleep Apnea
Getting the benefits of sleep apnea involves three crucial steps.
Get a Sleep Apnea Diagnosis
The first step, though uncomfortable, is to get a clinical study, also known as a sleep study. It involved the measurement of symptoms while you’re asleep, such as heart rate and breathing problems.
Service-Connect Your Sleep Apnea
You need to show that your sleep apnea was caused during your time in the military or due to service. Most veterans who get sleep apnea when in service get VA ratings quickly as it is directly linked to the service.
Sleep apnea can also be a secondary condition caused by a service-related illness. If you develop PTSD after serving in the military and are later diagnosed with sleep apnea, you may be eligible for benefits. Other conditions connected to sleep apnea include depression, substance-use disorders, or anxiety disorders.
Obtain a Sleep Apnea Nexus Letter
The final part is to get a sleep apnea Nexus from a physician. This should be after you have consulted with a VA-accredited claims attorney or agent. The nexus letter is a letter about your condition and states that it is most likely or not caused by your service-related condition. This information is crucial to obtaining any form of VA disability benefit.
Frequently Asked Questions
What is the current VA rating for sleep apnea?
Sleep apnea has several ratings and they are assigned percentages from 0, 30, 50, or 100 depending on the causes and symptoms. The lowest rating, 0 percent, is asymptomatic sleep apnea, while the highest rating involves chronic conditions.
How do you prove sleep apnea?
The best way to prove sleep apnea is through a diagnosis, which is confirmed through a sleep study test. Other diagnostic tests include respiratory and narcolepsy questionnaires which determine the severity and extent of the disability.
Why would a VA be denied sleep apnea?
If the medical evidence you provide is not conclusive enough or you have not been diagnosed by a professional, chances are your VA disability benefit may be denied. Denial of VA is regular and it is crucial to seek professional help before application.
Is sleep apnea a permanent VA disability?
Sleep apnea is not considered a permanent VA disability since it has various treatments and therapies to relieve symptoms. CPAP is the most recommended form of treatment and it reduces sleep apnea symptoms by up to 60% if used regularly.