Sleep apnea is a common condition that affects about 22 million people nationwide. If you are among the former military service members living with sleep apnea, you may be eligible for veterans’ disability compensation through the Department of Veterans Affairs.
We’re seeing veterans coming back from Iraq, Afghanistan, and the southwest Asia theater of war with severe sleep issues, which can oftentimes be linked to PTSD.
This guide will outline the basics of sleep apnea, how the VA disability rating works for this condition, and how qualifying veterans can prove direct service connection as well as sleep apnea as a secondary service connected condition to PTSD.
VA Diagnostic Codes
Sleep apnea is rated under 38 CFR § 4.97, diagnostic code 6847 – Sleep Apnea Syndromes (Obstructive, Central Mixed)
The VA assigns the following ratings for veterans based on the severity of their sleep apnea:
- 100 percent: chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy or the enlargement or failure of the right side of the heart due to lung disease. This is the most severe and the highest rating available.
- 50 percent: the veteran requires the use of a breathing device, such as a CPAP machine.
- 30 percent: the veteran is experiencing hypersomnolence, or excessive daytime sleepiness, that does not improve with sufficient sleep or even with naps during the day.
- 0 percent: the veteran’s condition does not produce any symptoms but has a documented sleep disorder. This rating is a non-compensable rating, however, a veteran may be entitled to other benefits, such as VA health care.
Common issues associated with Sleep Apnea include increased risk of stroke, high blood pressure, memory problems, and more.
Other Medical Conditions Sleep Apnea is Connected With
PTSD, Hypertension, Asthma, Cardiovascular Conditions, Type II Diabetes, Mental Health Conditions, Respiratory Conditions, Alzheimer’s disease.
VA Proposes Changes to Sleep Apnea Ratings
Under the current rating schedule, VA issues ratings at 0, 30, 50, 100 percent for sleep apnea even if treatments are somewhat effective in dealing with the condition.
However, in February 2022, VA proposed changes that would reclassify sleep apnea ratings to 0 percent, 10 percent, 30 percent, or 50 percent, with 100 percent for sleep apnea seeming even harder to qualify for.
Asymptomatic sleep apnea would not be compensated under the tentative regulation. If treatment for sleep apnea provides only limited alleviation, you will only receive ten percent of your maximum compensation, even if a CPAP machine is required.
A 50% rating would be given if treatment was ineffective or you were unable to use therapies due to another condition. Finally, a 100% rating is available when sleep apnea is so severe that it involves organ damage.
So if this proposed change for sleep apnea ratings goes through, it’s possible that veterans may start getting lowballed ratings. For now, these ratings are merely a proposal so stay tuned to this page while we update.
Veterans and Sleep Apnea
Sleep Apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted, or ceases, during the course of a night’s sleep. These sleep disturbances can occur from tens to hundreds of times per night.
Typically, sleep apnea symptoms are at their worst during REM Sleep due to the body’s naturally-occurring reduced muscle tone in the body’s airway. REM (Rapid Eye Movement) sleep is also sometimes known as deep sleep. The causes of these disturbances may vary depending on which form of the condition you have: obstructive, central, or a mixed form of both.
This sleep-disordered breathing leads to poor sleep quality and is a risk factor for the poor quality of life.
The team at Hill & Ponton may be able to assist you with a denial of benefits for sleep apnea. Click the button below to get more information.
Obstructive sleep apnea (OSA) is one of the more common types of sleep apnea, which occurs when the upper airway repeatedly becomes blocked throughout the night. This blockage is caused when the back throat muscles relax, impairing the airflow.
Central sleep apnea occurs when the brain either does not send signals to the muscles that control breathing or those signals are interrupted. The VA refers to mixed sleep apnea as a combination of the obstructive and central forms of the condition.
Common Sleep Apnea and Sleep Problems Symptoms in Veterans
The signs and symptoms of these three types of sleep apnea tend to overlap, sometimes making it difficult to determine which type a person has. The most common symptoms include:
- Loud snoring
- Gasping for air during sleep
- Waking with a dry mouth
- Morning headaches
- Insomnia
- Hypersomnolence (i.e., excessive daytime sleepiness)
- Difficulty concentrating
Causes of Sleep Apnea
There are a multitude of potential causes of sleep apnea in adults, but in veterans specifically, the causes could include:
- Long term exposure to dust and fumes
- Mental anxiety and/or depression related to combat
- Weight gain
Risks of Sleep Apnea
- Excess weight
- Neck circumference
- Narrowed airway
- Being male
- Being older
- Family history
- Use of alcohol, sedatives, certain medications or tranquilizers
- Smoking
- Nasal congestion
- Medical conditions
Types
- Obstructive Sleep Apnea (OSA): most common form, occurs when the throat muscles intermittently relax and block airways during sleep.
- Central Sleep Apnea (CSA): occurs when the brain doesn’t send proper signals to the muscles that control breathing.
- Complex Sleep Apnea (Mixed): occurs when someone has both obstructive and central sleep apnea.
Diagnosis
To confirm a diagnosis of sleep apnea, a sleep study must be given to show that you are experiencing breathing problems, and other sleep disorders and health problems have been ruled out. In order to determine whether you should be referred for a sleep study, a doctor will first perform a physical exam, ask about symptoms, and collect your personal and family history.
During an evaluation for sleep apnea, a doctor may ask some of the following questions:
- Do you feel tired or sleepy during the day?
- Do you take naps? If so, how often and how long are your naps?
- Is it difficult to stay awake performing tasks like driving, reading or watching TV?
- Do you currently smoke, or have you smoked in the past?
- Has anyone in your family been diagnosed with sleep apnea?
During the exam, the doctor may also take into consideration your weight, neck circumference, or blood pressure (all which could put you at higher risk for sleep apnea). Some doctors may have you fill out a questionnaire about your sleep habits.
Polysomnogram
A polysomnogram is a sleep study in which medical devices are used to monitor a person’s breathing, heart rate, and the electrical activity of their brain waves while they sleep. A person must have a polysomnogram, either in a sleep lab or at home, in order to be diagnosed with sleep apnea.
If a doctor thinks it’s highly likely you have sleep apnea, the sleep study may also involve a positive air pressure (PAP) device. This is called a split-night sleep study. If the first half of the night’s results confirm you have sleep apnea, the second half of the night will utilize the PAP device to prepare you for ongoing treatment.
A polysomnogram at a sleep center might be preferred if you have heart or lung disease, risk factors for central sleep apnea or a history of other sleep disorders.
VA CPAP Machines for Sleep Apnea Treatment
Since sleep apnea can correlate with conditions like heart disease and obesity, it’s important to seek treatment options. Physicians will treat sleep apnea depending on the type and severity of the condition. This can range from CPAP therapy, lifestyle changes such as diet, exercise, and others.
While some individuals with breathing disorders may show improvement from lifestyle changes, breathing assistance devices such as CPAP machines (Continuous Positive Airway Pressure), BiPap machines, etc. are still among the most common treatments. These machines create airway pressure to help the individual breathe throughout the night.
Note: Millions of Philips CPAP Machines have been recalled due to toxic chemical seeping into mask and unknowingly being inhaled by sleep apnea patients. Check out our Philips CPAP Recall page here!
Establishing Service Connection For Sleep Apnea
In order to establish direct service connection for sleep apnea, a claimant must show that they have:
- a current, diagnosis of sleep apnea
- an in-service event or illness/injury
- a medical nexus or link that shows the veteran’s sleep apnea is related to their in-service event, injury/illness.
A veteran can also establish service connection for sleep apnea on a secondary basis. This means that a veteran has an already service-connected disability that caused the veteran to have sleep apnea. In this case, there must be a medical nexus to link the sleep apnea to their already service-connected disability.
Some conditions that can be secondary to sleep apnea may include but are not limited to:
- heart conditions
- mental health conditions
- diabetes
If you have a service-connected condition that you believe is causing your sleep apnea, it may be a good idea to start to talk to your doctors about it.
C&P Exam for Sleep Apnea and Sleep Studies
The VA will usually order a sleep study to be performed in order to confirm a current diagnosis of sleep apnea. As a part of the VA’s duty to assist veterans in obtaining evidence to help prove their claim, the VA has a duty to assist veterans in scheduling the examination for a sleep study and helping them realize the VA disability claim that they are entitled to.
This study will serve as medical evidence for the veteran’s case and can help to prove the medical condition or medical conditions that go into a total rating.
What happens during a C&P exam for sleep apnea?
During a C&P exam for sleep apnea, you will be asked questions about your condition and how it affects your day-to-day life. You may also be asked to fill out what is called a Disability Benefits Questionnaire or a DBQ. The DBQ allows an examiner at a C&P exam to check boxes next to descriptions that best express how your sleep apnea is affecting you. Being honest and thorough is important so everything can be properly documented. Bringing someone with you to the appointment may also be useful.
Re-Examinations for Sleep Apnea
Sometimes the VA will schedule re-examinations to determine if there has been an improvement with a veteran’s sleep apnea has improved. If it has, there might be a rating reduction. However there are several rules that must be followed in order for this to occur:
- Proposed rating must be based on entire medical history
- Must show there has been improvement in veterans functionality
If the VA does propose a reduction of rating, then the veteran can submit an argument against it.
Additionally, there are some cases that the VA cannot schedule re-examinations:
- If you are over 55 years of age
- If you have a rating that has remained the same for over five years (stabilized)
- If you have a total disability rating, meaning 100 percent rating
- You have a permanent disability
If you are interested in learning more about C&P examinations, check out our guide!
How do I prove VA disability for sleep apnea?
Medical evidence and documented medical records from a VA C&P exam will be necessary for the process of filing your claim and could even reveal other secondary conditions. A C&P exam and a sleep apnea diagnosis are crucial to qualifying for the upper tiers of compensation.
Believe it or not, buddy statements can be helpful in proving sleep apnea claims if you can find vets who you served with and heard you snoring, or can talk about the issues that led to the sleep apnea. Loved ones like family or close friends could also be a good help in sharing how your sleep has changed.
How hard is it to get VA disability for sleep apnea?
For veterans who have already been diagnosed with sleep apnea without a sleep study by the VA, the veteran may have to undergo a sleep study done by the VA in order to confirm the diagnosis for benefit purposes. The medical examination may seem like extra hard work but could qualify that veteran for additional monthly compensation.
Linked Sleep Apnea and PTSD Symptoms
Research has shown that combat veterans with post-traumatic stress disorder, also known as PTSD, may be at higher risk for sleep apnea than the general population. There are risk factors that overlap in both disorders affecting sleep apnea and symptoms of PTSD, oftentimes aggravating the conditions.
Although all of these symptoms contribute to the interaction between sleep apnea and PTSD, the main culprits seem to be sleep deprivation and chronic stress. Studies have shown that war veterans exhibiting these symptoms tend to have increased frequency and length of apneic events that can be proven by a medical professional.
Check out our post on sleep apnea secondary connection with PTSD here!
Why would a VA claim be denied Sleep Apnea?
VA may deny a sleep apnea claim based on different aspects, whether there’s not enough medical evidence of sleep apnea or perhaps no logical connection between your military service and your current sleep apnea. If your obstructive sleep apnea VA claim, or other sleep apnea claim, was originally denied, you may be able to appeal the rating and receive VA disability compensation.
