Planning to File a Claim for Sleep Apnea? If So, Do It Before Mid 2024!

Sleep Apnea

Sleep apnea is a potentially serious sleep disorder in which you stop breathing in your sleep for short periods of time. A study by the Journal of Clinical Sleep Medicine in July 2021 concluded that about 52% of Veterans suffer from symptoms of sleep apnea of any severity

According to Mayo Clinic, if you snore, find it hard to wake up in the morning, or feel tired even after a full night of sleep, you may have undiagnosed sleep apnea.

If your sleeping disorder was caused by the conditions or particular events during your military service, or from a service-connected disability, you may be eligible for the VA Disability Benefits.

However, as common as sleep apnea is, this condition is probably the most disputed today. On the one hand, many Veterans see their sleep disorder as a simple nuisance and don’t claim it as a service-related disability. At the same time, sleep apnea claims and appeals have a pretty low success rate, because it’s not so easy to prove the connection between this condition and your military service. 

Recently, the VA announced massive changes in rates for sleep apnea, which will not affect Veterans who have already gained their VA rating for the condition but can become a game changer if you are planning to file your claim.

In this article, we’ll talk about those changes and what they mean for Veterans and their families and when is the best time to claim your sleep apnea VA disability benefits.

Sleep Apnea Among Veterans – Here’s What You Need to Know

As a Veteran, you know that military service is hardly associated with a healthy sleeping schedule. In fact, it can form the foundation for this notorious sleep disorder.

Here are the main reasons for the development of sleep apnea:

  • Prolonged sleep deprivation
  • Sleep fragmentation and hyperarousal
  • Disturbed sleep 
  • Stress and PTSD

However, sleep apnea is more serious than just a lack of sleep. If undiagnosed and not treated properly, this sleep disorder may lead to serious long-term complications, such as:

  • Extreme fatigue
  • Chronic headaches
  • Depression
  • Heart disease and heart failure
  • Chronic hypertension
  • Type 2 diabetes

The American Journal of Respiratory and Critical Care Medicine published a study focused on the potential risks of untreated sleep apnea. It showed that this sleep disorder makes you 3 times more likely to experience a stroke and increases the risk of sudden cardiac arrest or death!

Current VA Rates for Sleep Apnea

Sleep Apnea has a code 6847 in the Schedule for Rating Disabilities. Currently VA rates this sleep disorder according to the following criteria:

VA RateDescription
0%Asymptomatic (with or without treatment)
30%Persistent documented daytime hypersomnolence (you feel extremely sleepy during the day)
50%The severity of condition requires use of Continuous Positive Airway Pressure (CPAP) machine
100%The condition causes chronic respiratory failure with carbon dioxide retention or cor pulmonale, or requires tracheostomy

The VA may consider various factors when determining the final rating, such as the need for supplemental oxygen or a breathing assistance device. In fact, this factor is even more important in light of the upcoming changes to the sleep apnea VA rating system.

Also keep in mind that Sleep Apnea is often rated as a Secondary condition to PTSD and other medical issues. Studies show that there is a direct correlation between the severity of post-traumatic stress and sleep disorders. If you are diagnosed with PTSD, a certified medical expert will need to write a nexus letter to establish a direct connection between the two conditions and increase your VA disability compensation.

New VA Rates for Sleep Apnea

VA RateDescription
0%Asymptomatic (with or without treatment)
10%Sleep apnea diagnosis determined by a sleep study with treatment (including CPAP machine)
50%Sleep apnea diagnosis determined by sleep study with ineffective treatment, or inability to use treatment due to comorbid conditions. Without end-organ (major organs) damage
100%Sleep apnea diagnosis determined by sleep study with ineffective treatment, or inability to use treatment due to comorbid conditions.
With end-organ (major organs) damage

One of the key changes, which you probably notice right away, is the removal of the 30% rate. An even bigger change is that a Veteran will not automatically receive a 50% rating for sleep apnea due to the use of a CPAP machine. Moreover, this factor is now “demoted” to a 10% rate, which will probably become the most common rate for sleep apnea from now on.

But there is also good news: The changes offer a loophole that allows Veterans to increase a 10% VA rate to 50% for sleep apnea using the factor of “comorbid conditions.”

What are Comorbid Conditions and How Can They Increase Your Sleep Apnea VA Rate

Comorbid conditions, also known as comorbidities, are additional medical conditions that co-exist with the primary condition and significantly impact the diagnosis, treatment, and prognosis of the primary condition.

In the case of sleep apnea, comorbid conditions prevent you from the habitual use of a recognized form of treatment, including the use of a CPAP machine. Those can be:

  • Contact dermatitis in the area where the CPAP machine’s mask touches your face
  • Facial disfigurement or skull fracture that prevents normal and effective use of the breathing assistance device
  • Parkinson`s disease, missing limbs, or any other condition that may prevent you from effectively using the machine on your own
  • PTSD, anxiety, depression, or any other mental health condition that, according to a doctor’s statement, restricts your ability to use a CPAP machine

Once you have one or several of these comorbidities, backed by a healthcare professional’s statement, you can increase your sleep apnea VA rate to 50% or even 100%. 

However, once the changes come into action, the process of gaining or increasing the VA rate with sleep apnea is going to become a bit more complicated simply due to the fact that you’ll need to collect more evidence.

The updated VA rating for sleep apnea is expected to go into effect in the middle of 2024. Even then, there will be a 60-day “settlement” period, when claims, that were already filed but haven’t been rated yet, will be treated according to the “old” standards.

If you believe that you have service-related sleep apnea, it may be a good idea to file your claim now, as you will be assigned at least a 50% VA disability rate automatically if you are using a CPAP machine. However, once you have some qualifying comorbid conditions, there’s a strong possibility that you can increase your VA disability rate up to 100% once the new amendments come into play.

Final Thoughts on Sleep Apnea

Sleep apnea is more serious than you may think. It can affect every aspect of your life from personal relationships to the ability to work. If you want to learn more about your eligibility and chances to seek and claim your VA disability benefits, contact VCU today.

During a free 30-minute call with a VCU Veteran Specialist, you’ll get a deeper understanding of your case and we’ll outline next best steps. And from that point, the VCU team will become your reliable ally, helping you sidestep the bureaucracy and claim what you’ve earned. 

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