Va sleep apnea rating

Va sleep apnea rating DEFAULT

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The Bad &#;Secret&#; Change to VA Sleep Apnea Rules

VA sleep apnea rules changed.  Did you notice?

Probably not, because these changes are deep within VA&#;s claims adjudication manual that VA claims examiners use to decide claims.  If you are a veteran seeking VA sleep apnea disability compensation, here is what you need to know so you can meet the newest requirements by VA.

Where Are These Changes to VA Sleep Apnea Rules?

If you have been through the VA disability process before, you probably know that VA decision making seems random with different VA personnel deciding the same types of claims very differently.  The process is often filled with delays and errors that could be avoided.

It may surprise you to learn that the VA actually has a series of written policies on how to decide VA disability claims.  This huge document is a &#;playbook&#; for VA personnel to use in deciding every type of VA claim.

That playbook is MMR Adjudication Procedures Manual.  The MMR is constantly being updated in a piecemeal fashion.  One of those most recent updates was the section dealing with the adjudication of VA sleep apnea disability claims.

Women bothered by her partners sleep apneaBeware 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 (CPAP) 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 mMR:

  • &#;When determining whether the 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.

Doctor taking notes in notebookWhat You Can Do to Safeguard Your VA Sleep Apnea Claim?

VA&#;s own playbook now says the necessity of a CPAP or other breathing assistance device is a medical question.  In VA sleep apnea claims (and all VA disability claims, really), medical questions can only be answered with medical evidence.  That usually means a doctor&#;s opinion.

The bad news is that this extra scrutiny by VA will be a trap for the unwary.  If a veteran doesn&#;t have a statement from the doctor saying the CPAP is medically necessary, it is an invitation for VA to deny the claim now.

So, get the prescription for the CPAP or other breathing assistance device.  Also, have the doctor put in writing that the device is medically necessary to treat the sleep apnea.  Your doctor may give you a funny look when you ask him to give written justification for his prescription, but if he knows anything about the VA he should understand.

All The VA&#;s Secrets Aren&#;t Bad &#; We Will Tell You Those, Too

The VA also slipped in another little secret into their playbook.  This one is not a &#;dirty little secret&#; like this new medical necessity requirement.  Instead, this other one will probably help some veterans &#; if they know about it.

Sours: https://veterans.perkinslawtalk.com/post/bad-secret-change-to-va-sleep-apnea/
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VA Rating for Sleep Apnea Explained – The Experts Guide

In this post, we will be exploring how to get a VA Rating for Sleep Apnea.

A veterans final VA disability rating for Sleep Apnea depends upon the frequency, severity, and duration of symptoms, meaning, the more severe your symptoms, the higher the VA rating for Sleep Apnea.

In , Sleep Apnea VA ratings range from 0% to % with breaks at 30% and 50%.

The highest possible scheduler VA disability rating for Sleep Apnea is %, which includes symptoms such as, chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy.

Okay veterans – let’s take a minute to explore the law regarding the symptoms and level of impairment required to warrant a VA disability rating for Sleep Apnea.

You might also like the following Blog posts about Sleep Apnea:

#1. Sleep Apnea Secondary Conditions

#2. How to Service Connect Sleep Apnea secondary to PTSD

#3. Do I Need a Spousal Letter to Support My Sleep Apnea VA Claim?

Sleep Apnea in Veterans

Many veterans suffer from various sleep conditions due to their military service, to include Sleep Apnea—a sleep disorder whereby breathing repeatedly stops and starts during sleep (apneic episodes).

In fact, did you know U.S. military veterans are nearly four times (4x) as likely to have or develop sleep apnea when compared to those who didn’t serve in the military?

Veterans, do you think you might have Sleep Apnea?

Here’s a quick litmus test: If you snore during sleep, are tired during the day (maybe you take frequent naps), and stop/start breathing while sleeping (gasping for air), chances are you might have Sleep Apnea.

According to the Mayo Clinic, “Sleep Apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts.”

The 3 main types of Sleep Apnea are:

  • Obstructive Sleep Apnea, the most common form of Sleep Apnea, which occurs when throat muscles relax and block the upper airway.
  • Central Sleep Apnea, which occurs when your brain doesn&#;t send proper signals to the muscles that control breathing.
  • Complex / Mixed Sleep Apnea, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea.

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:

  • Loud snoring
  • Episodes in which you stop breathing during sleep (usually observed by your spouse or partner)
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Difficulty falling or staying asleep (insomnia)
  • Excessive daytime tiredness (hypersomnia)
  • Difficulty concentrating
  • Anger and irritability

If you suffer from any of these symptoms, it’s highly recommended to see a doctor right away.

You may need to undergo a Sleep Study to determine if you have Sleep Apnea.

Is Sleep Apnea a VA Disability?

CPAP machine for Sleep Apnea

Yes, Sleep Apnea is a VA disability and it’s rated under diagnostic code , Sleep Apnea Syndromes (Obstructive, Central, Mixed).

The most common VA rating for Sleep Apnea is 50%, which requires the use of a breathing assistance device such as Continuous Positive Airway Pressure (CPAP) machine.

VA Rating for Sleep Apnea

VA Rating for Sleep Apnea

Pursuant to Diagnostic Code , VA disability ratings for Sleep Apnea are as follows:

  • The0 percent VA rating for Sleep Apnea is warranted if you’re asymptomatic (no symptoms), but with documented sleep disorder breathing.
  • A 30 percent VA disability rating for Sleep Apnea is warranted if you have persistent daytime hypersomnolence, but do not require the use of a breathing device.
  • The 50% VA rating for Sleep Apnea is warranted if you require the use of breathing assistance device such as a Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP)
  • A percent VA rating for Sleep Apnea is warranted for chronic respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy.

Sleep Apnea is rated under diagnostic code , Sleep Apnea Syndromes (Obstructive, Central, Mixed):

, Sleep Apnea Syndromes (Obstructive, Central, Mixed):

Sleep Apnea VA Rating (%)

&#; Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or requires tracheostomy

%

&#; Requires use of breathing assistance device such as a CPAP machine

50%

&#; Persistent daytime hypersomnolence

30%

&#; Asymptomatic but with documented sleep disorder breathing

0%

Sleep Apnea and Secondary Service Connection

Many veterans with Sleep Apnea, especially those who were diagnosed long after leaving the military, might still be eligible if medical evidence shows your Sleep Apnea is proximately due to or aggravated by another service-connected disability such as musculoskeletal conditions and/or mental health conditions.

Service connection on a secondary basis requires a showing of causation.

A showing of causation requires that the secondary disability be shown to be “proximately due to,” or the result of, a service-connected disability.

By law, there are three elements that must be satisfied for Sleep Apnea Secondary VA Claims:

  1. A medical diagnosis of Sleep Apnea confirmed by a sleep study in VA medical records or private records (unless you did this already on active duty and it’s in your service treatment records)
  2. Evidence of a service-connected primary disability, such as musculoskeletal conditions or mental health conditions, AND
  3. Medical Nexus evidence establishing a connection between the service-connected disability and the current disability

The first part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.

The second part can be satisfied with a veteran’s existing service-connected disability rated at 0 percent or higher.

The third part can be satisfied with a Medical Nexus Letter, aka, Independent Medical Opinion (IMO) from a qualified medical professional.

Did you know there are more than 50 conditions that can be medically linked to cause or aggravate sleep apnea?

>> Click HERE now to get your FREE copy of my eBook: “The Insider’s Guide to VA Claims for Sleep Apnea.” <<

C&P Exam for Sleep Apnea

A C&P exam for Sleep Apnea might involve a physical examination and review of your medical history and severity of symptoms over time.

However, sometimes a VA C&P examiner (such as a Nurse Practitioner) will call you on the telephone and conduct an Acceptable Clinical Evidence (ACE) exam review of your Sleep Apnea claim.

You’ll want to explain to the C&P examiner HOW your Sleep Apnea condition is limiting or affecting your work, life, and social functioning.

For example, maybe your Sleep Apnea so severe, that you have difficulty working and lose productivity throughout the day due to frequent napping.

Maybe you’ve gained a significant amount of weight due to your other service connected disabilities, which has limited your ability to walk, run, or workout, and this is the “interim link” to secondary service connection due to weight gain (obesity).

It’s also important to document whether you have a breathing machine, such as a CPAP or BiPAP, as this is the most common difference between the 30% and 50% VA rating for Sleep Apnea.

Deserve a HIGHER VA Rating? WE CAN HELP.

Join our premier education-based membership program, VA Claims Insider Elite, connect with an expert-level Veteran Coach (VC) within minutes, and finally get the rating you deserve. Click the button below to start for FREE.


About the Author

Brian Reese

Brian Reese

Founder & CEO

Brian Reese is VA benefits expert, author of the #1 Amazon Bestseller You Deserve It: The Definitive Guide to Getting the Veteran Benefits You&#;ve Earned, and founder of VA Claims Insider – “The Most Trusted Name in Education-Based Resources for Veterans.”

His frustration with the 8-step VA disability claims process led him to create “VA Claims Insider,” which provides U.S. military veterans with tips, strategies, and lessons learned for successfully submitting or re-submitting a winning VA disability compensation claim.

Brian is also the CEO of Military Disability Made Easy, which is the world’s largest free searchable database for all things related to DoD disability and VA disability claims and has served more than 4,, military members and veterans since its founding in

His eBook, the “9 Secrets Strategies for Winning Your VA Disability Claim” has been downloaded more than , times in the past three years and is the #1 rated free VA disability claims guide for veterans.

He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).

Sours: https://vaclaimsinsider.com/va-rating-for-sleep-apnea-in/
Sleep Apnea Claims at the VA

Types of Sleep Disorders
and 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 heart—leading 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 (EDS): 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.

How to Obtain VA Disability Compensation for a Sleep Disorder

The first step in obtaining VA disability benefits is to show the VA that your disability is related to or began during your military service. To accomplish this, a veteran’s claim and the evidence that the VA develops must show three things: (1) that the veteran has a current disability, (2) an in-service injury or illness, and (3) a connection between the current disability and the in-service injury or illness.

In the case of sleep disorders, many veterans may have started experiencing symptoms during their time in service. Many veterans, for example, develop severe snoring during service, or are told by roommates or significant others that they stop breathing in their sleep. These can be symptoms of obstructive sleep apnea that continues to progress after a veteran’s service.

Many times, the veteran did not seek treatment for sleep issues during service because at the time they didn’t realize that they had a sleep disorder. In these cases, it can be difficult to gather the evidence a veteran needs to be service-connected for their sleep disorder.
The experienced attorneys at Berry Law Firm understand the requirements of VA law and regulations and know what kinds of evidence the VA looks for in deciding claims for VA disability benefits for sleep disorders. If the VA has denied your claim for benefits for a sleep disorder, contact us today and let us review your file.

How the VA Assigns Disability Ratings for Sleep Disorders

Once a veteran proves that their sleep disorder is related to military service, the VA will determine the veteran’s monthly compensation amount based on a complex series of rating criteria set forth in VA regulations.

The most common sleep disorder we see in veterans is obstructive sleep apnea. Disability ratings for sleep apnea are assigned at 0, 30, 50, or percent.

If sleep apnea causes disordered breathing but no other symptoms, the veteran will be assigned a 0 percent rating, meaning the veteran will not receive any monthly payment amount for sleep apnea.

If the veteran experiences persistent excessive sleepiness during the day, he or she will receive a 30 percent rating.

Use of a continuous positive airway pressure (CPAP) device will entitle a veteran to an automatic 50 percent rating.

And finally, if the veteran’s sleep apnea causes chronic respiratory failure with carbon dioxide retention or cor pulmonale, or if their sleep apnea requires tracheostomy, then a percent rating will be awarded.

Click here to learn more about how to increase your disability rating.

 

Sours: https://ptsdlawyers.com/veterans-disability-sleep-apnea/

Apnea rating sleep va

What&#;s My VA Sleep Apnea Disability Rating?

If you are one of the many veterans seeking VA disability compensation for sleep apnea, you have two main aspects to your claim: winning service connection for sleep apnea and obtaining the highest possible sleep apnea disability rating.  On the first point, you can read our earlier article with some basic information on sleep apnea and this other article on the basic elements needed to win service connection for sleep apnea.

In this article, our focus will be on how VA assigns a sleep apnea disability rating.  Once you understand the criteria VA uses, you will be better able to decide whether VA has awarded you the highest possible VA sleep apnea disability rating that you deserve under the law.

Sleep Apnea Disability Rating Criteria Are the Same for All Types of Sleep Apnea

VA uses the same sleep apnea disability rating criteria for all types of sleep apnea.  So, regardless whether you have obstructive, central, or mixed sleep apnea, your symptoms or treatment will determine your sleep apnea disability rating.  This makes sense because the symptoms associated with sleep apnea are basically the same even though the underlying causes can be different in different cases.

Your Sleep Apnea Disability Rating Can Range From 0% to %

Like many other disabilities in VA law, the lowest possible sleep apnea disability rating is a noncompensable evaluation of 0%.  This is the appropriate rating only those veterans who have had a sleep study that documents episodes of stopped breathing during sleep but who do not experience any symptoms as a result of those episodes.   This is not a very common rating since most people who experience these breathing stoppages suffer from other symptoms.

The next highest rating is 30%, which is based on evidence of &#;persistent day-time hypersomnolence.&#;  That is simply the medical term for ongoing sleepiness during the day.

Next, you have a 50% sleep apnea disability rating.  This is probably the most common sleep apnea disability rating since most doctors treat this sleep disturbance with CPAP machines or another breathing assistance device.  Remember, although the 50% sleep apnea disability rating mentions CPAP machines, you can use another treatment and still qualify at this rating level.  For more information on that, check out our earlier article.

Finally, you have the % sleep apnea disability rating.  These are much less common since they are reserved for the most severe cases of sleep apnea.  This level is warranted when certain physiological criteria are met (i.e., chronic respiratory failure with carbon dioxide retention or cor pulmonale) OR when certain radical treatment is undertaken (i.e., tracheostomy).

Where to Find the Criteria for a Sleep Apnea Disability Rating

38 C.F.R § provides the schedule of ratings for all respiratory related diseases and disabilities.  In the subsection for Restrictive Lung Disease, you will find the sleep apnea disability rating schedule.  Here it is:

   Sleep Apnea Syndromes (Obstructive, Central, Mixed):
Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy
Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine50
Persistent day-time hypersomnolence30
Asymptomatic but with documented sleep disorder breathing0

As you can see, some of the levels are based on symptoms (0% and 30%) while the common 50% is based on treatment.  The % level can be symptoms or treatment.  Make sure the VA does not require you to prove symptoms AND treatment at the % level.  If you are seeking one of the treatment based ratings, you need to be aware of the VA&#;s new emphasis on the medical necessity of that treatment.  They have rewritten their instructions for their employees when deciding rating increases.

Getting Your Correct Sleep Apnea Disability Rating May Not Be as Simple as It Looks

You may see the above chart and want to pursue your claim on your own.  That works for some veterans and not for others.  To win, you need to know exactly what must be proven and what you need to prove it.  The VA historically has been very loathe to award service connection and high ratings for sleep apnea.  If you do decide you need some legal help with your VA disability compensation claim, you can always contact our firm for a free consultation.

Sours: https://veterans.perkinslawtalk.com/post/whats-my-va-sleep-apnea-disability-rating/
VA Rating for Sleep Apnea Secondary to PTSD

VA Disability Rating for Sleep Apnea

What kind of VA disability rating is possible for sleep apnea? This is a condition that, like all other VA-compensated disabilities, must have an established connection to military service in order to get an award for VA disability compensation.

VA Disability Rating for Sleep ApneaService-connected medical issues including sleep apnea may be deemed to be directly caused by military service, there may be a “presumptive” condition that includes sleep apnea, or you may experience sleep apnea as a secondary condition associated with some other VA rated issue.

The key is to understand how the VA defines sleep apnea, and under what conditions it may justify a VA disability percentage rating.

Sleep Apnea Basics

In general, sleep apnea is medically defined as a sleep disorder where breathing stops and starts, which can result in feeling tired even after a full night’s sleep. There are three basic types of sleep apnea recognized by medical authorities including the Mayo Clinic. These include:

  • Obstructive sleep apnea
  • Central sleep apnea
  • Complex sleep apnea syndrome (which includes symptoms of both the other types above)

Obstructive sleep apnea is a common form of the problem, which occurs during sleep when the throat muscles relax and cause snoring, which can be disruptive to sleep patterns overall.

Central sleep apnea is a problem that involves the brain not sending the right signals during sleep to control breathing. Complex sleep apnea combines symptoms of the other two versions of the condition and is generally the more severe form.

To treat sleep apnea, a sleep study is usually required to properly diagnose the problem, and the use of external equipment known as a CPAP machine. CPAP, also known as a continuous airway pressure machine, helps keep the airway open during sleep to prevent sleep disturbances caused by sleep apnea.

Symptoms of Sleep Apnea

How do you know if you have a potential problem in this area? There are multiple symptoms to pay attention to. Remember that not all symptoms are automatically an indication of a medical problem, but they are worth paying attention to for future reference if you have some of the more benign types.

Don’t forget the power of a spouse, partner, roommate, or other housemates to give you information that could help your decision making about addressing this issue&#;if someone else tells you that you’ve been snoring or experiencing other sleep disturbances, take such reports seriously and consider having those observations committed to writing for your future claim’s sake.

Symptoms of sleep apnea include:

  • Snoring
  • Interrupted or stopped breathing during sleep
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Insomnia or difficulty remaining asleep
  • Excessive daytime sleepiness, AKA hypersomnia
  • Difficulty paying attention due to sleep deprivation
  • Irritability due to insomnia or lost sleep

How The VA Rates Sleep Apnea

There are several categories under which sleep apnea may be defined during a VA review of your health to determine what conditions you may have and which are considered by the VA to be service-connected. They include:

  • Conditions that require a tracheostomy due to “chronic respiratory failure with carbon dioxide retention” or “cor pulmonale”
  • Conditions that require the use of a breathing assistance device such as a CPAP machine
  • Persistent day-time hypersomnolence
  • Asymptomatic but with documented sleep disorder-type breathing

These ratings range from % disability (possible in cases where a chronic respiratory failure is documented)  all the way down to 0% (possible in cases where the patient is asymptomatic but with documented sleep disorder breathing).

The breakdown is as follows&#;remember that the VA rates all such cases individually but using a guide to qualifying conditions that include:

  • percent VA rating: awarded in cases of “chronic respiratory failure with carbon dioxide retention or cor pulmonare, or; requires tracheostomy”
  • 50 percent rating: awarded in cases where the use of a CPAP machine is required
  • 30 percent rating: awarded for persistent day-time “hypersomnolence”
  • 0 percent rating: awarded for asymptomatic sleep apnea with documented sleep disorder breathing

Sleep Apnea And Military Service Connections

The key in getting a VA disability rating for sleep apnea involves establishing that military service caused the problem.

But in cases where you may not be able to establish a direct link between military service and the condition it may be possible that it is due to the effects of a different service-connected medical issue.

For example, PTSD is said to aggravate sleep disorders or introduce them; veterans suffering from Gulf War Syndrome or other Gulf War-related conditions may also suffer from sleep apnea as a result.

How do you establish that sleep apnea is service-connected? If the first appearance of the problem occurs in your military medical records as opposed to being a pre-existing condition, that may be a step toward a VA disability rating.

Any military member experiencing sleep disorders should, in anticipation of needing this data at a later date, request a sleep study to be done in a military medical facility where possible to establish whether or not there is a service connection to the sleep issues.

You can also see a civilian medical provider to get supporting documentation of a service-connection for sleep apnea. The key will be having as much of the issue medically documented while still serving as possible and getting supporting medical opinions in addition to whatever treatment or study of your sleep issues happen while you are still serving.

If your sleep apnea is a recent development (even if it was not present or perceived to be present during your military service) it is still important to get the sleep study, have your results evaluated, and get supporting documentation to help your claim. It’s best to use both VA and military healthcare options AND any supporting evidence from private or civilian healthcare sources.


About The AuthorJoe Wallace is a year veteran of the United States Air Force and a former reporter for Air Force Television News


Filed Under: Benefits, Veterans Benefits

Sours: https://militarybenefits.info/disability-rating-sleep-apnea/

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