Veterans, if you’ve recently been diagnosed with sleep apnea that is service-connected, do not wait to submit your claim for disability benefits. The VA has proposed new sleep apnea ratings that, once implemented, will significantly change how all forthcoming claims for sleep apnea disability are measured and rated.
Currently, the most common VA rating for veterans who undergo Continuous Positive Airway Pressure (CPAP) therapy results in a rating of 50%.
Veterans filing for sleep apnea disability under the new system – particularly veterans who are prescribed a CPAP machine – will likely have a much harder time getting an equivalent rating.
In this post, we explain how this and other impactful changes will affect veterans preparing to file a sleep apnea claim and what action you can take now to protect your potential benefits.
If you qualify for compensation for sleep apnea but have not yet applied for disability compensation, we urge you to consider claiming benefits immediately before these changes occur.
On this page:
- Why Is the VA Changing the Rating Schedule for Sleep Apnea?
- Three Types of Sleep Apnea Are Rated by the VA: Obstructive, Central, or Mixed
- VA’s Current Sleep Apnea Ratings
- VA’s Proposed Sleep Apnea Ratings
- How Will the Proposed Rating Impact New VA Sleep Apnea Claims?
- Protect Your Benefits: File Now!
Two things to know upfront:
- While the VA has not yet announced an enactment date, sources suggest the new rating schedule may be effective by the end of 2024 or early 2025.
- The VA has a grandfathering clause for sleep apnea ratings. This provision protects veterans already rated for service-connected sleep apnea from future rating changes. If you’re currently receiving benefits for sleep apnea, those exact benefits will continue.
Why Is the VA Changing the Rating Schedule for Sleep Apnea?
The medical study of sleep apnea and how to treat it has advanced considerably since the VA published the present-day rating criteria.
For a free legal consultation, call 800-562-9830
In 2022, the VA proposed to bring its rating criteria up to current scientific standards per the American Academy of Sleep Medicine (AASM). Criteria for the definition, measurement, and treatment are all affected. Veterans will be evaluated based on the actual impact of sleep apnea on their daily functioning rather than solely on using a CPAP machine.
A prescription for a CPAP machine is fundamental to the current VA rating schedule for sleep apnea. A prescription for a veteran to use CPAP to treat their condition commonly leads to sleep apnea ratings as high as 50%.
VA’s proposed changes to the rating standards for sleep apnea are, according to the VA, meant to provide compensation more consistent with earning impairment than the current requirements are. In other words, sleep apnea is currently assessed based on treatment rather than actual disability.
Click to contact our disability lawyers today
Under the current rating schedule, the VA assigns higher sleep apnea ratings to veterans when their doctors prescribe more intensive treatment, such as the use of CPAP devices − without taking into account whether the veterans first tried more moderate remedies such as losing weight or wearing mouthpieces to keep the airway open during sleep.
The proposed rule changes focus on how well symptoms respond to treatment rather than the type of treatment prescribed (such as CPAP or oral device, etc.).
Three Types of Sleep Apnea Are Rated by the VA: Obstructive, Central, or Mixed
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts or is very shallow. It’s a chronic condition that can exhaust you, drain you of energy, and compromise your ability to work.
Complete a Free Case Evaluation form now
For some veterans, the disorder may be very mild, and for others, sleep apnea is a seriously disabling and possibly fatal condition. Victims may continuously stop breathing up to hundreds of times overnight and for various lengths of time per apnea episode. The result is that the veteran’s body and brain suffer greatly from oxygen deficiency.
The VA rates three types of sleep apnea:
Obstructive Sleep Apnea (OSA)
OSA is the most common type of sleep apnea, where the throat muscles relax during sleep, blocking the airways. People with OSA often choke, gasp, or temporarily stop breathing during sleep.
Complications of OSA include daytime fatigue, high blood pressure, heart problems, Type 2 diabetes, metabolic syndrome, liver problems, and complications with medicines and surgery.
Central Sleep Apnea (CSA)
Central sleep apnea is related to the central nervous system. CSA occurs when the brain fails to send the correct signals to the respiratory system, and the muscles that control breathing fail to activate properly. Your breathing may be very shallow or have brief periods without breathing. Risk factors for CSA can include stroke, heart failure, Parkinson’s disease, and kidney failure.
Complications of CSA include fatigue and cardiovascular problems.
Mixed Sleep Apnea (also called Complex Sleep Apnea)
Mixed sleep apnea occurs as a “mix” of OSA and CSA. It is also called treatment-emergent central sleep apnea (TECSA), as it develops when someone has OSA — diagnosed with a sleep study — that converts to CSA when receiving therapy for OSA.
VA’s Current Sleep Apnea Ratings
The VA follows a rating scale to evaluate the severity of sleep apnea and its impact on a veteran’s daily life. Each rating corresponds to a different level of disability and compensation.
The current scale consists of four primary rating levels: 0%, 30%, 50%, and 100%.
Sleep Apnea Syndromes (Obstructive, Central, Mixed) ─ Diagnostic Code 6847
- 100% rating ─ You have chronic respiratory failure with carbon dioxide retention or cor pulmonale (right-sided heart failure) or;
Requires tracheostomy. A tracheostomy is a surgically created hole through the neck and into the trachea (windpipe). A tracheostomy tube is placed into the hole to keep it open for breathing - 50% rating ─ Requires use of a breathing assistance device such as a CPAP machine
- 30% rating ─ Persistent daytime hypersomnolence (extreme sleepiness)
- 0% rating ─ Asymptomatic but with a documented sleep breathing disorder
VA’s Proposed Sleep Apnea Ratings
The proposed new scale consists of four primary rating levels: 0%, 10%, 50%, and 100%.
Sleep Apnea Syndromes (Obstructive, Central or Mixed) ─ Diagnostic Code 6847
- 100% rating ─ Treatment is ineffective (as determined by a sleep study) or you are unable to use treatment due to comorbid conditions; and with end-organ damage.
- 50% rating ─ Treatment is ineffective (as determined by a sleep study) or you are unable to use treatment due to comorbid conditions; and without end-organ damage
- 10% rating ─ Incomplete relief (as determined by a sleep study) with treatment (treatment may include a CPAP machine)
- 0% rating ─ Asymptomatic (without symptoms) with or without treatment
What Are Comorbid Conditions?
The new rating policy talks about “comorbid conditions.” Comorbidities are medical conditions that coexist alongside a primary diagnosis and affect one’s health, including treatment and outlook(1).
VA defines comorbid conditions specific to sleep apnea as follows:
“Conditions that, in the opinion of a qualified medical provider, directly impede or prevent the habitual use of a recognized form of treatment shown by sleep study to be effective in the affected veteran’s case
(e.g., contact dermatitis where the mask or interface touches the face or nares, Parkinson’s disease, missing limbs, facial disfigurement, or skull fracture).”
How Will the Proposed Rating Impact New VA Sleep Apnea Claims?
100% Rating:
VA would assign a 100 percent evaluation only if there is also end-organ damage.
End organ damage is severe impairment of significant body organs due to systemic disease. Under the new rating scale, there is no mention of carbon dioxide retention, cor pulmonale, or tracheostomy at 100% or any percentage rating.
50% Rating:
Under the current rating schedule, veterans prescribed CPAP treatments are generally eligible for a 50% rating – so much so that it’s widely referred to as the “Automatic 50% CPAP Rating.” About 90% of veterans with service-connected sleep apnea claims who are prescribed CPAP therapy are rated at 50%.
However, under the new rules, a 50% rating will be assigned only if:
- Treatment (meaning CPAP or similar device) was ineffective, or
- Treatments aren’t an option because of a comorbid condition that interferes with your ability to use the devices satisfactorily.
This removes a significant benefit to veterans!
30% Rating
The 30% rating for extreme daytime sleepiness will be removed under the new rules. This presents an even more significant hurdle to receiving disability benefits above a 10% sleep apnea rating.
0% – 10% Rating
Under the new VA rating schedule, sleep apnea claims involving a CPAP prescription will only achieve a 0% or 10% rating. Most veterans will likely score 10%. There may be opportunities to increase those ratings, but this is a far-reaching change overall, much less beneficial to veterans.
- 0% rating when sleep apnea syndrome is asymptomatic (the veteran does not complain of excessive daytime sleepiness), with or without treatment.
- 10% rating when treatment yields “incomplete relief.”
Any ratings above 10% (meaning 50 and 100%) will occur only when treatment is (a) ineffective – or – (b) you are unable to use the prescribed treatment due to comorbid conditions.
Note: While a 0% rating does not produce compensation right away, once sleep apnea is service-connected, it may make your path to compensation stronger if the condition worsens or can be connected to secondary conditions.
Protect Your Benefits: File Now!
Sleep apnea is a rampant and debilitating medical problem among veterans. Once adopted, the proposed sleep apnea ratings will unfavorably affect disability benefits awarded to many veterans who plan to file claims.
Claiming fair compensation for this military-related disability can be difficult without help. You’ll need to submit any additional evidence as soon as possible. Consider seeking legal representation to strengthen your claim before the changes are implemented.
- It will become more important to discuss any complications you have regarding therapy, such as CPAP and oral appliances, with your treating doctor.
- For claims pending when a new VA rating schedule goes into effect, the VA will evaluate the claim against both the old and new rating criteria and must award the rating that is more favorable to the veteran.
- If you are rated 50% now – could you possibly be rated 100% in the new schedule? Discuss this and other questions with us to see if you have a viable reason to reopen your claim.
No online material can replace one-on-one legal counsel from an accredited Veterans attorney. Call us now to discuss your sleep apnea claim: 800-562-9830. We are immediately available to advise you of your rights and help you pursue the maximum compensation you deserve.
Call or text 800-562-9830 or complete a Free Case Evaluation form