The SECRETS to your VA Sleep Apnea claim REVEALED!!
What’s up Insiders! We know how difficult it can be to file and WIN a Sleep Apnea claim.
The frustration of having a CPAP machine and not being able to get it service-connected is real!
Which is WHY we have created this guide to walk you through a sleep apnea claim!
We are going through 3 Steps to Veteran Disability Benefits for Sleep Apnea!! Including, the CRITICAL aspect of secondary sleep apnea claims, and how you can get service-connected for sleep apnea.
The good news is you can get your sleep apnea claim service-connected!
And as always, if you need anything you can reach out to my team HERE!
What is Sleep Apnea?
Sleep Apnea is a condition where during sleep, you temporarily stop breathing. It can arise from over 30 different medical conditions, including traumatic brain injury, obesity, or depression. It can also be the result of another injury.
This is a very common condition, affecting somewhere between 4-6% of the general population. That comes out to around 22 million people in the U.S.!
According to Max Hirshkowitz, director of the Sleep Disorder Center at the Houston Veterans Affairs Medical Center, four times as many veterans suffer from sleep apnea than other Americans! Because of this Congress has asked the VA to pay closer attention to the incidences of sleep disorders among veterans.
The trend is increasing, which has many health officials worried. In fact, Dr. Timothy Morgenthaler, president of the American Academy of Sleep Medicine and a national spokesperson for the Healthy Sleep Project, states that “The effective treatment of sleep apnea is one of the keys to success as our nation attempts to reduce health care spending and improve chronic disease management.”
If sleep apnea progresses into later stages it can also grow potentially dangerous. Sleeping can be interrupted up to hundreds of times per night in severe cases.
What are the types of Sleep Apnea?
There are three main types of sleep apnea.
- Obstructive sleep apnea is caused by a blockage in the upper airway because of soft tissue in the back of the throat. It leads to an inability to breathe. This is the most common type of sleep apnea
- Central sleep apnea is caused by a lack of signals from the brain reaching the muscles used for breathing. With this, your body stops trying to breathe while you sleep
- Mixed sleep apnea is a combination of obstructive and central
Chronic snoring is a strong indicator of sleep apnea is worth having your health professional evaluate. Sleep apnea tends to result in sleep deprivation, so you may notice signs such as tiredness during the day, morning headaches, depression, high blood pressure, and ultimately a stroke or heart attack. Sleep apnea can also increase the likelihood of Type 2 diabetes.
With sleep apnea, it’s normal to wake up in the morning feeling tired despite having a full night’s sleep. This can mean feeling fatigued during the day, having difficulty concentrating or even falling asleep unintentionally. Many people with sleep apnea have even reported falling asleep at the wheel of their car. Since people with sleep apnea wake up numerous times throughout the night they are unable to get the rest they need. Many times these people are not conscious that they are waking up.
Sleep apnea can occur at any age, including infants, although the chances of having sleep apnea increase with age.
Snoring is the main warning sign for sleep apnea, so if you are a chronic snorer get your butt to the doctor!
Women, especially, tend to underestimate the loudness of snoring and they may be more likely to report feeling fatigued or experience insomnia. Despite this, middle-aged men are still the most likely to develop sleep apnea.
The biggest risk factor for sleep apnea is obesity. Living at a healthy weight can assist in improving breathing during sleep. Other causes can be having a naturally narrow airway or larger tonsils, smoking, drinking alcohol, and nasal congestion.
Sleep Apnea can be challenging to diagnose. Many times it is not recognized until a spouse alerts the person who has it. But, if you know you have sleep apnea, get qualified for it through the VA!
Step 1: Getting a Secondary Service Connection for Sleep Apnea
It is possible to establish a connection on a secondary basis. In which case the link must be established between a previously accepted service-connected condition. A couple of conditions sleep apnea has been secondarily rated for are PTSD and asthma, for example. There are quite a few conditions that have been proven to lead to the development of sleep apnea, so this might be a good course for you to choose.
Studies have shown that there is an especially significant link between PTSD and sleep apnea. Many factors overlap in both disorders that can aggravate each other. Some of these may have begun during active duty, such as excessive sleep deprivation, hyperarousal, and chronic stress.
These studies have shown that if PTSD increases in severity, the chances of sleep apnea increase as well. So if you have PTSD, it is recommended that you get screened for sleep apnea.
Step 2: Knowing How the VA rates Sleep Apnea
According to Title 38, section 4.97, Diagnostic Code 6847 of the Department of Veteran Affairs’ rating schedule, sleep apnea syndromes (obstructive, central, mixed) are rated according to the following:
- 100% – Chronic respiratory failure with carbon dioxide retention, or cor pulmonale, or requires a tracheostomy.
- 50% – Requires use of breathing device (CPAP machine) persistent day-time hypersomnolence
- 30% – Persistent day-time hypersomnolence, leading to work and social deficiencies
- 0% – Asymptomatic but with documented sleep disorder breathing
If you do receive a rating of 50% or higher, you can get a CPAP machine provided to you by the VA on top of your benefits.
Regarding CPAP machines, a recent VA report on VHA health care spending for sleep apnea has called on the VA to implement spending reforms cutting up to $200 million over the next 5 years. This report specifically focuses on the spending and distribution of CPAP machines, where the number of veterans receiving CPAP machines increased by 96% from 2014-2018. The amount spent on CPAP machines increased from $147.6 million to $233.9 million during that same time.
The report concludes that half the veterans receiving the devices used them less than half of the time, leading them to conclude that the VA had misspent that money by not following up with veterans in a timely manner. It was also determined that there was a lack of guidance for alternatives to purchasing the machines.
What this means for veterans receiving CPAP machines in the future is currently unknown.
Step 3: What evidence do I need with Veteran Disability Benefits for Sleep Apnea claim?
Since sleep apnea can be difficult to diagnose, it is essential that you document symptoms and evidence to submit. This includes having a sleep study done (the VA will not accept a diagnosis without a sleep study!), a buddy letter from your spouse, and medical records from your doctor about your symptoms. Keeping a list of your symptoms and treatments can be beneficial evidence to submit.
In fact, even if you have been previously diagnosed with a form of sleep apnea it is highly likely the VA will ask you to have another study conducted.
Remember, you cannot expect the VA to take you just at your word. Many veterans have submitted claims without providing enough proof, resulting in most sleep apnea claims being rejected (as of 2014). This means that it is key to provide as much evidence as possible, leaving very little room for the VA to speculate about anything.
Sleep apnea has continued to be one of the harder disability claims for veterans to win, meaning you must do your due diligence to get the benefits you deserve for this condition.
By providing your medical records and relating it to a service-connected injury, this will show the VA how the injury and the sleep apnea are linked.
While there is a preparation you need to do to get your claim approved, it is worth it!
Although sleep apnea claims have spiked considerably in recent years, especially with veterans of Iraq and Afghanistan, the VA does not consider sleep apnea presumptive to a service connection.
Even though sleep apnea has been a difficult claim for veterans to win in the past, with the right amount of evidence your sleep apnea claim could be an easy win with the right materials.
That means as much Lay and Medical evidence as possible.
As with everything in the VA, there is a chart which quantifies the degree of your sleep apnea. Visit the VA’s website, under the respiratory tab, to find an estimate of what your compensation will be.
If all else fails, and you still need help figuring out how to get your sleep apnea claim approved, you click HERE. Our team of coaches have extensive research and knowledge in sleep apnea claims!
The VA and CPAP Machines
If you have a breathing machine, you need to provide medical evidence that it was prescribed by the doctor. As well as a letter from your doctor stating that this device is medically necessary for your sleep apnea. No longer is it sufficient to just provide the records for a breathing machine. The VA won’t assume anything, but by giving a letter of the doctor’s opinion, this will help to solidify your claim.
In the past, using a CPAP (Continuous Positive Airway Pressure) machine was the only way to get your claim approved. Now, a CPAP is just one of the available treatments. If you don’t have a breathing machine, you can buy one here. Having evidence from a breathing machine can significantly speed up your decision!
What Else Do I Need to Know About Getting Rated for Sleep Apnea?
Give the VA a detailed timeline. Spell out when you first started having sleep problems, when you’ve noticed them grow aggravated, and how you are currently feeling.
Next, be as specific as possible as to what caused your condition. What service injury caused your sleep apnea? Medical evidence proves how it is related to military service. This can come from your Nexus letter or DBQ.
Finally, and very importantly, describe in detail how sleep apnea affects your day to day life. This is where having buddy letters from your spouse, friends, or fellow service numbers can also be very helpful, as they can describe the difference in your life before and after the condition came to be.
Remember, proving a service connection is essential to having your claim approved. This can be difficult with sleep apnea, so be prepared to show records of an in-service injury, illness or event along with the medical nexus linking your sleep apnea to the originating occurrence. The medical nexus will be key to receive from your doctor or medical professional. They must be able to explain how the event you experienced could medically and scientifically cause your condition. This is what is referred to as the medical “nexus.”
Need more coaching on any of your VA claims? THIS is the link to get started!