C&P Exam for Sleep Apnea: What to Expect and How to Prepare

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In this article, VA disability expert Brian Reese explains what to expect and how to prepare for a VA C&P exam for sleep apnea.

After you’ve filed a VA claim for sleep apnea, you’ll likely be scheduled for a Compensation and Pension (C&P) exam by a private company contracted by the VA.

Sleep apnea is a serious condition known for causing disrupted sleep due to irregular breathing, and it is increasingly common among military veterans.

According to our data, sleep apnea is one of the most frequently claimed conditions for VA disability benefits, ranking #12 of the top 50 VA claims.

Pro Tip: The VA currently rates sleep apnea under CFR Title 38, Part 4, the Schedule for Rating Disabilities, Diagnostic Code 6847 from 0% to 100%, with breaks at 30% and 50% depending on the severity of the condition and the need for a CPAP machine. The 30% rating is assigned for persistent daytime sleepiness while the 50% rating is assigned if you require the use of a breathing device such as a CPAP. The 100% rating is only for the most severe cases. The 0% rating is assigned if you have sleep apnea with no symptoms.

Summary of Key Points

VA disability ratings for sleep apnea are 0%, 30%, 50%, and 100%. The 0% rating is for documented sleep apnea with no symptoms. The 30% rating is for excessive daytime sleepiness. The 50% rating is for sleep apnea with a CPAP machine. The 100% is uncommon and reserved for the most severe cases of sleep apnea.
The C&P exam for sleep apnea will assess whether you have a diagnosis confirmed by a sleep study, determine if there’s a “nexus” to your military service or another service connected disability, and evaluate the severity of your symptoms and their impact on your work, life, and social functioning.
If you were diagnosed with sleep apnea during military service, you have a case for direct service connection. If you weren’t diagnosed with sleep apnea during the military, you’re better off filing it secondary to another service connected disability.

What to Expect at a C&P Exam for Sleep Apnea

A C&P exam for sleep apnea is structured to determine three things:

• (#1) Whether you have a diagnosis of sleep apnea confirmed by a sleep study, and

• (#2) If there is a “nexus” for service connection (meaning your sleep apnea was caused or made worse by your military service), and

• (#3) The severity of your symptoms in terms of frequency, severity, and duration as well as their negative impacts to your work, life, and social functioning.

Note: It’s very common for the VA to utilize the ACE exam process (records-only review of the evidence) for sleep apnea claims.

Here’s what you can expect during a VA Compensation and Pension (C&P) exam for sleep apnea:

• Review of Medical History: The examiner will review your medical records that pertain to respiratory or sleep disorders, specifically focusing on sleep apnea. They will look at past diagnoses, treatments you’ve undergone, and the results of those treatments. It’s crucial that the VA has all relevant medical records before the exam. You can also bring additional documents that you think may help.

• Discussion of Symptoms and Onset: During the exam, there will be a conversation about when you first noticed symptoms of sleep apnea, such as snoring, daytime fatigue, or episodes of breathing cessation during sleep. The examiner might ask about any relation between your military service and the onset of symptoms, considering factors like stress, noise exposure, or injuries that might contribute to sleep disturbances.

• Negative Impacts on Work, Life, and Social Functioning: The examiner will need to understand how sleep apnea affects your ability to work, perform daily activities, and engage in social interactions. Issues such as excessive daytime sleepiness, difficulty concentrating, and the potential for accidents or decreased work efficiency due to fatigue will be explored.

• Physical Examination and Observations: The physical examination may include checking your throat for obstructions and the general health of your respiratory system. The examiner might observe your body habitus, as obesity can be a contributing factor to sleep apnea. They may also inquire about the use of a CPAP machine and how well you are adapting to it if applicable.

• Sleep Study Review: If a sleep study (polysomnography) has been conducted, the examiner will review these results. They will look at indicators such as the number of sleep disturbances, the severity of breathing cessation episodes, and overall sleep quality. These results are critical in diagnosing the type and severity of sleep apnea.

• Completion of the Disability Benefits Questionnaire (DBQ) for Sleep Apnea: After the assessment, the examiner will fill out a DBQ for Sleep Apnea. They will document the findings, the severity of your condition, and its impact on your life. This questionnaire will be submitted to the VA Rater, who will use it to determine the eligibility and rate of your disability claim.

List of Sleep Apnea C&P Exam Questions

During a C&P exam for sleep apnea, you can expect to be asked a series of detailed questions that align with each section of the Sleep Apnea DBQ.

Here’s a breakdown of the potential questions by section:

SECTION I – DIAGNOSIS

Have you been diagnosed with sleep apnea confirmed by a sleep study?

• If yes, what type of sleep apnea do you have (Obstructive, Central, Mixed)?

• What is the date of diagnosis for your sleep apnea?

• Have any other sleep disorders been diagnosed?

SECTION II – MEDICAL HISTORY

Can you describe the history of your sleep disorder?

• When did you first notice symptoms?

• How has the condition progressed over time?

Is continuous medication required to control your sleep disorder condition?

• If yes, what medications are you taking for your sleep disorder?

Do you require the use of a breathing assistance device such as a CPAP machine?

• If yes, how often do you use your CPAP machine?

SECTION III – FINDINGS, SIGNS AND SYMPTOMS

Do you currently experience any of the following symptoms due to your sleep apnea?

• Persistent daytime hypersomnolence (excessive sleepiness)

• Cor pulmonale

• Carbon dioxide retention

• Requirement for a tracheostomy

• Chronic respiratory failure

• Any other symptoms? Please describe.

SECTION IV – OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS, SIGNS AND/OR SYMPTOMS

Are there any other pertinent physical findings, complications, or conditions related to your sleep apnea?

Do you have any scars related to the treatment of your sleep disorder?

• If yes, are any of these scars painful, unstable, or located on the head, face, or neck?

• Provide the location and measurements of the scar.

SECTION V – DIAGNOSTIC TESTING

Has a sleep study been performed?

• If yes, when was the sleep study done and what were the results?

• Where was the sleep study performed?

Are there any other significant diagnostic test findings or results?

• If yes, please provide details about the type of test, the date, and the results.

SECTION VI – FUNCTIONAL IMPACT

Does your sleep apnea impact your ability to work?

• If yes, can you provide examples of how sleep apnea affects your work performance?

SECTION VII – REMARKS

Are there any additional remarks or details you would like to provide about your condition?

Examples of Work, Life, and Functional Impacts of Sleep Apnea

Sleep apnea is a serious sleep disorder that can significantly affect various aspects of a veteran’s life, impacting work, daily activities, and overall functionality.

Here are some examples of how sleep apnea can influence these areas:

Work Impacts

• Reduced Alertness: Jobs that require high levels of concentration, such as driving, operating machinery, or precision tasks, can become hazardous due to daytime sleepiness and reduced cognitive function.

• Increased Absenteeism: The fatigue caused by poor sleep quality might lead to more frequent absences from work as veterans may struggle with waking up or feeling too tired to work effectively.

• Decreased Productivity: Sleep apnea can impair decision-making abilities and concentration, potentially decreasing productivity and increasing the risk of errors at work.

Life Impacts

• Daily Activities: Simple daily activities like reading, watching TV, or engaging in social interactions can be hindered by the overwhelming need for naps or rest due to daytime fatigue.

• Social and Emotional Strain: Sleep apnea can lead to mood disturbances, such as irritability and depression, affecting relationships and social activities.

• Sleep Disruptions: The repeated awakening during the night not only affects the veteran but can also disrupt the sleep of a partner or family members, leading to strained household dynamics.

Functional Impacts

• Overall Health Risks: Untreated sleep apnea increases the risk for serious health issues, including hypertension, heart disease, and diabetes, affecting overall health and requiring more medical attention and lifestyle adjustments.

• Cognitive Impairment: Chronic sleep disruption can lead to impaired cognitive functions, such as memory loss and difficulty concentrating, affecting the ability to perform tasks that require mental clarity.

• Energy and Motivation: The constant fatigue associated with sleep apnea can decrease energy levels and motivation to engage in physical activity, which is vital for maintaining health and preventing other conditions.

Tips to Help You Prepare for Your VA C&P Exam for Sleep Apnea

Here’s a list of tips to help you prepare for your C&P exam for sleep apnea:

• Gather Records and Documents: Collect all relevant medical records, including sleep study results, diagnoses, treatment histories, medication lists, and any pertinent correspondence about your sleep apnea. These documents are essential evidence to support your claim during the examination. Review them thoroughly and bring hard copies to the C&P exam for reference.

• Maintain a Sleep Diary: Keep a detailed record of your sleep patterns, noting the frequency and severity of symptoms such as snoring, gasping, or periods when breathing stops. Record any factors that exacerbate your symptoms, such as sleeping positions or specific activities prior to sleeping. This diary will play a crucial role in illustrating the impact of sleep apnea on your daily life and functionality during the examination.

• List Functional Impacts: Document specific ways in which sleep apnea affects your daily functioning. For example, sleep apnea can cause significant daytime fatigue and sleepiness, making it challenging to concentrate or stay awake during activities. It might also limit your ability to engage in routine physical activities or exercise, impacting your overall health and well-being.

• Need for a Breathing Device: If you use a CPAP machine or other breathing assistance devices, be ready to discuss how often you use the device, how it has improved your symptoms, and any challenges you face with its use.

• Review the DBQ for Sleep Apnea: Familiarize yourself with the Disability Benefits Questionnaire (DBQ) for sleep apnea before your exam. Focus on sections relevant to sleep apnea and be prepared to discuss the onset, progression, and current status of your condition. Describe any treatments you have undergone, their effectiveness, and how you manage your condition daily. The examiner will use this information to complete the DBQ for Sleep Apnea, which will then be reviewed by the VA Rater for further assessment of your claim.

DBQ for Sleep Apnea [Download]

The examiner will follow the sections and questions of the electronic DBQ for Sleep Disorders, including sleep apnea, to evaluate the severity of disability caused by your sleep condition.

We’ve made a copy available for review and download below:

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