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October 24, 2017

Getting a Claim for Sleep Apnea Approval

Last updated on March 24, 2021

Sleep Apnea Approval: Sleep Apnea is a condition where during sleep, you temporarily stop breathing. It can arise from traumatic brain injury, obesity, or depression. It can also be the result of another injury.

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! Read this post to find out how.

Evidence

It is essential that you document symptoms and evidence to submit. This includes having a sleep study done, 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.

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 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!

Give the VA a timeline. Spell out when you first started having sleep problems. What caused them? What service injury caused your sleep apnea? Medical evidence which proves how it is related to military service. This can come from your psychologist’s DBQ. And very important, how sleep apnea affects your day to day life.

VA Ratings

According to Title 38, section 4.97 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 persistent day-time hypersomnolence
  • 30% – Persistent day-time hypersomnolence
  • 0% – Asymptomatic but with documented sleep disorder breathing  

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.

More About Sleep Apnea Approval

While there is preparation you need to do to get your claim approved, it is worth it! Your sleep apnea claim could be an easy win with the right materials.

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, send us an email. We can work with you to file your claim and gather the necessary evidence!

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About the Author

About VA Claims Insider

VA Claims insider is an education-based coaching/consulting company. We’re here for disabled veterans exploring eligibility for increased VA disability benefits and who wish to learn more about that process. We also connect veterans with independent medical professionals in our referral network for medical examinations, disability evaluations, and credible Independent Medical Opinions & Nexus Statements (Medical Nexus Letters) for a wide range of disability conditions.

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