11/12/2024
VA Disability for Sleep Apnea: Eligibility & Benefits Guide
Sleep apnea is one of those common yet serious conditions that affects a significant number of veterans. It can severely impact daily life and overall health, leading to complications if left untreated. For many veterans, sleep apnea may be directly linked to their military service, qualifying them for VA disability benefits.
In this blog, we will explore sleep apnea as a service-connected disability and provide a step-by-step guide on how to claim benefits.
Understanding Sleep Apnea
Sleep Apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, known as apneas, can last for a few seconds to a few minutes and can occur multiple times an hour.
The three main types of sleep apnea are:
- Obstructive Sleep Apnea (OSA): The most common form, caused by a blockage of the airway when the soft tissue in the back of the throat collapses during sleep.
- Central Sleep Apnea (CSA): This occurs when the brain fails to send proper signals to the muscles that control breathing.
- Complex Sleep Apnea Syndrome: A combination of both obstructive and central sleep apnea.
Symptoms of sleep apnea include:
- Loud snoring
- Episodes of stopped breathing during sleep
- Abrupt awakenings with gasping or choking
- Morning headaches
- Daytime sleepiness
- Difficulty concentrating
- Irritability
Sleep Apnea as a Service-Connected Disability
Veterans may develop sleep apnea due to various factors related to their military service. These can include:
- Exposure to environmental hazards such as burn pits, fumes, and exhaust, pollution, or chemicals
- Obesity due to service-connected disabilities
- Caused by service-connected PTSD
- Caused by medication such as antidepressants to treat service-connected disabilities
- Caused by service-connected tinnitus
Recognizing the connection between sleep apnea and military service, the VA offers disability benefits for veterans diagnosed with this condition.
Establishing Service Connection
To receive VA disability benefits for sleep apnea, a veteran must establish service connection. This means proving that the sleep apnea is related to their military service. There are three primary ways to establish this connection:
- Direct Service Connection: Demonstrating that sleep apnea was diagnosed during military service or that symptoms began while in service.
- Secondary Service Connection: Showing that sleep apnea is a result of another service-connected condition, such as post-traumatic stress disorder (PTSD) or a physical injury, including due to obesity caused by a service-connected condition.
- Presumptive Service Connection: Although VA does not presume a connection between sleep apnea and any specific exposures during military service, if you served in the Southwest Asia theater of operations or elsewhere in the Middle East, you might be able to claim sleep apnea as a Gulf War Illness.
Evidence Needed
To support a claim for VA disability benefits for sleep apnea, veterans need to provide complete evidence, including:
- Medical Diagnosis: A formal diagnosis of sleep apnea from a qualified healthcare provider, typically confirmed through a sleep study. If you haven’t had a sleep study yet, at minimum veterans should provide a statement of symptoms.
- In-service exposures or onset of symptoms: Documentation of in-service exposures, such as presumed exposures in the Middle East or due to your MOS, and evidence of in-service onset of symptoms. Consider asking buddies from service to write a letter if they witnessed you holding your breath in your sleep.
- Or—Connection to service-connected conditions: If a veteran’s symptoms did not begin in service or cannot be linked to an exposure, medical literature relating to medications or service-connected disabilities can prove secondary service connection. If a veteran has become obese due to a service-connected condition, a statement explaining the weight gain can also show secondary service connection.
How to File a Claim for Sleep Apnea
Step 1: Submit the Claim
Veterans can apply for VA disability benefits online, by mail, or in person at a VA regional office. The primary form used for filing a disability claim is VA Form 21-526EZ, “Application for Disability Compensation and Related Compensation Benefits.”
Submit your completed application along with any supporting evidence you can obtain. Be thorough, and ensure that all necessary documentation is included to avoid delays or denials.
Step 2: Attend a VA Examination
After submitting your claim, the VA may schedule a Compensation and Pension (C&P) exam if you don’t already have a sleep apnea diagnosis. This examination is conducted by a third-party vendor company who will evaluate the severity of your sleep apnea and its connection to your military service. Be prepared to discuss your symptoms, their impact on your daily life, and any treatments you have received.
Step 3: Await the Decision
The VA will review your claim and all submitted evidence before making a decision. This process can take several months. If approved, you will receive a disability rating based on the severity of your sleep apnea.
Disability Ratings for Sleep Apnea
The VA assigns disability ratings in 10% increments, ranging from 0% to 100%, based on the severity of the condition and its impact on the veteran’s ability to function. For sleep apnea, the ratings are as follows:
- 0% Rating: Sleep apnea is diagnosed, but treatment is not required.
- 30% Rating: Persistent daytime hypersomnolence (excessive daytime sleepiness).
- 50% Rating: Requires the use of a continuous positive airway pressure (CPAP) machine or other breathing assistance device.
- 100% Rating: Chronic respiratory failure with carbon dioxide retention, cor pulmonale (right ventricle failure), or requires tracheostomy.
Appealing a Denied Claim
If your claim for sleep apnea is denied, you have the right to appeal. The appeals process can be complex, but it is essential to pursue if you believe your condition is service-connected. Here are the options for appealing a denied claim:
- Higher-Level Review: You will not be allowed to add more evidence to your file. An experienced reviewer will determine whether VA made any errors (for example, relying on an inadequate medical opinion) and have those corrected before issuing a new decision. It usually takes bout 4 to 8 months for a final decision.
- Supplemental Claim: You must add new evidence to your file that relates to a part of your claim that VA denied. It usually takes about 7 or more months to a decision.
- Board of Veterans Appeals: Attorneys will review your case. You can choose the evidence docket (90 days to submit evidence), the hearing docket (a hearing and 90 days after that to submit evidence), or the direct docket (no new evidence accepted). It usually takes about 3 years for a decision.
Sleep apnea is a serious condition that can significantly impact the lives of veterans. Recognizing the connection between sleep apnea and military service, the VA offers disability benefits to support those affected. Navigating the VA disability claims process can be challenging, but understanding the requirements and steps involved can help improve your chances of a successful claim.
A Deuterman Law Group, we are dedicated to advocating for veterans and ensuring they receive the benefits they deserve. If you need assistance with your VA disability claim for sleep apnea or any other service-connected condition, contact us today. Schedule a consultation today!
