In order for the VA to assign a 100% rating for Sleep Apnea, the VA must first determine that the condition is related to service.
Generally, VA will grant service connection if the following are met:
- Proof of a current diagnosis,
- Proof of an in-service event, disease or injury, and
- Proof of a medical nexus between the first 2 elements.
VA Schedule of Rating
After VA grants service connection, it must determine the correct rating. To do so, VA consults the Schedule of Ratings. The ratings should reflect how much that specific disability impairs your ability to work. In order to get a 100% rating for sleep apnea, it must be so severe that it prevents gainful employment.
Requirements Specific to Sleep Apnea
The Schedule of Ratings breaks down disabilities into different categories. Each category contains groups of medical problems. For example, Sleep Apnea is found in the Respiratory System category. Each group contains a list of disabilities, and each disability has its own diagnostic code. In turn, each diagnostic code specifies the symptoms required for various ratings. For example, the 6847 code applies to Sleep Apnea. See 38 C.F.R. § 4.97. A 100% VA rating for Sleep Apnea requires:
- Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or
- The condition requires tracheostomy.
Chronic Respiratory Failure
Chronic respiratory failure usually happens when the airways that carry air to your lungs become narrow and damaged. In other words, less oxygen gets in and less carbon dioxide goes out. A tracheostomy is a surgically made hole in the front of your neck where a breathing tube is connected to your windpipe to help you breathe. Naturally, a veteran with these extreme symptoms deserves a 100% VA rating for Sleep Apnea.
Sleep Apnea Medical Evidence
Only medical evidence can satisfy these requirements. It is not enough for the veteran to say “I cannot work because of my sleep apnea.” Fortunately, VA provides rating tools such as Disability Benefits Questionnaires (“DBQs”) on their website. Specifically, VA provides a Sleep Apnea DBQ that focuses on the symptoms described in the Schedule. Veterans seeking a higher rating for sleep apnea should have their doctors complete the DBQ. The VA will likely grant the rating if the DBQ includes the criteria for a 100% rating for Sleep Apnea.
Disability Benefits Questionnaire
A doctor who treats the disability in question should fill out a Disability Benefits Questionnaire. For example, an orthopedic specialist who is treating a foot condition should not complete a DBQ for PTSD.
Watch out for Pyramiding
When seeking a 100% rating for Sleep Apnea, one must consider every rule and exception related to VA ratings. Under the VA rating system, a veteran should be compensated for each service-connected disability. However, there is one big exception. VA cannot pay a veteran more than once for the same disability or same manifestation. For example, Asthma and Sleep Apnea have nearly identical manifestations. They both involve impairment of the airways, they share symptoms such as daytime fatigue, and they are under the same category in the Schedule of Ratings. A veteran who is service connected for both will only receive a rating for one of them. In that circumstance, VA must assign the higher of the 2 possible ratings.
Disability Help Group Case Study Sleep Apnea
The anti-pyramiding rule recently affected a DHG client. He is a 64 year-old veteran of the Army who filed a claim for asthma and sleep apnea. VA denied the sleep apnea claim, but granted the asthma claim at 30%. After a successful appeal, VA granted 60% for his asthma. Furthermore, the VA conceded that the criteria for sleep apnea was met and granted a 50% service-connected disability. The VA, however, could not grant the additional 50% rating because of the anti-pyramiding rule. Instead, VA awarded 60% for his “asthma with sleep apnea.”
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- Sleep Apnea Form: VA Form 21-0960L-2
- National Institute of Health: Respiratory Failure
- National Heart, Lung and Blood Institute: Tracheostomy
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