The VA recognizes sleep apnea as a disabling condition, subject to sleep study confirmation or receipt of medical evidence disclosing a diagnosis from a competent private medical provider or specialist for purposes of rating for compensation (sleep apnea is not a presumptive condition, which means the responsibility lies with the veteran to connection the condition to the veteran’s military service).
Pursuant to 38 CFR 4.97, current ratings are:
- 100 percent: chronic respiratory failure with carbon dioxide retention or cor pulmonale; or, requires tracheostomy
- 50 percent: requires use of breathing assistance device such as continuous airway pressure (CPAP) machine
- 30 percent: persistent daytime hypersomnolence
- 0 percent: asymptomatic, but with documented sleep disorder breathing
Sleep disturbances are recognized as a qualifying chronic disability (pursuant to 38 CFR 3.317) resulting from an undiagnosed illness or a medically unexplained chronic multisymptom illness. In a change to the VA compensation adjudication manual (M21-1) dated November 30, 2015, sleep apnea cannot be presumptively service-connected under the authority of 38 CFR 3.317 because it is a diagnosable condition. When claimed as a disability for compensation purposes, sleep apnea will be considered on a non-presumptive basis. This means that a veteran who served in Southwest Asia and claims service-connected respiratory system or sleep disturbance disability should be scheduled for an examination and a medical nexus opinion requested. Once again, a diagnosis from a competent private medical provider or specialist stating the veteran’s condition is “more likely than not” connected to the veteran’s service will be added to the overall VA claim record and can help make the service connection.
Veterans should take the Sleep Apnea Disability Benefits Questionnaires (DBQs) form (found here) to their private medical provider or specialist to complete.
Also, sleep apnea is associated with a higher prevalence of psychiatric comorbid conditions (meaning the presence of one or more additional disorders or diseases co-occurring with a primary disease or disorder) in Veterans Health Administration beneficiaries. This association suggests that patients with psychiatric disorders and coincident symptoms, such as post-traumatic stress disorder (PTSD), suggesting sleep-disordered breathing should be evaluated for sleep apnea.
While the VA’s National Center for PTSD has not posted current evidence to link PTSD and sleep apnea, other studies and articles have done so. The submission or these studies and articles would not suffice as “complete” evidence to support a disability compensation claim, but they can be used as part of the evidence as a whole.
Veterans who have had their claims linking PTSD and sleep apnea denied by the VA have won their cases on appeal with sleep apnea as secondary to service-connected PTSD. The decisions from two of these appeals can be found here (http://www.va.gov/vetapp01/files01/0102100.txt) and here (http://www.va.gov/vetapp13/Files2/1316035.txt)
