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Learn About the Sleep Apnea VA Rating
Disability benefits claims for veterans dealing with sleep apnea are some of the most common that the U.S. Department of Veterans Affairs receives. In some years, the VA may approve as many as 280,000 sleep apnea claims, but it’s important to note that the VA will deny many more for the disorder. If you think you might qualify for VA disability compensation based on your sleep apnea, we’ve summarized all you need to know about sleep apnea’s most common symptoms and how they factor into a VA disability claim.
5 Common Symptoms of Sleep Apnea
- Loud Snoring
- Dry Mouth
- Excessive Daytime Sleepiness
- Gasping For Air
The inability to get the kind of restful sleep necessary for optimal health can affect a veteran’s ability to effectively secure and maintain gainful employment, which is often the case with sleep apnea, a common sleep disorder. Sleep apnea makes it so difficult to concentrate, stay awake, and maintain effective relationships with colleagues that you can’t possibly do your day-to-day work, you may be eligible for VA disability benefits.
While the VA often denies VA disability claims associated with sleep apnea, there is a reason for optimism – when the right sleep disturbance symptoms are supported with the right kind of documentation, there’s no reason to believe that the VA would deny your sleep apnea claim, or at the very least that you can’t ultimately win your case through the appeals process. Moreover, once your VA claim has been approved, you also may be eligible for VA disability back pay.
This is why it’s often important to work with a trusted and qualified VA disability attorney, who can evaluate your sleep apnea claim from the very beginning, advise as to its chances of being approved, and help track down the documentation and medical evidence you need to support your VA claim effectively. So before you get started, review our list of symptoms and work with your attorney to determine whether you have the right documentation to support them. Ultimately, your goal is to present to the VA the most comprehensive and medically supported military disability claim possible.
Sleep Apnea VA Rating
As with most disabilities, the VA rating for sleep apnea depends on your situation. The military provides an extremely physically demanding environment that can lead to many conditions associated with sleep apnea syndromes, ranging from post-traumatic stress disorder (PTSD) to various injuries that limit mobility and exposure to dust and fumes. Some indications are that one in five U.S. veterans has sleep apnea. For example, in one study, combat veterans in Iraq were more than 45% more likely than non-combatants to develop sleep apnea.
Before considering your VA claim for a sleep apnea disability rating, the VA will insist that you provide the results of a sleep study, which can help define the severity of your medical condition. You can undergo a polysomnogram that measures brain activity, blood pressure, eye movements, blood oxygen levels, heart rate, snoring, and chest movements throughout the night as you sleep. This sleep study typically occurs at a medical facility or specialized sleep lab.
You can sleep with a home-based monitor that records much of the same information while allowing you to sleep in your bed at home. Depending on the home test results, a sleep specialist may advise that you follow up with a more formal sleep study as part of your VA claim.
Based on the results of your sleep study, along with any other medical documentation you submit with your VA disability claim, the VA can choose to rate your sleep apnea as a respiratory condition according to four different levels of disability benefit, as follow:
- 100%: Chronic Respiratory Failure that includes carbon dioxide retention or “cor pulmonale” – enlargement or failure of the right side of the heart. This level of respiratory disability also may require a tracheostomy.
- 50%: Requires assistance to breathe healthily during the night, including sleeping with a continuous airway pressure device, CPAP machine, dental appliances, or other devices designed to keep your airway open and prevent periods of suspended breathing throughout the night.
- 30%: Signified by excessive daytime hypersomnolence – chronic daytime sleepiness that doesn’t improve even when you get a recommended amount of sleep.
- 0%: Indicates that the claimant is largely asymptomatic but does show documented sleep apnea.
For the most part, if you’re a disabled veteran with a sleep apnea claim, the 50% sleep apnea rating is your best-case scenario. This places a disabled veteran in the VA’s Group 1 for treatment. The condition is given a serious VA disability rating because of sleep apnea’s ability to cause grave long-term damage.
Please note that for the 50% rating, the VA must see the documentation that the breathing apparatus you’re using is medically prescribed. So, in addition to providing the prescription for your breathing assistance device, you’ll also need to include a statement from your physician attesting to the medical need for the device. Again, your veteran’s disability attorney can help you work with your physician on this.
The VA also will want to see the documentation that your sleep apnea condition has either developed or become progressively worse during your time of active duty and that your current condition can be tied back to your time of military service.
What Is Sleep Apnea?
Sleep apnea is a serious disorder that can detrimentally affect someone’s health and well-being. People with untreated sleep apnea routinely stop breathing throughout the night – sometimes as many as hundreds of times within one night’s sleep, resulting in the brain getting decreased oxygen.
The VA recognizes three different types of sleep apnea, as follows:
- Obstructive Sleep Apnea: This is the most common form of sleep apnea. Obstructive sleep apnea occurs when the airway becomes blocked during sleep – usually because the soft tissue collapses at the back of the throat . According to the National Sleep Foundation, obstructive sleep apnea affects around 18 million Americans.
- Central Sleep Apnea: With this kind of sleep apnea, the airway isn’t necessarily blocked during sleep, but the brain doesn’t trigger the muscles to breathe appropriately. This usually ties back to some instability in the brain’s respiratory control center.
- Mixed Sleep Apnea: A combination of the two types of sleep apnea listed above.
While some view sleep apnea as more of a nuisance than anything else, it can result in serious long-term health effects when left untreated. For example, excessive daytime sleepiness can lead to difficulty concentrating and falling asleep at work, which can make completing work duties extremely challenging. People with sleep apnea are at a much higher risk of being involved in workplace accidents and motor vehicle collisions.
The sudden drops in blood oxygen levels from prolonged periods of not breathing during the night can easily lead to high blood pressure and heart issues. These repetitive drops strain the cardiovascular system, putting you at a higher risk of stroke, heart attack, and abnormal heartbeats.
Those with untreated sleep problems associated with sleep apnea also show a higher risk of developing Type 2 diabetes and other metabolic disorders, plus a higher chance of developing liver problems such as nonalcoholic fatty liver disease. The livers of those with sleep apnea are also more likely to exhibit significant scarring. Dealing with sleep apnea – particularly obstructive sleep apnea – can increase your risk of complications after surgery and with some medications, especially those related to anesthesia.
5 Common Symptoms of Sleep Apnea
While every sleeper is different, sleep apnea as a disorder presents several distinct symptoms, which we’ve outlined below.
1. Loud Snoring
Sleepers usually snore when the soft tissues of the neck and back of the throat collapse or narrow and block their airway. As you try to breathe, these tissues vibrate, which makes the vibratory noise we know as snoring. People snore because of many other issues besides sleep apnea: enlarged tonsils, a deviated septum, an enlarged uvula, congestion, weight gain, or drinking alcohol right before sleep.
The difference with the kind of snoring associated with sleep apnea is that the snoring is also accompanied by stretches during which you stop breathing because your airway is blocked, as with obstructive sleep apnea, or when your brain fails to instruct your body to breathe, as with central sleep apnea. Such pauses may be followed by gasping, choking, snorting, or struggling for air.
2. Dry Mouth
In addition to snoring, sleep apnea can cause mouth breathing while sleeping, which causes many sleepers to wake up with an extremely dry mouth or xerostomia. For example, one study found that out of roughly 1,000 adults, 31.4% of those with sleep apnea woke up with a dry mouth, compared to just 3.2% of sleepers without sleep apnea.
Dry mouth sounds like a nuisance, but it also can be linked to gum disease, cavities, anxiety, and a decreased sense of taste, which in some cases can lead to a decreased quality of nutrition.
3. Excessive Daytime Sleepiness
The inability to get a good night’s sleep eventually results in sleep debt, which can mean excessive daytime sleepiness and an inability to concentrate. Excessive daytime sleepiness can spell trouble.
The ability to focus, concentrate, and maintain collaborative working relationships can dramatically decrease when someone doesn’t get healthy, restful sleep. In addition, many jobs require people to maintain extreme focus and caution or risk serious, even fatal, on-the-job injuries.
Sleep apnea headaches are a common symptom of the condition. As many as 50% of sleep apnea sufferers routinely wake up with morning headaches. These headaches are caused by the decrease in oxygen levels when the sleeper stops breathing throughout the night. These lower levels of oxygen, combined with carbon dioxide buildup, can lead to morning headaches typically associated with sleep apnea.
The carbon dioxide buildup also causes the brain’s blood vessels to dilate, resulting in a throbbing, migraine-like headache. Sleep apnea headaches usually cause pain on both sides of the head, dissipate once you wake up and begin breathing normally – typically within an hour – and recur regularly.
5. Gasping For Air
Obstructive sleep apnea is the most typical kind of sleep apnea that leads sleepers to wake during the night gasping for air, sometimes feeling as if they’re suffocating. When the throat muscles relax so much that they block your airway, it can cause you to wake abruptly, gasping to get air into your lungs. This is an extremely common symptom of sleep apnea and can be quite frightening for sleepers. However, the sleeper may not always awake when this happens and may regain normal breathing while still asleep.
What Causes Sleep Apnea?
Sleep apnea is a sleep disorder that occurs when the muscles in the throat relax when you sleep, resulting in a narrower airway. Because you aren’t getting as much oxygen, your body responds by waking you up briefly to breathe, which starts a cycle of repeatedly stopping and starting to breathe. These pauses between breaths can last a minute or more, and sufferers can wake up 30 or more times during the night, disrupting healthy sleep. Many people suffer from loud snoring and daytime sleepiness and often complain of a morning headache.
The three main types of sleep apnea are obstructive sleep apnea (by far the most common when the muscles of the soft palate relax and block the airway), central sleep apnea (when your brain isn’t sending signals to breathe correctly), and complex sleep apnea syndrome (when you suffer from both obstructive and central apnea). However, sleep apnea causes vary, and sleep disorders research continues to uncover new connections.
Research has shown that those with asthma have a nearly 40% greater risk of developing sleep apnea. The longer the person’s asthma goes untreated, the greater their risk is. The symptoms of asthma are similar to those of sleep apnea. With asthma, a person’s airway swells and narrows, making it harder to breathe, which can cause chest pain, tightness, and disturbed sleep. Those with sleep apnea may already have weakened or irritated airways which can make them inflamed and narrow, exacerbating both the apnea and asthma. Acid reflux is also common in those with sleep apnea, which is known to worsen asthma.
Some sleep apnea sufferers and people with asthma may find relief using a continuous positive airway pressure (CPAP) machine while they sleep. CPAP therapy is designed to help those with severe sleep apnea by preventing the airways from collapsing using continuous air pressure. It has also proved beneficial in reducing asthma symptoms by increasing airflow, inflammation, and acid reflux.
Sinusitis (also known as a sinus infection) is when the sinuses become inflamed and cause pain around the face and eyes, nasal congestion, runny nose, headache, coughing, throat irritation, and difficulty sleeping. Sinusitis can be either a temporary reaction to allergens or a cold or be chronic, lasting several weeks or more.
Sinusitis does not cause the throat’s muscle tone to weaken as sleep apnea does. Still, it often causes you to breathe through your mouth at night, worsening apnea symptoms. If chronic sinusitis is left untreated, it can also lead to obstructive apnea. Additionally, if you frequently suffer from chronic sinusitis, you may have an anatomical issue that makes you more prone to infections, and this same issue may also cause sleep apnea.
Allergic rhinitis is when the inner lining of the nose becomes inflamed due to an allergic reaction. These include seasonal allergens like pollen or grass seed or environmental allergens like dust, pet dander, smoke, or chemicals. This inflammation can lead to a stuffy or runny nose, sneezing, and excessive mucus that runs down the throat. If you suffer from allergic rhinitis either seasonally or chronically, it can force you to breathe out of your mouth, worsening sleep apnea. And those with allergic rhinitis are over 50% more likely to also suffer from sleep apnea.
Your septum is the portion of bone and cartilage that divides your nose in half. When the septum becomes misaligned or damaged due to an accident or as a trait you were born with, it can cause uneven breathing and narrower airways. People with a deviated septum will often breathe out of their mouth, especially at night, because their oxygen level is too low. Excessive mouth breathing can lead to dry mouth, sinus pressure, and mild sleep apnea.
Those suffering from both a deviated septum and sleep apnea may find that septoplasty (surgically reconstructing the septum) can help relieve sleep apnea, but this is generally only recommended if you’ve exhausted another treatment option like using positive airway pressure or an oral appliance.
Those with type 2 diabetes are at a significantly higher risk of suffering from obstructive sleep apnea. Obesity is the most well-known risk factor for sleep apnea because it results in extra weight applied to the throat muscles or fat deposits around the upper airway, which restricts breathing.
Obesity is also a major risk factor for type 2 diabetes. These two conditions combined can exacerbate one another and lead to further problems like high blood pressure or heart disease. Additionally, those with sleep apnea often experience stress related to sleep deprivation which can trigger your body to release stored glucose, elevating blood sugar levels and worsening the effects of diabetes.
Lastly, a recent study has shown that people with amyotrophic lateral sclerosis (ALS) are more likely to suffer from sleep apnea. It’s long been known that ALS patients suffer from sleep disturbances. Still, these new sleep studies show that at least 40% of those with ALS experience nocturnal hypoventilation (periodic breathing), a key indicator of sleep apnea. However, more research needs to be done to support these new findings.
Can Sleep Apnea Be Secondary to Tinnitus?
Sleep apnea is a sleep disorder where breathing repeatedly stops and starts during sleep. This can lead to disrupted sleep, fatigue, and other problems. Tinnitus, on the other hand, is that ringing, buzzing, or humming sound in the ears that doesn’t have an external source. Knowing the potential connection between sleep apnea and tinnitus can help you receive crucial benefits and better medical care.
At first glance, these two conditions might seem unrelated; however, growing evidence suggests a link between them. Some researchers believe that tinnitus can disrupt sleep patterns, making it harder to get a good night’s rest. This disruption can, in turn, exacerbate or even lead to sleep apnea. For instance, veterans with severe tinnitus might find it harder to fall asleep; over time, this lack of deep sleep can lead to changes in breathing patterns, paving the way for sleep apnea.
Also, both sleep apnea and tinnitus can result from traumatic brain injuries (TBIs)—a common injury among combat veterans. When someone experiences a TBI, it can affect both the parts of the brain that regulate sleep and the auditory system. So, while tinnitus might not directly “cause” sleep apnea, they can be twin outcomes of a deeper issue.
The U.S. Department of Veterans Affairs (VA) recognizes both sleep apnea and tinnitus as service-connected disabilities. So, if a veteran can show that these conditions were caused or worsened by their time in service, they might be eligible for compensation.
To be eligible, veterans must prove the connection between their military service, tinnitus, and sleep apnea. Gathering evidence—like service records, medical exams, or statements from fellow service members—can help build a solid case.
10 Steps to Writing a Nexus Letter for Sleep Apnea
1. Team Up with Your Doctor
Your doctor’s opinion matters more than you’d think. Approach your physician and explain why you need the nexus letter. Look for a doctor specializing in sleep medicine, preferably one with experience handling VA claims. A specialist with a solid reputation can provide an authoritative opinion that carries significant weight during the claims process. This collaboration will add credibility to your claim.
2. Share Your Story
You must present a comprehensive account of your condition in the nexus letter. Write about your sleep apnea symptoms, how they impact your daily life, and when they first appeared. Explain how your military duties, such as exposure to loud noises, hazardous substances, or extreme stress, could have contributed to your sleep apnea developing (or worsening).
Be honest, detailed, and don’t hold back. Remember, this is your chance to make the case personal and convincing.
3. Cite Medical Evidence
Back up your story with medical evidence. Your nexus letter should refer to relevant medical records, test results, and sleep study reports. Be sure to include dates, locations, and any other relevant information that strengthens the link between your condition and service.
4. Connect the Dots
The magic happens when your doctor connects the dots between your service and sleep apnea. Ask them to state that your condition is “at least as likely as not” connected to your military service. This phrase carries weight and demonstrates the causal relationship you’re looking for.
5. Be Specific and Clear
Avoid using vague language or medical jargon in your nexus letter. Keep it simple and easy to understand. You want the decision-maker to grasp your situation without needing a medical dictionary.
6. Address Counterarguments
Acknowledge any potential counterarguments that might arise. If there’s any evidence suggesting your sleep apnea is unrelated to your service, don’t ignore it. Instead, ask your doctor to explain why they believe it’s connected despite those factors.
7. Timely Filing
Time is of the essence! Submit your nexus letter along with your disability claim promptly. This shows how important your case is, and that you’re serious about getting the benefits you deserve.
8. Seek Professional Assistance
If you’re uncertain about how to structure your nexus letter or need help with the medical jargon, don’t hesitate to seek assistance. There are veterans’ organizations, advocates, and even attorneys experienced in handling disability claims who can lend a hand.
9. Proofread Like a Pro
Typos and grammatical errors can be distracting and may weaken your case. Read the letter carefully, and ask a friend or family member to review it as well. A polished nexus letter reflects your dedication to your claim.
10. Stay Positive and Persistent
Sometimes, claims can get tangled up in bureaucracy. Stay positive and persistent throughout the process. If your claim gets denied initially, don’t give up. Appeal the decision, and continue pushing forward.
Winning a VA disability claim for sleep apnea and similar respiratory conditions is an uphill battle, but it isn’t impossible. With the information presented here, you can work with us to evaluate the strength of your sleep apnea disability claim and decide whether applying for VA disability compensation is the best path for you.