Tips and Strategies to Get a VA Rating for Sleep Apnea
Sleep apnea is one of the most common VA disabilities that veterans file claims for.
If you’re experiencing sleep apnea symptoms and served in the military, there’s a good chance that your condition is service-connected.
But proving it to the VA can be an entirely different story.
Sleep apnea is one of the hardest claims to get service-connected, especially if you weren’t diagnosed with sleep apnea via a sleep study during the military.
Most veterans are better off filing sleep apnea as a secondary claim to a condition that’s already service-connected (more on that below).
You’ll want to get a nexus letter for sleep apnea from a private healthcare provider to help make the connection.
What is Sleep Apnea?
Sleep apnea is a serious condition where your breathing repeatedly stops and starts during sleep.
There are three main types of sleep apnea:
- Obstructive Sleep Apnea (OSA): The most common form, caused by the throat muscles relaxing.
- Central Sleep Apnea: Occurs when your brain doesn’t send the proper signals to the muscles that control breathing.
- Complex (Mixed) Sleep Apnea: A combination of obstructive and central sleep apnea.
For veterans, Obstructive Sleep Apnea (OSA) is the type most often seen in VA claims.
VA Disability Rating Criteria for Sleep Apnea
The VA rates sleep apnea from 0% to 100% with breaks at 30% and 50%, under Diagnostic Code 6847 in 38 CFR § 4.97, schedule of ratings for the respiratory system.
The rating criteria are based on the severity of the condition and the treatment required.
Here’s a breakdown of the ratings:
100% VA Rating for Sleep Apnea
- Criteria: Chronic respiratory failure with carbon dioxide retention or cor pulmonale (right heart failure), or the need for a tracheostomy.
- Explanation: This is for veterans with the most severe form of sleep apnea. If your condition leads to respiratory failure, heart issues, or requires a tracheostomy, you’ll qualify for the highest rating of 100%.
50% VA Rating for Sleep Apnea
- Criteria: Requires the use of a continuous positive airway pressure (CPAP) machine.
- Explanation: Most veterans with sleep apnea who require a CPAP machine fall into this category. If you’ve been prescribed a CPAP to help manage your sleep apnea, you’re likely eligible for a 50% rating.
30% VA Rating for Sleep Apnea
- Criteria: Persistent daytime hypersomnolence (excessive daytime sleepiness).
- Explanation: This rating is for veterans whose sleep apnea causes significant daytime sleepiness, but who don’t require a CPAP machine. If your sleep apnea disrupts your sleep to the point where it impacts your daily life, you may qualify for 30%.
0% VA Rating for Sleep Apnea
- Criteria: Asymptomatic but with documented sleep disorder breathing.
- Explanation: This rating is for veterans who have documented sleep apnea but don’t experience symptoms severe enough to affect daily life or require a CPAP machine. A 0% rating means your condition is recognized as service-connected, but it doesn’t warrant compensation.
How to Prove Service Connection for Sleep Apnea
To receive a VA rating for sleep apnea, you must first establish service connection.
It can be difficult, but not impossible.
There are two main ways to prove your sleep apnea is service-connected:
#1. Direct Service Connection for Sleep Apnea
You’ll need to provide Service Treatment Records (STRs) showing that your sleep apnea began or worsened during your military service. It also helps to have in-service documentation of sleep issues, such as snoring, gasping for air, or daytime sleepiness. If you were diagnosed with sleep apnea while on active duty, this is a strong case for direct service connection. Note: This means you had a sleep study on active duty and received a formal diagnosis during your military service.
#2. Secondary Service Connection for Sleep Apnea
If your sleep apnea is caused or worsened by another service-connected condition (e.g., PTSD, obesity, or respiratory issues), you can file a claim for secondary service connection. For example, many veterans experience sleep apnea as a result of weight gain related to other service-connected conditions like joint pain or anxiety and depression. Note: If your sleep apnea was not diagnosed during the military, you’re better off trying to connect it secondary to another service connected disability.
5 Pro Tips for Winning Your VA Sleep Apnea Claim
I’ve educated thousands of veterans over the years on VA sleep apnea claims.
Here’s my top 5 pro tips to win and service connect sleep apnea:
#1. Get a Diagnosis of Sleep Apnea via a Sleep Study
Your sleep apnea VA claim starts with a sleep study. You need an official diagnosis of sleep apnea confirmed by a polysomnogram or similar testing. Without this, the VA will not consider it as a valid diagnosis.
#2. Get a Disability Benefits Questionnaire (DBQ) for Sleep Apnea
In addition to getting a nexus letter to connect sleep apnea as a secondary claim, I also recommend you have a private healthcare provider complete a DBQ for sleep apnea and submit it and your nexus letter with your Fully Developed Claim (FDC). The combination of a DBQ and a nexus letter at claim submission can potentially get your sleep apnea claim approved without a separate C&P exam for sleep apnea.
#3. Link Sleep Apnea Secondary to Other Service-Connected Conditions
If you’re filing a secondary claim (e.g., for sleep apnea caused by PTSD), get a nexus letter from a medical professional explaining how your service-connected condition contributes to your sleep apnea. This letter is essential to establish the connection.
#4. Document the Severity of Your Symptoms
If you’re experiencing significant daytime sleepiness, make sure it’s documented in your medical records. If you require a CPAP machine, ensure that this is also clearly documented by your doctor. Remember, your final VA rating for sleep apnea depends on the severity of your symptoms in terms of frequency (how often), severity (how bad), and duration (how long).
#5. Buddy Letters Can Tip the Scales in Your Favor
Statements from family members or fellow service members who witnessed your sleep issues during or after service can be very effective. If your spouse has observed you snoring loudly, gasping for air, or stopping breathing in your sleep, their testimony could strengthen your claim. I’ve seen well-written buddy letters tip the scales in favor of the veteran, especially when you’re trying to provide evidence to the VA that your sleep apnea and sleep issues existed during military service.
What If Your Sleep Apnea Claim Is Denied?
Don’t be discouraged if the VA denies your claim initially — it happens frequently with sleep apnea claims.
You have the option to file an appeal.
Focus on strengthening your medical evidence:
- If you didn’t have a nexus letter at initial claim submission, you’ll want to get one and file a Supplemental Claim.
- If you did have a nexus letter at intitial claim submission, and the VA denied service connection, you’ll want to file a Higher Level Review (HLR).
- Consider obtaining a second nexus letter for sleep apnea from a private physician to bolster your case.
- Consider obtaining a DBQ for sleep apnea and submitting it and your new nexus letter as a Supplemental Claim.
Remember, a denial is not the end — you have the right to challenge it and provide additional evidence to support your claim.
Can Sleep Apnea Be a Secondary Claim?
Yes, sleep apnea can be connected secondary to another service-connected disability.
In my experience, most veterans are better off trying to connect sleep apnea via secondary service connection versus direct service connection.
Here’s a list of the five strongest sleep apnea secondary conditions that are easy to win with a nexus letter:
1. Sleep Apnea Secondary to PTSD
Sleep apnea is frequently linked to PTSD, especially in veterans. PTSD causes chronic stress and hyperarousal, which can disrupt sleep patterns and worsen breathing issues during sleep. Veterans with PTSD are at higher risk of developing sleep apnea because the constant state of heightened anxiety often leads to fragmented sleep. This disrupted sleep can cause or exacerbate obstructive sleep apnea (OSA), creating a cycle where each condition worsens the other. Medical research indicates that nearly half of veterans diagnosed with PTSD may also suffer from sleep apnea, making this one of the most common secondary connections.
2. Sleep Apnea Secondary to GERD
Gastroesophageal reflux disease (GERD) can lead to or worsen sleep apnea due to the regurgitation of stomach acid, particularly at night. Acid reflux causes irritation and inflammation in the throat and airways, which can obstruct breathing during sleep. This increased difficulty breathing can result in more frequent apneic episodes, disrupting restful sleep. The correlation between GERD and sleep apnea is well-established, as both conditions exacerbate each other, with GERD contributing to breathing interruptions that are characteristic of obstructive sleep apnea.
3. Sleep Apnea Secondary to Rhinitis
Rhinitis, which is inflammation of the nasal passages, can lead to breathing difficulties during sleep, contributing to the onset of sleep apnea. When nasal passages are congested, airflow is restricted, forcing individuals to breathe through their mouths. This shift from nasal to mouth breathing can lead to airway collapse during sleep, resulting in obstructive sleep apnea episodes. Rhinitis, especially when chronic, has been shown to increase the risk of developing sleep apnea by narrowing the airway and restricting airflow.
4. Sleep Apnea Secondary to Sinusitis
Sinusitis, the inflammation or infection of the sinuses, can cause blockage of the nasal airways, leading to interrupted breathing during sleep. When the sinuses are swollen and blocked, airflow is reduced, which can worsen or cause obstructive sleep apnea. This condition is particularly problematic for veterans who may already have underlying respiratory issues. Chronic sinusitis often results in long-term nasal congestion, making it harder to maintain normal breathing patterns during sleep, and increasing the likelihood of experiencing apneic episodes.
5. Sleep Apnea Secondary to Deviated Septum
A deviated septum occurs when the nasal septum, the thin wall between the nostrils, is misaligned, restricting airflow through one or both nostrils. This reduced airflow can make it difficult to breathe through the nose, particularly during sleep, leading to mouth breathing, which increases the risk of airway collapse and obstructive sleep apnea. Veterans with a deviated septum often experience heightened breathing issues at night, contributing to the development or worsening of sleep apnea, especially when combined with other respiratory conditions.
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About the Author
Brian Reese is one of the world’s top VA disability benefits experts and the #1 bestselling author of VA Claim Secrets and You Deserve It. Frustrated with the VA claim process, Brian founded VA Claims Insider to help disabled veterans win their VA disability compensation faster. He has served over 10 million military members and veterans since 2013. A former Air Force officer, Brian deployed to Afghanistan in 2011. He is a Distinguished Graduate from the U.S. Air Force Academy and holds an MBA from Oklahoma State University, where he was a National Honor Scholar.
