IMPORTANT UPDATE (Effective April 18, 2016)
Before April 18, 2016, all you had to show to get that 50% rating level was that your doctor had prescribed you a CPAP breathing assistive device.
New changes to the VA M21-1MR (click here to see what the M21-1MR manual is) made two significant changes that made it both harder – and easier – to get a 50% rating for Sleep Apnea.
Here’s the Question You Think You Want to Know the Answer To.
How does the VA Rate (assign a percentage and $ compensation amount) to Sleep Apnea?
I’ll go ahead and answer that, but I don’t think it is the question you are REALLY asking me….scroll down to see the questions I think you meant to ask (and my answers to those questions).
The VA uses the Rating Tables for sleep apnea, and you can find the Table used to rate Sleep Apnea at 38 C.F.R. § 4.97.
Go to that section of the CFR, and look for diagnostic code (DC) is 6847.
You can tell if the VA rated you directly for Sleep Apnea, as your code sheet will list only the four digit DC for Sleep Apnea (6847).
You can tell if the VA rated your sleep apnea as secondary to another condition, as your Code Sheet will list an 8-digit DC for the sleep apnea condition. (e.g. XXXX-6847, where the XXXX is the four digit code for another disability, disease, or illness).
6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed):
100%: Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy
Cor pulmonale is, oversimplified, failure or enlargement of the right ventricle of your heart.
50%: Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine
30%: Persistent day-time hypersomnolence
Hypersomnolence is, oversimplified, the need for a great deal more sleep than average; like narcolepsy, it can make you fall asleep unintentionally, although it is quite different from narcolepsy.
0%: Asymptomatic but with documented sleep disorder breathing
Asymptomatic is a medical term used to describe a condition which has been diagnosed, but which is not currently showing any visible symptoms. For example, the VA often erroneously concludes that a condition was misdiagnosed or that a diagnosis cannot be confirmed when in fact the disease or condition is “asymptomatic”.
* And just because the particular symptoms or limitations of your Sleep Apnea aren’t listed here, don’t forget that you can seek an EXTRA-SCHEDULAR rating if your Sleep Apnea symptoms and limitations present a unique VA disability picture. Learn more about this little-known type of VA claim by visiting this post on the Veterans Law Blog.
Here’s the Question I Think You Meant to Ask:
Anybody can go online and find the Sleep Apnea VA Disability Rating criteria. You may have found this page searching for that very phrase.
But I don’t think you are really asking me for that easy information – after all, before you came here, you probably found a dozen websites with the information above.
What I think you’re REALLY wanting to know is how to get the Sleep Apnea VA Disability Rating you believe you are entitled to. If that’s what you want, I’ve written a post to answer this specific question – check out the answer here.
Did I get it wrong?
Are you looking to learn something else about VA Sleep Apnea Claims? Here are a few posts on the Veterans Law Blog you should check out: