A Guide to Filing a Sleep Apnea Claim with the VA

Obtaining a sleep apnea VA rating can be easier said than done. Even though veterans have the opportunity to file for disability benefits through the VA, not every claim is accepted. Sleep apnea cases can be especially complex, as finding a direct link to a service-related event is not always easy. 

While following these steps might lead to a denied claim, it is crucial to understand that this does not mean your case has come to an end. Many veterans get the benefits they deserve during the appeals process. Let the attorneys of Gang & Associates help you get the best possible outcome on appeal.

Step 1: Make Sure You Qualify for a Sleep Apnea VA Rating

Before you ever file your claim, it is a good idea to review the eligibility requirements first. Sleep apnea can be more difficult to directly link to your military service than an acute injury or an illness caused by toxic exposure. Reviewing each of these qualifications could improve your chances of filing a viable claim. Generally stated, the requirements are that you are a veteran, you are living with a disability, and your disabling condition is linked to an event during your service.

Proof of Your Veteran Status

It should come as no surprise that VA benefits are restricted to veterans, but that word could mean more than you realize. You qualify as a veteran if you were on active duty, active duty for training, or inactive duty for training. You may not attain veteran status under VA’s laws if you received an other than honorable, bad conduct, or dishonorable discharge. Gang & Associates has helped countless veterans overcome these hurdles and secure veteran status. If you or someone you know needs help attaining veteran status, do not hesitate to contact us.

A Diagnosis of Sleep Apnea

You will also need evidence that you are living with a disabling condition, specifically sleep apnea. While a diagnosis is not necessary for every claimed disability, to secure service connection for sleep apnea specifically, you will require a formal diagnosis from a doctor; otherwise, you can expect your claim to be denied. Sleep apnea is a unique condition that generally requires a sleep study, or a polysomnography, to obtain a diagnosis. These studies usually take place in clinics where you are observed by medical experts who specialize in this field as you sleep. These doctors have usually completed a residency in a field such as internal medicine, pulmonology, otolaryngology, psychiatry, or neurology, and are board certified by the American Board of Sleep Medicine (ABSM).

A Nexus Between Your Condition and Your Service

For your claim to succeed, you will need a nexus between an event during your service and your sleep apnea. On occasion, the symptoms of sleep apnea began while on active duty. However, if this is not the case, or if those symptoms are not well documented in service medical records, establishing a nexus can be difficult to prove. Often, the factors that lead to sleep apnea frequently result from other disabling conditions or from exposure to an environmental hazard, such as dust, sand, and/or burn pit smoke while deployed overseas in Southwest Asia. Most veterans rely on a medical expert to write a nexus letter on their behalf. This document provides a formal medical opinion that a veteran’s sleep apnea is related to a specific event during their service. 

It is worth noting that you may also qualify for benefits when sleep apnea is a secondary condition. In other words, you could recover benefits if you can show that your sleep apnea is tied to another disability that has already been rated by the VA.  Common examples of disabilities that cause, or aggravate, sleep apnea are posttraumatic stress disorder (PTSD), rhinitis, and sinusitis. In addition, obesity can be used as an intermediate step to link sleep apnea to a service-connected disability. 

Step 2: File Your Claim

You have a few different ways to file your claim with the VA. Most people file online using VA’s website. You can also apply by mailing and/or faxing a VA form 21-526EZ to the VA. Another option involves walking into the local VA office to apply in person. Regardless of what method you choose, ALWAYS make sure to secure and keep a record of the filing.

If you are still developing the evidence needed to win your claim – for instance, if you are experiencing sleep apnea symptoms, but have yet to secure a sleep study formally diagnosing it – you  might want to first submit an Intention to File a Claim, VA form 21-0966. This serves as a placeholder for effective date purposes so long as you complete your formal application by filing a VA Form 21-526EZ within the year. 

Step 3: Follow Any Instructions From the VA

For some people, all that is left to do after filing their claim is to wait. For others, the VA may request additional documentation. To avoid delays, it is important to provide them with what they ask as soon as possible. In many cases, the VA will require that you attend a Compensation and Pension (C&P) examination. These exams are often performed by VA or VA-contracted doctors, but are also frequently conducted by other VA or VA-contracted medical professionals who never attended medical school, such as nurse practitioners or even physicians’ assistants. Unfortunately, it is not uncommon for the VA decision-makers to use the C&P examination results to deny your claim. The right attorney could help you refute negative C&P examinations. 

Once you have followed any additional instructions, it is time to wait for a result. The VA will formally notify you of the outcome.

Step 4: Consider an Appeal if Necessary

If your claim is ultimately denied, you have the opportunity to file an appeal with the VA. Even if VA grants service connection for sleep apnea, VA does not always assign the correct disability rating. Therefore, it may be in your best interest to appeal for a higher rating even if service connection is established. Under the Appeals Modernization Act, you have one year from the date of your denial letter to file an appeal. There are a number of appellate paths you can take, and it is a good idea to consult legal counsel before determining how to proceed.

Get Help With Your Sleep Apnea VA Rating Appeal 

If your claim for VA benefits is denied, or if it is granted but with a rating you disagree with, you have legal options. With our assistance, many veterans have successfully appealed to secure the compensation they deserve. 

At Gang & Associates, we understand what your sleep apnea VA rating means to you. We can handle every aspect of your appeal while answering any questions you might have along the way. Appealing on your own is a risk you may not be able to afford. Contact us online or call 888-878-9350 as soon as possible to discuss your options.