Sleep apnea VA Rating

Sleep apnea is rated under diagnostic code 6847. In the VA Schedule for Rating Disabilities it appears as Sleep Apnea Syndromes (Obstructive, Central, Mixed), within the Respiratory System section of 38 CFR Part 4.

The essentials

Other names for this condition

VA and treating providers may use different terms for the same condition. If your records use any of these, they may still support a claim for Sleep apnea:

• OSA
• obstructive sleep apnea

What evidence decides the rating

For respiratory system conditions, these are the findings VA weighs when assigning a percentage. If your examination did not address them, the examination may be inadequate for rating purposes — which is itself an argument on appeal.

• Pulmonary function testing — FEV-1, FEV-1/FVC and DLCO, with post-bronchodilator values
• For sleep apnea: a sleep study confirming the diagnosis, and whether a breathing assistance device is required
• Documentation that any prescribed device is actually medically required, not merely issued
• Frequency of exacerbations, courses of steroids or antibiotics, and any oxygen requirement

Why these claims get denied or under-rated

These are the failure patterns we see most often on sleep apnea and related respiratory system claims:

• Sleep apnea denied because there is no in-service sleep study — even though the claim was pled as secondary, where an in-service diagnosis is not required
• The examiner said the CPAP was 'issued' rather than 'required', which is the distinction between a 50% rating and a much lower one
• Pulmonary function testing was performed pre-bronchodilator only, or the wrong value was used for rating

Secondary service connection

Under 38 CFR §3.310, a condition caused or aggravated by an already service-connected condition is itself service-connected. Secondary claims are where most veterans are leaving compensation on the table — and where most denials turn on the nexus opinion rather than the diagnosis.

Sleep apnea is commonly claimed secondary to

• PTSD and other mental health conditions
• Allergic rhinitis and chronic sinusitis
• Asthma
• GERD
• Weight gain caused by a service-connected condition (obesity as an intermediate step under VAOPGCPREC 1-2017)
• Medication side effects, particularly sedatives and psychotropics

Sleep apnea commonly causes or aggravates

• Hypertension
• Depression and anxiety
• Migraine
• Cardiovascular disease

If you are already service-connected for sleep apnea and any of these apply to you, they may be claimable as secondary conditions.

If your claim was denied or under-rated

A denial is not the end of the claim. Which route is right depends on why VA decided the way it did:

• Higher-Level Review — when the evidence already in the file supports a grant and VA got the decision wrong, or the examination was inadequate.
• Supplemental Claim — when you have new and relevant evidence, such as a private nexus opinion.
• Board Appeal — when you need a Veterans Law Judge to decide, or want a hearing.
• Clear and Unmistakable Error — when a decision more than a year old contains an undebatable error, which can recover retroactive pay.

Effective dates matter as much as the percentage. See effective dates and back pay for how far back an award can reach.

Sources

• 38 CFR Part 4 rating criteria on eCFR
• VA Disability Benefits Questionnaires (DBQ) index

Related conditions

• Sarcoidosis (DC 6846)
• Diaphragm paralysis (DC 6840)
• Diffuse interstitial fibrosis (DC 6825)
• Malignant neoplasms of the lower respiratory system (lung cancer) (DC 6819)
• Chronic obstructive pulmonary disease (DC 6604)
• Emphysema (DC 6603)