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VA Proposes to Change How it Rates Sleep Apnea

Posted by Gregory M. Rada | Firm News

The VA announced that it is beginning the process of amending its rating criteria for sleep apnea to change the way it assigns ratings. These changes are currently in the proposal stage and are subject to change before they are finalized in the following months.

Why is VA Revising the Rating Criteria for Sleep Apnea?

The VA continuously revises the rating schedule so that rating criteria are consistent with up-to-date medical knowledge. With respect to sleep apnea ratings, VA states that “the discipline of sleep medicine has greatly evolved since VA published the existing criteria,” and thus, “VA proposes to extensively revise the rating criteria for sleep apnea to primarily provide compensation that is more compatible with earning impairment than the current criteria” because “the current criteria evaluates based upon treatment rather than actual impairment.”

Put another way, VA is proposing to rate sleep apnea based on whether treatment works or not. If you use a CPAP and the CPAP resolves your symptoms of being unable to sleep or daytime tiredness, then you would receive a 0% rating. If your treatment doesn’t work, you will be able to receive a rating higher than 0%.

How is VA Proposing to Rate Sleep Apnea?

In VA’s own words, it wants to “focus on the results rather than the type of treatment” when assigning a rating for sleep apnea.

VA is proposing to assign a 0% rating when sleep apnea is “asymptomatic, with or without treatment.” It would assign a 10% rating when treatment results in “incomplete relief.” It would assign a 50% rating when “treatment is either ineffective or a veteran is unable to use the prescribed treatment due to comorbid conditions.” Finally, it would assign a 100% rating when sleep apnea results in end-organ damage  (damage occurring in major organs fed by the circulatory systems such as the heart, kidneys, brain, eyes).

These changes will make it difficult to receive more than a 10% rating for sleep apnea. Further, the new criteria ignores the fact that someone prescribed a CPAP has to be hooked up to a machine every night to get relief.

Will these Changes Impact my Current Rating?

No. The proposed changes would only apply to new claims and increased rating claims (and only after these proposed changes are finalized which is going to at least be months from the date of this post). Your current sleep apnea rating will stay as it is until/if you file a new claim for increased rating.

Is there Anything Else I Should Know about the New Rating Criteria?

This is currently a proposal and won’t go into effect until months after this blog post. Moreover, there’s a chance it doesn’t go into effect all.