Obstructive Sleep Apnea rating

Jim,

I just found your website and thank you very much, I found it helpful.

On the WEB I have been following the development on OSA and the VA seeking to change the disability rating, but don’t know when that will take effect. I have OSA and use a CPAP, diagnosed on AD three years ago. I have not had my VA exam yet but intend to retire next year. What do you hear about this topic and when might it be officially changed? Are they already denying new claims?

Reply:

No, for now the rating remains the same. To my knowledge, there is no immediate or active push by VA to change the rating. The issue is being studied but as with most things VA, by the time they get around to it the current administration will change and a new set of temps will be in those offices to make their own changes. Change at VA occurs very slowly if it occurs at all.

There has been a lot of noise about the rating lately. This is mostly because veterans benefits are in the news a lot lately as VA has done such a poor job of processing claims and serving veterans.

The 50% rating for having a CPAP prescribed because of Obstructive Sleep Apnea (OSA) seems relatively high at first glance. However, if we look at The Schedule For Rating Disabilities

http://www.benefits.va.gov/warms/bookc.asp

and scroll to The Respiratory System and review the ratings there, we see that many respiratory ratings are comparatively high. I believe that this is because the people who originally put those ratings in place recognized the severity of the impact of any condition that interferes with breathing.

Most detractors of the current 50% rating denigrate it and the veterans who receive it because they believe that it's only about snoring and everyone snores...at least a little. Of course, this denies the fact that OSA is a serious problem and will impact the overall health of the veteran patient. OSA contributes to the development of many other health problems. OSA may be a factor in diabetes, high blood pressure, heart disease, stroke and many other health problems. PTSD and OSA have been shown to be connected. Daytime sleepiness is thought to be a contributor to traffic accidents because of a lack of focused attention by the sleepy driver.

It's very annoying to read things like, "But Smith followed up by comparing a CPAP to eyeglasses. 'If I don’t use my glasses, my earnings are going to be a hell of a lot less because I’m blind,' he said. 'Once I put them on, no problem.” If CPAP 'pretty much cures the problem, why would you give a service rating for it?'”

http://www.stripes.com/news/veterans/va-looks-to-tighten-sleep-apnea-rating-schedule-1.226772

That from a committee member who is supposed to understand these things. He would likely say that to give a blind man a dog fixes everything or to offer an amputee an artificial leg is enough, so let's not compensate him.

Also please read:

http://umm.edu/health/medical/reports/articles/obstructive-sleep-apnea

http://www.nejm.org/doi/full/10.1056/NEJM199903183401104

Simply giving a patient a CPAP doesn't cure the disease. A CPAP isn't an easy machine to use. It requires a lot of initiative by a patient who may be claustrophobic to use it at all. Strapping that mask onto ones face every night isn't a particularly pleasant experience. Using a CPAP may break apart the marital bed as the partner who has to deal with the hoses and noises of the machinery feels pushed out.

To change a rating and to downgrade it isn't easy for VA. The Secretary does have the authority to make such changes but it's pretty rare in my experience that significant changes are made. The most recent changes have all been positive...and controversial. When Secretary Shinseki added benefits for Vietnam veterans who were exposed to agent orange, many opposed that. The impact on the budget was significant and a lot of detractors tried to stop those benefits from becoming effective as the Secretary wanted them to.

Overall, I believe that OSA is a serious problem and it's becoming more serious for the younger generations of warriors who were exposed to such chemicals as are found in the infamous burn pits of our recent wars. Much like agent orange, it may be years before the government recognizes the injuries that were caused to the respiratory systems of these soldiers.

http://www.publichealth.va.gov/exposures/burnpits/health-effects-studies.asp

I'd hazard a guess that when rational minds are given a chance to make decisions about the rating, it won't change. Finally...if the VA were to change the 50% rating assigned to OSA that requires the use of a CPAP, many veterans who hold the rating today may be protected from the change.

http://www.benefits.va.gov/warms/docs/admin21/m21_1/mr/part3/subptiv/ch08/ch08_secc.doc

For more information about Obstructive Sleep Apnea be sure to visit these links:

http://www.danaise.com/index.php/veteran-disability/44-understanding-veteran-disability-rating-for-sleep-apnea

and

The VAWatchdog OSA Page at http://www.vawatchdog.org/obstructive-sleep-apnea-osa.html