VA Continues to Pay Disability to Veterans with Sleep Apnea

By Debbie Gregory.

Sleep apnea has become a major health concern in the Veteran community. The VA’s Veterans Health Library claims that as many as 30 million Americans may suffer from varying types of sleep apnea. The VA says that as many as 24% of men and 9% of women between the ages of 30 and 60 may be affected by the disorder.

The most common type is Obstructive Sleep Apnea (OSA). The Mayo Clinic describes OSA as: “a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep.” The clinic calls OSA a serious medical condition that can lead to cardiovascular problems, daytime fatigue and sudden death.

Back in 2001, the number of Veterans who received compensation from the VA for sleep apnea claims was 983. By the end of 2013 more than 143,000 Veterans were rated disabled by sleep apnea. Almost 90% of OSA claims are approved for a 50% disability rating or higher. Any Veteran who is prescribed a Continuous Positive Airway Pressure (CPAP) machine receives a mandatory 50% VA disability rating. And any Veteran who was diagnosed with OSA while on active duty, or who can link their condition back to their service is prescribed a CPAP machine. It is estimated that the VA paid out over $1.5 billion last year.

The increase in claims and the seemingly high disability ratings and subsequent payouts have caused some people to question the legitimacy of the claims. Civilians and Veterans have made accusations of Veterans abusing the system. Some even claim that service members are encouraged, even coached, on how to get sleep apnea claims approved before they separate in order to guarantee their 50% or more disability rating. The VA said that they take these accusations seriously, and would look into their claims process.

The current process requires a diagnosis from a doctor. According to VA Form 0960L-2, the Sleep Apnea Disability Benefits Questionnaire, the diagnosis of sleep apnea must be confirmed by a sleep study, conducted by a licensed physician. The VA will then review the doctor’s findings, and either approve or disapprove the claim according to VA guidelines, governed by Congress.

Last summer, the VA’s Advisory Committee on Disability Compensation made a recommendation to the department’s Under Secretary for Benefits, retired Brigadier General Allison Hickey. The committee recommended that the VA change their policy regarding sleep apnea claims by requiring compensation exams for sleep apnea be conducted exclusively by VA doctors, researching a possible connection between military service and sleep apnea, establishing an average earning loss for Veterans who are diagnosed with sleep apnea, and commissioning the Institute of Medicine to conduct research regarding the debilitating effects of sleep apnea to ensure that the current disability rating is not too high

So far, the VA has not directly acted on the committee’s advice. The VA has acknowledged accusations made about “fraudulent sleep apnea claims,” and the VA denies that there are Veterans abusing the system.  In direct response to the accusations made regarding abuse of the system by Veterans and the mishandling of claims by the VA’s claims representatives, the VA issued the following statement:

“It is the position of the Veterans Benefits Administration that it is never a waste of tax dollars to pay Veterans the benefits to which they are legally entitled. Our primary concern is to ensure that Veterans, their families and their survivors receive disability compensation to which they are entitled.”