Probably not, because these changes are deep within VA’s claims adjudication manual that VA claims examiners use to decide claims. If you are a veteran seeking VA sleep apnea disability compensation, here is what you need to know so you can meet the newest requirements by VA.
Keep reading and we’ll let you in on a secret about VA sleep apnea claims.
Where Are These Changes to VA Sleep Apnea Rules?
If you have been through the VA disability process before, you probably know that VA decision making seems random with different VA personnel deciding the same types of claims very differently. The process is often filled with delays and errors that could be avoided.
It may surprise you to learn that the VA actually has a series of written policies on how to decide VA disability claims. This huge document is a “playbook” for VA personnel to use in deciding every type of VA claim.
That playbook is M21-1MR Adjudication Procedures Manual. The M21-1MR is constantly being updated in a piecemeal fashion. One of those most recent updates was the section dealing with the adjudication of VA sleep apnea disability claims.
Beware This Pitfall in VA Sleep Apnea Claims
One of the two changes makes it a little easier for the Regional Office to deny your VA sleep apnea claim at the 50% disability rating level. The diagnostic criteria for a VA sleep apnea claim, found in the Code of Federal Regulations, have not changed. For a 50% rating, the diagnostic criteria still “Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine.”
But, with these changes in the VA playbook, VA is placing a greater emphasis on what is meant by the word “required.” Look at this new language in the m21-1MR:
“When determining whether the 50-percent criteria are met, the key consideration is whether use of a qualifying breathing assistance device is required by the severity of the sleep apnea.”
A little bit later on, the manual now says,
“Use absent a medical determination that the device is necessary does not qualify. The regulation requires that the device be necessary and this is a medical question.”
That last phrase should be a warning – and a clue – to you. In the past, if you presented evidence that your doctor prescribed a CPAP machine to help with your sleep apnea that was sufficient evidence in the eyes of VA for a 50% VA sleep apnea rating. VA personnel were like me; they assumed doctors did not prescribe anything that was not medically necessary.
So, a prescription for a CPAP was proof that it was required for treatment of sleep apnea. Now, you need more than that because VA refuses to assume anything.
What You Can Do to Safeguard Your VA Sleep Apnea Claim?
VA’s own playbook now says the necessity of a CPAP or other breathing assistance device is a medical question. In VA sleep apnea claims (and all VA disability claims, really), medical questions can only be answered with medical evidence. That usually means a doctor’s opinion.
The bad news is that this extra scrutiny by VA will be a trap for the unwary. If a veteran doesn’t have a statement from the doctor saying the CPAP is medically necessary, it is an invitation for VA to deny the claim now.
So, get the prescription for the CPAP or other breathing assistance device. Also, have the doctor put in writing that the device is medically necessary to treat the sleep apnea. Your doctor may give you a funny look when you ask him to give written justification for his prescription, but if he knows anything about the VA he should understand.
All The VA’s Secrets Aren’t Bad – We Will Tell You Those, Too
Travis Studdard is an attorney who focuses on representing veterans in VA disability compensation claims. He regularly writes about issues that are important to veterans and their families.
You can subscribe to his Veterans Disability channel on YouTube.
I highly recommend Travis and his team. From start to finish, the communication and professionalism were outstanding. Jessica was absolutely amazing — responsive, knowledgeable, patient, and always willing to help answer questions and keep me informed throughout the process.
Travis was also excellent and made me feel confident that I was in good hands. Their entire office treated me with respect and care, and I truly appreciate everything they did for me. If you’re looking for an attorney and legal team that genuinely cares about their clients, I would definitely recommend them.Carlos Thornton
Travis Studdard and his team were always professional and from intake to case resolution, they were extremely pleasant to work with. After working closely with them for roughly six years, they successfully appealed my sleep apnea claim with the VA. At times I thought about giving up, but it was their diligence and confidence in their approach that gave me the ability sustain. There were no surprises, they led me by hand every step of the way. My family and I are truly appreciative for their great work. His team truly cares and it shows. They will fight to the end for veterans. I couldn't be happier with the results.James
I had the pleasure to be helped by Travis and his team on my VA disability claim. They know what they are doing, and I would definitely work with them again. I recommend them to any veteran that has a wrongfully denied claim with the VA...Joel Onomo
Travis and his team helped me get my case done when I couldn't get it done by myself.Everything went much faster and better than I expected.I highly recommend his team for any veteran trying to get a claim processed. Norman Scott,U.S.Army veteranNorman Scott
Jason Perkins and his team are so kind, knowledgable and helpful. They were thorough with all my legal needs and made sure my medical needs were taken care of financially. What I most appreciate is that he was always very clear about what was best for my case, but he also always told me I needed to do what was best for me, both mentally and physically. He was always available to answer questions, made sure I understood, and was willing to let me make decisions regarding my case. His ethics are beyond reproach. He would not take a percentage of a payment he did not help me receive. You can trust him. He always made it clear that my mental and physical well-being were more important than any part of my case. Then he would explain what would be best for the case and why, and allow me time to decide. Being in the Worker's Compensation system was an incredibly demeaning experience. I am a strong, educated woman, but when everyone in a system tells you that you are not worthy of the care you have received your entire life, and you instantly become less than to many of those who are suppose to be caring for you, it would weigh on anyone. I am so thankful I had Jason and his team fighting for me, getting me things I never would have imagined would be denied, like a second opinion before surgery, or physical therapy instead of opioids. I cannot imagine trying to handle this experience by myself.Andri Pilgrim
Would definitely recommend 10/10! The team was super helpful through the entire process, and always were available for questions anytime I needed. Always quick to respond, and we’re always sweet and professional!Haley Nicole
Perkins Studdard LLC has been wonderful to work with from the first day through the final journey. They were prompt in requesting the information from me so they could appeal my claim with the VA. I had exhausted all means trying but they were able to get me to 100%. I would "HIGHLY" recommend using them if you are having difficulty getting anywhere with the VA.Mike Black
When i found this law firm I was going through a hard time not just with the VA but mentally as well. And after i hard denial i reached out to Travis and let me just say that was the best decision of my life. From the first call i knew i had made the right decision they are nothing short of amazing. Shoutout to Jessica and Chandler they both helped ease my stress and make the process so smooth it felt really good to be heard. My only mistake was not reaching out to them sooner. Thank you all so very muchRilesia Singleton
Perkins Studdard LLC has done for me what VSO, the DAV, and I could not do on my own. For 10 years after my last rating the VA was bound and determined to keep me at my current percentage. My body was tired physically and mentally. I needed help that the civilian world was not going to let me stop work for. I contacted Perkins Studdard and worked with Jessica and Travis. To tell you what I ever hoped for was greatly exceeded. I am able to now properly heal since 2007 when I was medically discharged. I promise when we feel like we are forgotten you have people like Travis and Jessica that work hard for you to make sure you are not. Their policy on pay is exceptional and even when I got aggravated they understood how to keep me calm and helped my patience. I think the VA does not like to see them coming. I got the holy grail, home run, I can breath decision I needed. Let them help you!Lisa Jordan
I have enjoyed my experience with Perkins Studdard. The team is always available to answer questions and make me feel comfortable, and like I matter. Did a great job with my VA Disability.Matt Strange
I understand you want your VA claim to be done as quickly as possible. But remember the ultimate goal – to win your VA disability compensation claim.
You may eventually get there on your own, but it may be after a series of decisions by the Regional Office and Board of Veterans Appeals. Sometimes claims are appealed and remanded several times, which can cause a claim to drag on for years. If you are interested in avoiding unnecessary delay in your claim and want to do everything you can to maximize your chances of success, it is probably a good idea for you to consult with an accredited veterans disability attorney.
We would be happy to talk to you. If you would like a free consultation with our Perkins Studdard veterans disability attorneys just click here or give us a call to begin the process.
