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'm so thankful and grateful for all the hard work Jason, Tina and Liz did for me. They went above and beyond to get the best outcome for me. They took the to explain everything that was going on with my case again I'm so thankful grateful and happy with the outcome of my workers comp case.Adrian Adams
First off, I must say thank you again to the office of Perkins Studdard. I appreciate all the hard work and dedication your office has shown to achieve a successful and happy outcome. You have forever changed my family’s life!
Also, I wanted to give a special shoutout to Jessica Hyatt for her excellent attitude, advice, and overall professionalism throughout every step of this process.
This journey has finally been complete after more than a decade of being denied and almost giving up. However, two of my old coworkers advised me that the office of Perkins Studdard had also successfully helped them achieve their proper rating too.
Needless to say, this has been one of my best decisions in life. I can now sleep a little better and stress free knowing I finally got what I deserved all along.
Once again, thank you for everything! And shoutout to Travis Studdard, “we did it.”
Respectfully,
Jonathon FloresJonathon Flores
My family and I are so grateful for Jason Perkins and his team. Jason explains thing's to detail and walks you through every step of your case. I would highly recommend Perkins Studdard for your legal needs. Thank you so much Jason and Tina!Chapin & Lea Anne Warner
The best I know for workers comp attorney'sDenise Williams
Jason really has helped me so much through this hard experience I have went through! And the ladies in the office was wonderful with any and everything I had questions about! I highly recommend using this lawyer office to everyone and Jason Perkins for sure!! Thank y'all for everything and making it easier to get through this long though experience!
James HammittJames Hammitt
Thank you so much ! I received excellent representation from the entire Perkins Studdard Law firm, my VA claim was resolved and granted in a timely manner, they were hands on with me during the entire process. I would definitely recommend the firm to any veteran deciding to file a VA claim.Darrell Lynn
I would like to thank the law firm of Perkins-Studdard (Travis) and his team, for performing such an outstanding job, at every possible level, during my recent situation with the VA Disability Claims . From the first time I called and spoke with Mr Studdard with an overview of my situation, until the final settlement was executed (successfully I may add), I always felt that I was in good hands with this firm. Everyone in the office, Jessica, and April were responsive, approachable, knowledgeable, good listeners, and extremely professional. Mr. Studdard was realistic of the circumstances and of the potential difficult process that would lay ahead, should I proceed. I can’t say enough about Travis, and I will always be thankful to him. Travis was committed, and he instilled a real sense of confidence during both the highs and the lows. He ultimately prevailed and the outcome was very much in my favor. Of course, each case is different on its own merits and one can never predict how things ultimately will turn out. All I know is that the settlement far exceeded my expectation. Mr. Studdard has been a blessing to me.
I strongly recommend that anyone who would find themselves in a similar legal situation with the VA to contact Law Offices of Perkins Studdard for a consultation. It was a very positive experience given the circumstances. Thank you again, I shall forever be in your debt.Concetta Hogg
Mr. Perkins, I cannot express enough how thankful I am for your exceptional representation. Your hard work, expertise, and unwavering commitment to my case have left an indelible mark. Thanks to you, I can now move forward with my life, confident that justice has been served.Esli Roque
Travis and his team have been a blessing for me and my family. They have done an amazing job in helping me navigate the VA appeals process. They kept their eye on the ball all the way through the long, difficult and confusing process. I highly recommend Travis and his team because thanks to their professionalism and know how, I got the benefits I deserve.Daniel patriot
Travis has been a blessing to our family, he left no stone unturned and delivered the "W" for my VA claim. Every bit of my experience with the Perkins Studdard team was respectful and they demonstrated their appreciation for our service as veterans. I highly recommend this Law Firm and truly appreciate their willingness to stand on my behalf.M L
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.
