The Bad “Secret” Change to VA Sleep Apnea Rules

VA sleep apnea rules changed.  Did you notice?

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.

top secret
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.

Women bothered by her partners sleep apnea 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.

Doctor taking notes in notebook 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

The VA also slipped in another little secret into their playbook.  This one is not a “dirty little secret” like this new medical necessity requirement.  Instead, this other one will probably help some veterans – if they know about it.

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.

It has been a pleasure working with Jason and firm, very knowledgeable and professional, He did awesome job to get settlement that I need for my workmen comp case which was fair in my case, cause the insurance company was trying low ball me and not give me nothing but Jason fix that ….I truly recommend Perkins&studdard any workmen comp case that you have and also want thank Tina also for helping me along this process Thank you Perkins&studdardjahbari swint
Thank you Jason and Tina for everything you've done. Much appreciated. Great law firm! Great results!! Thank you!!! (Austin and Valerie)Valerie Mellinger
Travis and the team working on my VA claim are awesome. I’m happy with their integrity and diligence on working on my claim.Chris “Greybeard” Mullennix
I can't express enough how great it was to work with Perkins Studdard. They are extremely knowledgeable, professional and keep you aware of everything happening with your case. Very friendly from the front office to Mr. Perkins. I would HIGHLY recommend Perkins Studdard!James Strickland
I recommend Travis for an Veteran that has been dealing with constant denial with claims. He also , cover cost for my nexus letter when I ran into financial troubles , that helped me win my case.edwin Cook
I highly recommend Travis Studdard to represent anyone looking to help with VA claims. The VA is very difficult to deal with when attempting to get benefits from service connected injuries, at least that's my experience. Travis and his team knows the VA system and the legal procedures to help you get what you deserve. Travis was kind and passionate with me throughout this process and therefore, I highly recommend this law firm to represent DAV's.Terry Hembree
Such an awesome team. They spoke to me like a person and helped me through every decision with knowledge.Kevin Collett
Highly recommend this firm. Did exactly what they said they were going to and fairly timely. The VA is sometimes extremely difficult to navigate but this took all the leg work away from me and got me the result I thought was fair.Andrew Boone
Amazing staff, very informed along with excellent communication. Within just a few weeks of work, Mr Studdard was able to make things happen that normally take years! Highly recommendJacob Sylvester
Perkins Studdard LLC is the place you need to be if you have a Workers Comp case going on! Mr. Jason Perkins and his staff get the results that you need. They work with you and fight for you.Coming from another lawyer my husband and I were really surprised and appreciated the communication and honesty and understanding throughout the entire process. My husband loves the videos because they held so much information and helped him understand what what was going on. Thank you so much for representing us!!!Deborah Tompkins

Related Posts

Contrast:

Font Size: