Proposed VA Sleep Apnea Rating Changes
By Telemedica
5/6/2025
Table of Contents
- Key Takeaways
- Current Sleep Apnea VA Ratings
- Proposed VA Sleep Apnea Rating Changes
- Comorbid Conditions and Sleep Apnea Ratings
- How Should Veterans Respond to These Upcoming Changes?
- Action Steps for Winning Sleep Apnea Claims
- Conclusion
- Frequently Asked Questions (FAQs)
- Will my current VA sleep apnea rating be reduced in 2025?
- Is a CPAP machine enough to get a 50% rating under the new rules?
- Has the VA announced the VA sleep apnea changes effective date?
- Can I still submit a sleep apnea claim even if I don’t have a Nexus letter?
- How will the 2025 sleep apnea changes impact veterans filing new claims?
- Medical Evidence Wins VA Claims
Significant sleep apnea rating changes are on the way. If you’re a veteran with sleep apnea, it’s critical to understand what these VA sleep apnea rating changes mean for your disability benefits.
For years, a CPAP prescription virtually guaranteed a 50% sleep apnea rating. That’s no longer going to be the case. The new VA sleep apnea rating change focuses on factors such as sleep studies and comorbid conditions (i.e., two conditions exist at the same time).
Whether you’ve been rated, are considering filing a sleep apnea claim, or are requesting a VA rating increase, here are some tips for protecting your rating and maximizing your benefits.
Key Takeaways
- Significant VA sleep apnea rating changes are expected in 2025.
- New sleep apnea ratings are focused on the severity of your impairment and the effectiveness of treatment.
- CPAP use alone will no longer guarantee a 50% sleep apnea VA rating.
- Co-occurring conditions (e.g., PTSD, asthma, or GERD) can boost your rating to 50% or higher, depending on the severity of your sleep apnea and other factors.
- All sleep apnea claims filed after the VA implements the changes will be assessed based on the updated sleep apnea rating criteria.
- Sleep apnea claims filed before the proposed changes are implemented will be assessed under the current criteria, which may result in more favorable ratings.
Current Sleep Apnea VA Ratings
The criteria for sleep apnea (i.e., diagnostic code 6847) is rated under 38 CFR § 4.97 Schedule of Ratings—Respiratory System.
The VA currently focuses on whether you need a CPAP or similar device at night, which will automatically result in a 50% sleep apnea VA disability rating. Other criteria are included on the VA rating table below.
| VA Rating | Criteria | Definitions/Glossary |
| 100% | Sleep apnea causes chronic respiratory failure with carbon dioxide retention or cor pulmonale, or requires tracheostomy | Carbon dioxide retention – also known as “hypercapnia”- is when the body cannot effectively remove carbon dioxide (CO2), leading to a buildup in the blood Cor pulmonale – a possibly life-threatening condition involving enlargement of the heart due to any type of lung or breathing disorder that causes high blood pressure in the lungs (i.e., pulmonary hypertension); severe or untreated cur pulmonale could lead to heart failure Tracheostomy – a surgical opening in the throat to bypass any obstructions of the upper respiratory tract and enable normal breathing |
| 50% | Sleep apnea requires use of breathing assistance device such as continuous airway pressure (CPAP) machine | CPAP machine – (i.e., continuous positive airway pressure) is a treatment for sleep apnea that keeps the airways open, promoting steady breathing during sleep |
| 30% | Persistent daytime hypersomnolence | Hypersomnolence – excessive daytime sleepiness |
| 0% | Asymptomatic but with documented sleep disorder breathing | Asymptomatic – without symptoms Sleep disorder breathing (SDB) – abnormal or difficult breathing during sleep; an example is snoring for those with obstructive sleep apnea |
Proposed VA Sleep Apnea Rating Changes
A significant change is that simply using a CPAP machine will no longer automatically result in a 50% disability rating. The new VA rating evaluation will instead focus on:
- The effectiveness of your sleep apnea treatment (e.g., complete or incomplete relief)
- Whether you can tolerate or use the treatment (e.g., CPAP)
- Functional impairment (e.g., end-organ damage, such as to the heart or lungs)
| VA Rating | Criteria | Definitions/Glossary |
| 100% | Sleep apnea with ineffective treatment (as determined by sleep study) or unable to use treatment due to comorbid conditions; and with end-organ damage | Comorbid conditions – when one or more medical conditions coexist alongside a primary diagnosis and adversely affects your health and treatment outlook. In sleep apnea, comorbid conditions may include PTSD, insomnia, obesity, diabetes, anxiety, depression, or other conditions. End-organ damage – severe harm or impairment of major organs (i.e., the brain, heart, kidneys, or eyes) caused by a systemic (i.e., involving the entire body) disease or condition |
| 50% | Sleep apnea with ineffective treatment (as determined by sleep study) or unable to use treatment due to comorbid conditions; and without end-organ damage | Comorbid conditions – when one or more medical conditions coexist alongside a primary diagnosis and adversely affects your health and treatment outlook. In sleep apnea, comorbid conditions may include PTSD, insomnia, obesity, diabetes, anxiety, depression, or other conditions. End-organ damage – severe harm or impairment of major organs (i.e., the brain, heart, kidneys, or eyes) caused by a systemic (i.e., involving the entire body) disease or |
| 10% | Sleep apnea with incomplete relief with treatment (as determined by sleep study) | Sleep study – medically coined a “polysomnogram,” is a test performed while you sleep that monitors and records different body functions (e.g., breathing patterns, brain activity, and heart rate) to help diagnose sleep disorders. |
| 0% | Sleep apnea is asymptomatic with or without treatment | Asymptomatic – without symptoms |
Note: Sleep apnea will be rated under the current diagnostic code (DC 6847) for the 2025 sleep apnea VA rating changes.
Comorbid Conditions and Sleep Apnea Ratings
Comorbid conditions involve health problems from one or more medical conditions that occur alongside your sleep apnea and adversely affect your health and treatment outlook. In sleep apnea, comorbid conditions may include PTSD, insomnia, obesity, diabetes, anxiety, depression, or other conditions.
Unlike secondary conditions, comorbid conditions may or may not be primary or secondary to sleep apnea. Instead, comorbid conditions exist alongside a primary diagnosis; they can occur independently, be related through shared factors (e.g., having symptoms that worsen each other), or result from complications of sleep apnea.
Comorbidities and New Sleep Apnea VA Ratings
Comorbidities are a key factor in the new sleep apnea rating system. New sleep apnea ratings will be 0%, 10%, 50%, or 100%. The rating will be based on sleep study results, showing the effectiveness of CPAP treatment, or inability to use treatment due to comorbidities, and the presence of end-organ damage.
Comorbid conditions can significantly increase your VA rating when these conditions render your sleep apnea treatment ineffective or impossible.
Common Sleep Apnea Comorbid Conditions
Post-traumatic stress disorder (PTSD) and anxiety disorder are quite common comorbid conditions linked with sleep apnea.
It could become difficult or impossible to use a CPAP machine if your anxiety worsens or you experience flashbacks of PTSD— or other mental health triggers—because the CPAP machine mask is constricting. In this case, the CPAP machine will be less effective or could be completely ineffective/impossible in treating your sleep apnea.
Other common sleep apnea comorbid conditions that may potentially impact the VA’s new sleep apnea ratings may include:
- Chronic Obstructive Pulmonary Disease (COPD): Veterans with COPD and sleep apnea may experience respiratory problems which makes CPAP treatment less effective.
- Obesity and Metabolic Disorders: Conditions like obesity, diabetes, and metabolic syndrome increase the severity of sleep apnea and are linked with poor treatment effectiveness.
- Cardiovascular Disease: Untreated sleep apnea can contribute to or worsen cardiovascular conditions (e.g., high blood pressure [hypertension], irregular heart rate [arrhythmia], heart failure, or stroke); when any of these comorbid conditions are worsened by sleep apnea and cause end-organ damage, it may result in a 100% rating under the new criteria.
- Neuromuscular Disorders: Conditions such as ALS, multiple sclerosis (MS), or myasthenia gravis can impair breathing and prevent the use of standard sleep apnea treatments.
- Chronic Pain Conditions: Veterans with conditions like fibromyalgia or severe arthritis may struggle to comfortably sleep in positions that allow effective CPAP use, reducing its effectiveness, which justifies a higher disability rating under the proposed changes.
- Gastroesophageal Reflux Disease: GERD symptoms can cause discomfort — particularly while lying down — potentially interfering with proper positioning for effective CPAP mask placement and use. Increased air swallowing or regurgitation due to reflux can cause air leaks in the CPAP mask, reducing its ability to deliver the necessary air pressure to keep the airways open.
- Asthma: Asthma causes airway inflammation and often obstructs the airways, which can worsen sleep apnea symptoms and reduce CPAP effectiveness.
Demonstrating Evidence of a Comorbid Condition
If you have comorbidities and wish to receive a higher rating, you should include the following items in your VA claim submission:
- Medical evidence (e.g., current diagnoses, treatment history, sleep study results, and documentation of CPAP treatment effectiveness)
- A Nexus Letter (often the key to a winning claim, a nexus letter highlights medical evidence in your chart that meets the new rating criteria)
How Should Veterans Respond to These Upcoming Changes?
How to respond will depend on where you are in the VA disability process. Below we look at four common scenarios veterans with sleep apnea may experience.
- Veterans who have been diagnosed with sleep apnea (but are not yet service connected)
- Veterans who have a pending sleep apnea claim
- Veterans who have an existing sleep apnea VA rating
- Veterans who are looking to increase their current sleep apnea VA rating
New Sleep Apnea VA Claims
If you are diagnosed with sleep apnea but are not yet service-connected, file your claim as soon as possible. If you have been prescribed CPAP treatment, you will automatically be rated 50% for sleep apnea under the existing VA rules.
Once the new VA sleep apnea rating changes are implemented, getting a VA rating for sleep apnea will be more difficult.
Pending Sleep Apnea VA Claims
If you have a VA claim pending when the new changes go into effect, your claim will likely be rated under the new criteria, which could adversely affect the outcome of your claim because the new rating criteria are much more rigorous.
In this case, submit any additional evidence, such as a Nexus Letter, as soon as possible to strengthen your claim under the existing rating criteria.
Existing VA Sleep Apnea Ratings
If you already have a service-connected VA rating for sleep apnea, you will be grandfathered in under the old rating criteria, meaning you will keep your current VA rating. You won’t need to respond unless you want to apply for an increased rating.
Applying for a Sleep Apnea Rating Increase
If you are planning to apply for an increased sleep apnea VA rating, it’s advisable to do it now, don’t wait until the new rating criteria is in effect it may be more difficult to qualify, particularly if you aim to get an increase from a 10% to a 50% rating. Follow the same advice as new applicants to lock into the existing sleep apnea VA rating criteria.
Action Steps for Winning Sleep Apnea Claims
- Submit an Intent to File (ITF) to lock in your effective date today so your claim will be rated according to the current sleep apnea VA rating table.
- Get a VA-approved sleep study test, which is required to confirm a current sleep apnea diagnosis.
- Document persistent symptoms, including fatigue, headaches, poor concentration, daytime sleepiness, etc.
- Establish a Service Connection by submitting military records, a Nexus Letter, and medical records to show medical evidence.
- Identify comorbid conditions – including PTSD, COPD, GERD, cardiovascular disease, anxiety disorder, depression, and other applicable conditions- to boost your rating and help offset any rating deficits under the new criteria.
Sleep Apnea Nexus Letter Example
Although a Nexus Letter is not required for your VA disability claim, it is often the key to a winning claim, particularly for showing evidence of comorbid conditions. Here is an example of what the provider may include in a Nexus Letter for a person with chronic pain:
- A current sleep apnea diagnosis
- A current chronic pain disorder diagnosis
- A review of your sleep study results
- Objective symptoms (those the provider notices)
- Subjective symptoms (those you tell your provider about)
- Your CPAP treatment prescription and how well it works
- How your comorbid disorder (i.e., chronic pain) impacts your ability to use your CPAP machine properly due to the inability to maintain the proper position
- A note that your sleep apnea is “at least as likely as not” worsened due to your chronic pain
Conclusion
Although the 2025 VA sleep apnea changes may make qualifying for a 50% rating more challenging, you can take essential steps to ensure you get the rating you deserve, such as filing your claim or ITF early to lock in your effective date today.
Frequently Asked Questions (FAQs)
Will my current VA sleep apnea rating be reduced in 2025?
No. If you are already rated and do not request an increase, your rating will remain the same under the VA’s grandfather clause.
Is a CPAP machine enough to get a 50% rating under the new rules?
No. Under the 2025 changes, you must prove that your treatment is ineffective or unusable and show functional impairment or comorbidities.
Has the VA announced the VA sleep apnea changes effective date?
There is no definitive effective date for the VA sleep apnea changes yet, but some sources say you can expect the new rating criteria to go into effect after April 2025. Once the VA approves the proposed changes, a 60-day cooling-off period applies before they take effect.
Can I still submit a sleep apnea claim even if I don’t have a Nexus letter?
Yes. Although a Nexus Letter is not required, it can significantly strengthen your case, especially when linking sleep apnea to other service-connected conditions like PTSD or asthma.
How will the 2025 sleep apnea changes impact veterans filing new claims?
New claims filed after the changes are implemented will be reviewed under the VA’s new criteria. A CPAP prescription alone will no longer guarantee a 50% sleep apnea rating. Under the proposed VA sleep apnea changes, veterans must show ineffective or intolerable treatment, comorbid conditions affecting treatment, and sleep study results.
Medical Evidence Wins VA Claims
Did you know that a lack of medical evidence is the #1 reason VA disability claims are denied?
Medical evidence is a crucial piece of the puzzle that VA raters consider when reviewing a disability claim. Telemedica provides solutions for veterans looking to bolster their claims through high-quality medical evidence that wins claims!
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