How VA Rates Sleep Apnea

Under 38 CFR 4.97, Diagnostic Code 6847, the most common rating for severe sleep apnea is 50 percent. This rating requires documented evidence that the veteran requires a breathing assistance device, such as a CPAP or BiPAP machine. The requirement for the device must be prescribed by a medical provider based on a sleep study.

If a veteran has a documented diagnosis of sleep apnea and experiences persistent daytime hypersomnolence (excessive daytime sleepiness that persists despite adequate sleep), but does not require a CPAP or breathing assistance device, the condition is typically evaluated at 30 percent.

A 100 percent rating is reserved for the most severe cases involving chronic respiratory failure with carbon dioxide retention, cor pulmonale, or the requirement of a tracheostomy.

A formal sleep study (polysomnography) is required to diagnose sleep apnea and determine its severity. While a Disability Benefits Questionnaire (DBQ) helps organize these findings, the sleep study results and treatment notes showing the prescription of a CPAP or daytime sleepiness are the critical pieces of evidence.

Sleep apnea is often claimed secondary to other service-connected conditions. For example, conditions like PTSD can cause medication-induced weight gain or sympathetic nervous system dysregulation, which may aggravate or cause sleep apnea. Severe rhinitis or sinusitis can also cause anatomical airway resistance leading to sleep apnea. A strong medical nexus letter is required to establish these secondary connections.