Criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed

[Tbird]

The Veterans Law Blog just got word today that the criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed, effective April 18, 2016. http://www.veteranslawblog.org/va-sleep-apnea-ratings-rules-changing/

[Joe Hillbilly]

I could see where OSA could cause the jerking.  That's not what's happening to me.  Flashbacks and nightmare like stuff is causing mine.  I assumed they were thinking it would occupy my mind or something and help.

[gs106]

o.  Evaluating Sleep Apnea

Evaluate sleep apnea using the criteria in 38 CFR 4.97, DC 6847 (sleep apnea syndromes (obstructive, central, mixed).    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.     There are two related considerations   ·   what devices qualify, and ·   whether use of a qualifying device is necessary.    On the question of what qualifies as a breathing assistance device, the DC lists a continuous positive airway pressure (CPAP) machine as an example.   Other qualifying breathing assistance devices include: ·   other positive airway pressure machines (automatic positive airway pressure device (APAP); bilevel positive airway pressure device (BiPAP)). ·   nasopharyngeal appliances (nasal dilators; nasopharyngeal stents) ·   oral appliances (mandibular advancement devices (MAD); tongue-retaining mouthpieces), and ·   implanted genioglossal nerve stimulation devices.   Note:  Positive airway pressure machines may also be called non-invasive positive pressure ventilation (NIPPV) or non-invasive ventilation (NIV).   On the question of whether sleep apnea requires use of a breathing device, there are two important and related points   ·   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.  ·   If the competent medical evidence of record shows that use of a qualifying breathing assistance device is medically required, the fact that the claimant is not actually using it as prescribed is not relevant.

[gs106]

I don't see any big change except providing clarification.  I am surprised that you don't have to use it to keep the rating...maybe they're thinking that if you don't use it you may die earlier and save VA money in the long run. 

Vync hit the nail on the head with his comment about buying a machine online....".Use absent a medical determination that the device is necessary does not qualify."

[Andyman73]

Wondering if this will help my claim, or not.

[Gastone]

Only time will tell, how this VA SA change plays out.

As to Vets having problems getting their VA Sleep Drs to complete a  SA DBQ or even opine in their VMC Med Recd, regarding a possible Nexus to a current SC. Good luck on that.

If a 50% Secondary SA SC is what you need, "Who Doesn't," find a SA Specialist on the outside. Expect to spend a couple $100 on Co-pays and deductibles for office calls. If the Non VA Specialists agrees with the VA SC being the Primary Causative Factor, his clinician notes are all you need. You do not need to spend 1 to $1.5K for an IMO.

My personal opinion, VA Raters look at IMO's from professional IMO suppliers in a different light than Clinician Notes from "Non Hired Gun," SA Specialists.

This only works, cost wise, if you already have the SA DX. No further Sleep Studies will be necessary. Try it, you'll like it.

(2) of my brother SA Vets here on Hadit, went to see my SA Neurologist in the past 9 months. Both have gotten what they needed to prevail on their SA Claim and get Awarded the 50% SC.

Semper Fi

[Andyman73]

I do wonder if my MDD and hypertension would also tie into SA, for SC? I will have to make sure I cover every medical issue when I go see my SA specialist in a few weeks.