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Tag: How to get VA 100 PTSD

Can I get VA 100% for Sleep Apnea?

Posted on by Ken LaVan

Service Connection

In order for the VA to assign a 100% rating for Sleep Apnea, the VA must first determine that the condition is related to service.

Generally, VA will grant service connection if the following are met:

  1. Proof of a current diagnosis,
  2. Proof of an in-service event, disease or injury, and
  3. Proof of a medical nexus between the first 2 elements.

VA Schedule of Rating

After VA grants service connection, it must determine the correct rating.  To do so, VA consults the Schedule of Ratings.  The ratings should reflect how much that specific disability impairs your ability to work.  In order to get a 100% rating for sleep apnea, it must be so severe that it prevents gainful employment.

Requirements Specific to Sleep Apnea

The Schedule of Ratings breaks down disabilities into different categories. Each category contains groups of medical problems.  For example, Sleep Apnea is found in the Respiratory System category.  Each group contains a list of disabilities, and each disability has its own diagnostic code.  In turn, each diagnostic code specifies the symptoms required for various ratings.  For example, the 6847 code applies to Sleep Apnea.  See 38 C.F.R. § 4.97.  A 100% VA rating for Sleep Apnea requires:

  1. Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or
  2. The condition requires tracheostomy.

Chronic Respiratory Failure

Chronic respiratory failure usually happens when the airways that carry air to your lungs become narrow and damaged.  In other words, less oxygen gets in and less carbon dioxide goes out.  A tracheostomy is a surgically made hole in the front of your neck where a breathing tube is connected to your windpipe to help you breathe.  Naturally, a veteran with these extreme symptoms deserves a 100% VA rating for Sleep Apnea.

Sleep Apnea Medical Evidence

Only medical evidence can satisfy these requirements.  It is not enough for the veteran to say “I cannot work because of my sleep apnea.”  Fortunately, VA provides rating tools such as Disability Benefits Questionnaires (“DBQs”) on their website.  Specifically, VA provides a Sleep Apnea DBQ that focuses on the symptoms described in the Schedule.  Veterans seeking a higher rating for sleep apnea should have their doctors complete the DBQ. The VA will likely grant the rating if the DBQ includes the criteria for a 100% rating for Sleep Apnea.

Disability Benefits Questionnaire

A doctor who treats the disability in question should fill out a Disability Benefits Questionnaire.  For example, an orthopedic specialist who is treating a foot condition should not complete a DBQ for PTSD.

Watch out for Pyramiding

When seeking a 100% rating for Sleep Apnea, one must consider every rule and exception related to VA ratings.  Under the VA rating system, a veteran should be compensated for each service-connected disability.  However, there is one big exception.  VA cannot pay a veteran more than once for the same disability or same manifestation.  For example, Asthma and Sleep Apnea have nearly identical manifestations.  They both involve impairment of the airways, they share symptoms such as daytime fatigue, and they are under the same category in the Schedule of Ratings.  A veteran who is service connected for both will only receive a rating for one of them.  In that circumstance, VA must assign the higher of the 2 possible ratings.

Disability Help Group Case Study Sleep Apnea

The anti-pyramiding rule recently affected a DHG client.  He is a 64 year-old veteran of the Army who filed a claim for asthma and sleep apnea.  VA denied the sleep apnea claim, but granted the asthma claim at 30%.  After a successful appeal, VA granted 60% for his asthma.  Furthermore, the VA conceded that the criteria for sleep apnea was met and granted a 50% service-connected disability.  The VA, however, could not grant the additional 50% rating because of the anti-pyramiding rule.  Instead, VA awarded 60% for his “asthma with sleep apnea.”

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VA Disability Rating for PTSD

Posted on by Ken LaVan

What is Required: VA Disability Rating for PTSD

Before VA will award a disability rating for post-traumatic stress disorder (PTSD), the veteran must first prove service connection.  Thereafter, the VA must determine the correct rating percentage, which will determine how much money VA must pay to the veteran.  Rather than assign percentages at random, VA uses a Schedule of Ratings.

Schedule of Ratings: VA Disability Rating for PTSD

The Schedule of Ratings breaks down disabilities into different categories.  Firstly, each category contains groups of medical problems.  Secondly, each group contains a list of disabilities, and each disability has its own diagnostic code.  Thirdly, every diagnostic code specifies the symptoms required for various ratings.  For example, the 9411 code applies to PTSD.  VA rates PTSD –along with 36 other mental health conditions – under the General Rating Formula for Mental Disorders.  Depending on the symptoms, a veteran may receive either 0%, 10%, 30%, 50%, 70% or 100%.

The Criteria: VA Disability Rating for PTSD

100% = Total occupational and social impairment

  • gross impairment in thought processes or communication;
  • persistent delusions or hallucinations;
  • grossly inappropriate behavior;
  • persistent danger of hurting self or others;
  • intermittent inability to perform activities of daily living, such as maintenance of minimal personal hygiene;
  • disorientation to time or place;
  • memory loss for names of close relatives, own occupation, or own name

70% = Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood

  • suicidal ideation;
  • obsessional rituals which interfere with routine activities;
  • speech intermittently illogical, obscure, or irrelevant;
  • near-continuous panic or depression affecting the ability to function independently, appropriately and effectively;
  • impaired impulse control (such as unprovoked irritability with periods of violence);
  • spatial disorientation;
  • neglect of personal appearance and hygiene;
  • difficulty in adapting to stressful circumstances, such as work or a work-like setting;
  • inability to establish and maintain effective relationships.

50% = Occupational and social impairment with reduced reliability and productivity

  • flattened affect;
  • circumstantial, circumlocutory, or stereotyped speech;
  • panic attacks more than once a week;
  • difficulty in understanding complex commands;
  • impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks);
  • impaired judgment;
  • impaired abstract thinking;
  • disturbances of motivation and mood;
  • difficulty in establishing and maintaining effective work and social relationships.

30%= Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks

  • depressed mood;
  • anxiety;
  • suspiciousness;
  • panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

10% = Occupational and social impairment due to mild or transient symptoms

  • decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or
  • symptoms controlled by continuous medication.

0% = A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.

100% VA Disability Rating for PTSD

A 100% disability rating for PTSD reflects total impairment.  Symptoms in the 100% range include persistent suicide attempts.  However, a veteran with very mild PTSD controlled by medication will probably receive 10%.  VA is bound by the Schedule of Ratings.  Especially, if your service-connected disability satisfies the criteria for a higher rating, then VA must grant that rating.

Case Studies: VA Disability Rating for PTSD

To meet the criteria for a specific PTSD rating, the veteran’s symptoms must approximately match the listed criteria.  The following examples show how VA assigns disability ratings for PTSD:

Case Study 2: 50% Rating for PTSD

A 63 year-old veteran with PTSD rated at 10% provided a Disability Benefits Questionnaire (DBQ) from his doctor.  The DBQ noted depressed mood, flattened affect, panic attacks twice a week, impaired judgment and difficulty in establishing effective relationships.  In the end, VA increased his PTSD disability rating to 50%.

Case Study: 10% Rating PTSD

VA rated a 44 year-old veteran at 10% because her PTSD symptoms were well controlled with medication.  She asked VA to increase the rating to 30% because she had 2 panic attacks in the past 12 months.  The panic attacks happened during her commute to her full-time job.  The attacks resolved within minutes, and she did not lose any time from work.  In brief, VA kept her PTSD disability rating at 10%.