Quick question: I have been diagnosed with sleep apnea/restless leg syndrome through a sleep study conducted 8 months ago. I'm waiting for my VA rating on both conditions. Upon being diagnosed with sleep apnea I was provided with a CPAP for use. I gave the machine a good run (~3 months) of trying to adjust to sleeping with the mask, nostril tubes, etc, but I was losing way more sleep by wearing the machine vice sleeping without it. I explained why I don't used the machine to the sleep clinic where I was a patient. The clinic told me that if I don't use the machine then I will lose my rating for sleep apnea - they track use of the machine via an SD chip inside it. Is that an accurate statement by the clinic? Could I lose my rating if I prefer to not use the machine? Thanks all!
CPAP use required to maintain sleep apnea rating?
- Thread starter Porkganic
- Start date
I was specifically told they monitor the use of the machine for the first 3 months to ensure you use it enough for them to justify paying for it through insurance. After that I'm not sure about the tracking. However since the 50% rating on sleep apnea through the VA is predicated on the required use of a cpap machine it wouldn't surprise me if they continued tracking it. I wondered about this myself and will ensure I continue to use it just in case. Maybe someone else has more detailed info. Hope this helps.
I was recently prescribed a CPAP and was given the same briefing regarding a minimum amount of use for the first 90 days.
However, about a month into using it I received another call indicating that the compliance check was no longer required through Tricare.
Like the OP I was losing more sleep trying to use it than without it.
However, about a month into using it I received another call indicating that the compliance check was no longer required through Tricare.
Like the OP I was losing more sleep trying to use it than without it.
Thanks eerf123! Hopefully that's something Tricare canned because they understood that some people just CANNOT get a good night's sleep wearing that sucker.
When you go in for follow-ups with your sleep doctor, you are supposed to bring either the SD card or the entire machine so they can download the data. That is how they can verify usage. The doctors are supposed to notify TriCare of non-compliance. The gouge is that if you don’t use it at least 21 days a month for 4 hours, they will take it and yes, you can say bye to your 50% rating...
The short answer to your question is "no" as its written here: https://www.knowva.ebenefits.va.gov...4-Section-F-Respiratory-Conditions?query=cpap
| III.iv.4.F.5.d. Required Use of a Breathing Assistance Device | Assignment of the 50-percent evaluation for sleep apnea under 38 CFR 4.97, DC 6847 entails the required use of a breathing assistance device. Consider the factors below in determining whether the criteria for required use of a breathing assistance device are satisfied.
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Also, if the mask doesn’t work, these devices are alternatives that qualify.
8 CFR 4.97, DC 6847 lists a CPAP machine as an example of a breathing assistance device for treatment of sleep apnea which is required for assignment of the 50 percent evaluation.
Other qualifying breathing assistance devices include
8 CFR 4.97, DC 6847 lists a CPAP machine as an example of a breathing assistance device for treatment of sleep apnea which is required for assignment of the 50 percent evaluation.
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.
Thanks SFC H. Good to know there are some alternatives out there.
Thanks RGZWS6! Good to have all this in writing vice "folklore facts".
Vets, heads up, VA founding went up from $96 millions to $200 millions on CPAP equipment and supplies. It was an articles from VA couple weeks ago. They will start monitor the CPAP use because the cost doubled.
Anyone have eyes on this article?
VHA May Cut Sleep Apnea Spending Up To $200 Million After ‘Mismanagement’
Discover how VHA aims to save up to $200M by addressing sleep apnea mismanagement, impacting veterans' well-being.
www.disabledveterans.org
From the OIG report
“Veterans with a sleep apnea diagnosis requiring the use of a breathing assistance device are rated as at least 50 percent service-connected when VA determines the condition was incurred or aggravated during active military service.7 VA does not require veterans to use their breathing assistance device to manage their sleep apnea in order to obtain or maintain their service-connected disability rating for the disorder.8 Since FY 2013, sleep apnea has become the most prevalent service-connected disability of all the respiratory disabilities for which veterans receive benefits.9 VHA provides sleep apnea treatment and devices for veterans regardless of whether they have a service-connected disability specifically for this disorder.”
“Veterans with a sleep apnea diagnosis requiring the use of a breathing assistance device are rated as at least 50 percent service-connected when VA determines the condition was incurred or aggravated during active military service.7 VA does not require veterans to use their breathing assistance device to manage their sleep apnea in order to obtain or maintain their service-connected disability rating for the disorder.8 Since FY 2013, sleep apnea has become the most prevalent service-connected disability of all the respiratory disabilities for which veterans receive benefits.9 VHA provides sleep apnea treatment and devices for veterans regardless of whether they have a service-connected disability specifically for this disorder.”
An alternative to the CPAP is a SUAD. I have OSA with frequent sinus infections and I was recommended to use the SUAD because it does not effect my sinuses. I have attached an image.
FYSA: Many VA dental clinics are able to provide these devices to individuals who are unable to use a CPAP or any other device that covers the nose.
FYSA: Many VA dental clinics are able to provide these devices to individuals who are unable to use a CPAP or any other device that covers the nose.
Attachments
I tried one of those prior to my CPAP, mainly because when going to the field I couldn’t always sleep near electricity. It pushed my lower jaw out so far I couldn’t fall asleep with it. Mine had a chip embedded in it that the VA would read the usage when I had follow ups with the sleep clinic.
After experimenting with a few different masks I found the CPAP much more tolerable especially after retirement. Almost don’t feel rested without using it now.
Did you have problems adjusting to it at first? I feel much more energized when I'm able to sleep with mine, but often times take it off.
For me its the hose the irritates me more so than the mask.
This is the mask I use, it puts the hose behind your head, you can watch tv to help fall asleep and is less claustrophobic. VA provided every three months.