Americans are becoming increasingly aware of the need for sleep, and what the Centers for Disease Control and Prevention have referred to as the “epidemic of sleep deprivation.” One of the many results of this growing awareness is that more people are paying attention to their own symptoms and seeking medical diagnosis and treatment, and this includes America’s veterans. A recent government survey has revealed a 150% increase in the number of veterans who have submitted claims for treatment of obstructive sleep apnea, a serious condition whose treatment classifies those vets who have been diagnosed with it at 50% disabled. This level of disability qualifies for one of the highest levels of monthly compensation.
The VA recently completed a ten-year phase in period for disability payments that allows those veterans who have been determined to be at least 50% disabled to receive both their pension payments and disability compensation at full payment levels at the same time. Prior to this change a disability payment and retirement payment offset one another, but in order to receive both payments in full, the veteran has to be considered disabled at a level of fifty percent or more. In order for a veteran’s sleep apnea diagnosis to put them at that level, their diagnosis has to include being prescribed a Continuous Positive Airway Pressure (CPAP) machine – which has been the case for nine out of ten veterans receiving compensation for sleep apnea. The 50% disability compensation for veterans who are single without dependents is $822.15 per month.
There are many who do not understand how obstructive sleep apnea accounts for such a high level of disability; by comparison, a veteran who has lost a leg below the knee while serving his country who receives a prosthetic limb is considered to be forty percent disabled, which qualifies them for just $577.54 per month (amputees also receive an additional $101 per month), but sleep experts and veterans’ officials point to that as a lack of understanding of the importance of sleep and the impact that not sleeping can have on quality of life. Says Bradley Flohr, senior adviser for compensation service at the Veterans Benefits Administration, “Sleep apnea has become more and more known as a disease. It can be quite severe. You can die from it.”
Sleep apnea is exacerbated by and associated with being overweight. According to the National Institutes of Health nearly half of those who are diagnosed with the condition are overweight, and aging is a factor as well. The condition involves the tissue in the airway collapsing on itself while the sufferer is asleep, and this results in a complete cessation of breathing that can occur hundreds of times per night. This can lead to a number of serious health conditions, including heart disease, stroke, and high blood pressure. The CPAP machine provides a constant flow of air into the throat, preventing the airway from collapsing. Michael Twery, director of the National Center on Sleep Disorders Research at the National Institutes of Health, says that though the CPAP machine can eliminate all of the symptoms of sleep apnea, it is not a cure – the condition remains. Additionally, many people find that using the machine, which involves wearing a mask over the face, uncomfortable and therefore compliance is an issue. This may be a particular problem for veterans who may find the mask, or the noise that the machine that it is attached to, disturbing.
It is the fact that the condition remains that elevates those with sleep apnea to a fifty percent disability level explains Thomas Murphy, director of compensation service for the VA. “If a veteran’s missing a limb and I put a new limb on him, and he can now walk around, why am I compensating him? That’s an extreme exaggeration. You have hearing loss, and I put hearing aids in, I still compensation you for that.”
The disability rating system is currently under review, and new rules are being considered. There are concerns that people may be learning of the level of rating and trying to take advantage of it – in 2010 only 63,118 veterans had been diagnosed with sleep apnea, and by 2013 there were 127,713 who had been diagnosed. According to Murphy, “Soldiers talk. Marines talk. It’s not us going out there and telling them to do this. I don’t doubt that that occurs. But it’s not us coming out there and saying, “hey, you should go do this and find out.” If the condition exists and it’s documented, we’ll rate it. If it doesn’t exist and it’s not documented, we won’t.”
There is some evidence of a link between combat stress and sleep apnea – Joe Davis, a spokesman for the Veterans of Foreign Wars, points out that disability compensation is warranted if the condition arose during service, and if veterans have been diagnosed with the condition then they deserve compensation. “Sleep apnea is a medical evaluation that can’t be gamed, and something that must have been documented while in service. The fifty percent disability evaluation could be because a good night’s sleep is critical to everything we do.”
Unfortunately, those who manage and oversee the VA budget may not understand the importance of sleep, or agree with the rating, particularly with the overall budget dramatically increasing. According to Todd Harrison, a military budget expert at the Center for Strategic and Budgetary Assessments, the budget increased from $96 billion in 2009 to $151 billion in 2014, with much of the jump coming from the increased cost of care of the veterans who served during Vietnam. Harrison says, “People who think about disabled veterans have in mind a person who was wounded in combat. Sleep apnea is not a combat injury, especially if it’s caused by obesity.” Despite his assertions, VA officials say that the surge in claims is coming from a younger group – 94% are those who served in the first Gulf War or in Afghanistan or Iraq, and they attribute it to greater awareness of the condition.