The Centers for Disease Control and Prevention (CDC) estimates that around one in three people, or 25 million Americans, have asthma. Many of those that are veterans have other conditions as well. These are called secondary-connected conditions.
Of these adult patients, roughly 50% also suffer from obstructive sleep apnea, or OSA. At the same time, nearly 28% of asthma sufferers are at risk of developing OSA and 20% have some form of sleep-disordered breathing (SDB).
If you’re a veteran who has both asthma and sleep apnea, you could be eligible to receive compensation from the U.S. Department of Veterans Affairs (VA). Take a closer look at the VA rating for asthma, as well as how these two conditions are linked in this article. We’ll also explain how the presence of a secondary condition can help you earn a higher VA disability rating, which means more money in your pocket.
What We Cover in this Article About Secondary-Connected Conditions to Asthma:
- What is the Relationship Between Sleep Apnea and Asthma?
- What is the VA Rating for Sleep Apnea?
- What is the VA Rating for Asthma?
- Establishing a Service Connection for Asthma or Sleep Apnea
- How Can Sleep Apnea Improve My Rating For Asthma?
- Other Service-Related Disabilities Related to Sleep Apnea
- Maximize Your VA Rating for Asthma
What is the Relationship Between Sleep Apnea and Asthma?
Before we dive into how the VA rates each condition, let’s briefly discuss how asthma and sleep apnea are medically linked. The VA assigns separate ratings for asthma and sleep apnea, so it helps to know what each entails.
Asthma is a lung condition in which your airways become inflamed, narrow, and swollen at certain times.
They can also fill up with excess mucus, and all of these factors combined can make it difficult to breathe. From chest pains to coughing and wheezing, there are many different symptoms that asthma can trigger. This can occur only on occasion or it can be a chronic condition that affects your life regularly.
Sleep apnea is categorized as a sleep disorder. If you suffer from this condition, your breathing will suddenly stop and start again at different times of the night while you sleep.
- Obstructive Sleep Apnea (OSA): Occurs when your throat muscles overly relax
- Central Sleep Apnea (CSA): Occurs when your brain fails to send signals to your body to keep breathing
- Complex Sleep Apnea Syndrome: Occurs when you suffer from both OSA and CSA
Are They Linked?
Researchers have found that there is a direct link between bronchial asthma and a particular form of sleep apnea: OSA.
This link is a bidirectional relationship, which means that each individual disorder worsens or adversely influences the other. Specifically, those who suffer from asthma are at a greater risk of developing OSA than the general population.
In addition to sleep apnea itself, asthma patients also display a higher tendency to experience snoring and excessive daytime fatigue, both of which are symptoms associated with OSA.
What’s more concerning is that these two conditions do not always appear at the same time. In other words, you could have asthma for years without any symptoms of OSA, and then suddenly have an onset of sleep apnea symptoms. One study followed asthma patients for four years and found that 27% of them developed new-onset OSA, compared with 16% of people who developed OSA but did not suffer from asthma.
While there is an obvious correlation between the two and a direct overlap of symptoms, more research is required before scientists can understand exactly what triggers these two conditions to occur simultaneously. Most studies have found that there are certain multidirectional pathways that are shared between the two, including:
Among asthma patients, these combined symptoms are often described using the acronym “CORE” which stands for:
- Cough or asthma
- Obesity or OSA
- Esophageal Reflux
Is this sounding familiar? If you suffer from asthma and sleep apnea, it’s worth looking into how these conditions are rated by the VA. Often, there are secondary conditions that can increase your compensation as long as you can prove a service connection.
What is the VA Rating for Sleep Apnea?
The VA rates sleep apnea under 38 CFR § 4.97, Diagnostic Code 6847.
This code is designated to cover all sleep apnea syndromes, including those associated with the obstructive, central, and mixed forms of the condition.
We go into greater detail about VA disability ratings for sleep apnea in this post. Here, we’ll just hit the highlights.
Depending on the severity of your condition, the VA can assign a rating of 0%, 30%, 50% or 100% to your condition. Let’s take a look at the breakdown:
- 0% Rating: You have a documented sleep disorder, but you are not exhibiting any symptoms (asymptomatic).
- 30% Rating: You’re experiencing chronic daytime sleepiness (hypersomnolence), regardless of how much sleep you get.
- 50% Rating: You require the use of a breathing assistance device (e.g. a CPAP machine) to sleep at night.
- 100% Rating: Your sleep apnea has resulted in chronic respiratory failure with carbon dioxide retention. You can also receive this rating if you require a tracheostomy to alleviate your symptoms.
While it is possible, a 100% rating for sleep apnea is relatively rare and is only assigned in the event of very severe symptoms. A tracheostomy is a surgically-created hole made in your windpipe to serve as an alternate airway for breathing.
What is the VA Rating for Asthma?
Bronchial asthma is rated under VA Diagnostic Code 6602. The ratings under this code vary depending on the asthma disability associated with your condition.
There is one metric that is used to help classify these ratings. It’s known as your FEV value, which stands for Forced Expiratory volume. In short, FEV-1 measures how much air a person can exhale with a forced breath. Most of the time, physicians will measure the force of the exhale on three different occasions. Do your best on these tests and don’t try to fake your breathing problem. They can detect a lot of conditions with these tests and you’ll need them to be as accurate as possible.
Thus, your FEV-1 value is the amount of air you can exhale in one second. Likewise, your FEV-2 and FEV-3 values specify how much air you exhaled during the second and third seconds. Your physician may also measure your Forced Vital Capacity, or FVC, to determine the total amount of air that you exhale during your FEV test.
Referencing these values, the VA disability rating breakdown for asthma is as follows: 10%, 30%, 60% or 100%. Let’s take a look at each rating in greater detail.
Your bronchial asthma has resulted in FEV-1 or FVC values that are 71% to 80% of expected values. You can also receive a 10% rating if you require intermittent use of inhalational anti-inflammatory medication.
Your bronchial asthma has resulted in FEV-1 or FVC values that are 56% to 70% of expected values. You can also receive a 30% rating if you require daily inhalational or oral bronchodilator therapy, or if you regularly use inhalational anti-inflammatory medication.
Your bronchial asthma has resulted in FEV-1 or FVC values that are 40% to 55% of expected values or you visit your physician at least once a month for an asthma attack or exacerbation. You can also receive a 60% rating if you take at least three courses of systemic corticosteroids per year to help manage your condition.
Veterans who can’t hold down a steady job that supports them financially (known as substantially gainful employment) because of their service-connected disabilities are eligible for TDIU if they have:
- At least one service-connected disability rated at 60% or more disabling OR
- Two or more service-connected disabilities with at least one rated at 40% or more disabling and a combined rating of 70% or more
Your FEV-1 or FVC values are less than 40% of expected values, or you have more than one asthma attack per week while also suffering episodes of respiratory failure. You can also receive a 100% VA rating if you take systemic corticosteroids, high-dose corticosteroids or immune-suppressive medications to help manage your condition.
Establishing a Service Connection for Asthma or Sleep Apnea
If you believe your asthma is service-related, you’ll need to be able to provide the VA with a current medical diagnosis for the condition. In addition, you should also be able to trace your condition back to an in-service injury, event or symptom.
Finally, the VA will require that you combine these two references to establish a medical “nexus” that links your diagnosis and the in-service incident together.
The same process will be required to prove a service connection for your sleep apnea. In addition to an official, professional diagnosis, you’ll also need to provide evidence that your condition started or worsened during your military service.
How Can Sleep Apnea Improve My Rating For Asthma?
As you might imagine, it can be difficult to receive a higher rating for asthma alone, as there are myriad different symptoms required and your FEV-1 values must be significantly low to qualify.
That said, is there any way you can use your sleep apnea to increase and improve your rating?
Yes, but to do so you’ll need to know how to effectively link the two conditions together. This is where it helps to understand VA math! While the VA does publish a Combined Ratings Table that can help you determine how to raise your rating to 100%, it’s no secret that this table is difficult to read and navigate.
As you do so, keep in mind that sleep apnea is considered a secondary condition to asthma. As mentioned before, this is because people suffering from asthma will often develop new-onset sleep apnea symptoms, meaning that if the two are linked, asthma is the primary condition.
Other Service-Related Disabilities Related to Sleep Apnea
Asthma isn’t the only condition linked to sleep apnea. In addition, you may be able to improve your disability rating even more if you also suffer from the following conditions and can prove a viable service connection:
Once your claim is approved and you get your rating back, it’s time to crunch the numbers. Starting with your highest rating, use our VA Math Calculator to determine how much your secondary conditions helped your cause.
Just because they are called secondary doesn’t mean you can only have one or two of them. Secondary means it was caused by your service-connected disability. As you can see, one service-connected disability can bring about several secondary-connected conditions.
How do you calculate the combined rating for more than two conditions? While our online tool makes it easy, you can also use the Combined Ratings Table. Start with your highest number on the left and move across horizontally to find the next-highest number. Then, take the number you land on and make that your new left-hand number. Slide across to your third number for the final answer.
You can continue this process as required to include all of your secondary conditions.
Maximize Your VA Rating for Asthma
Can you trace your asthma back to a service-related event or symptom? If so, chances are you’re suffering from more than this physical ailment alone.
Many times, asthma occurs concurrently with other conditions, including sleep apnea and rhinitis, among others. Once you know your VA rating for asthma and subsequent medical issues, you can use VA math to combine these various ratings. This helps you optimize your compensation and make sure you’re getting the money that you deserve.
While this process is relatively straightforward, applying and appealing your ratings can be a time-consuming and often confusing process. Our team of VA disability lawyers can help you get it right the first time. We’ll walk you through all of the steps and help you make sure your claim is complete.
If you have any questions or want to discuss any aspect of your claim, we’re here to connect. Contact our team today and let’s get started.
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Frequently Asked Questions
Yes, if your Asthma is rated at 60% or higher or of you have another disability rated higher than 60%. TDIU combinations can get a little tricky, but Asthma can definitely be a contributing factor for your TDIU application.
If you already had a VA rating for asthma and any illness made it worse, you should apply for an increase of your benefits. The VA will regularly re-examine you every 5 years, but if your next re-examination is too far off, talk to your doctor and your VA lawyer about applying for an increase.