The 50% Rating Is Going Away
What Veterans Are Saying About the VA's Proposed Sleep Apnea Rating Changes
For more than two decades, a CPAP machine prescription meant one thing for a Veteran with service-connected sleep apnea: a 50% disability rating. That translated to over $1,000 a month in tax-free compensation money that many Veterans and their families have built their lives around.
Now the VA is proposing to change that. Under the pending rulemaking, most Veterans who receive relief from CPAP therapy would see their rating drop from 50% to 10%. The 30% rating tier would be eliminated entirely. And the community of Veterans who have been watching this unfold is not quiet about it.
IMPORTANT NOTE
As of March 2026, these changes remain proposed. No final rule has been published in the Federal Register. Current ratings are still in effect. Veterans already rated are protected by a grandfathering provision. But the clock may be running.
What the VA Is Actually Proposing
The VA first published its Notice of Proposed Rulemaking on this issue in February 2022. After reviewing public comments, it issued a supplemental notice in September 2024. The core shift: sleep apnea would no longer be rated based on the treatment prescribed, but on how well that treatment works.
The Proposed Rating Scale
- 100%: Ineffective treatment or inability to use treatment with end-organ damage (heart, brain, kidney).
- 50%: Ineffective treatment or inability to use treatment without end-organ damage.
- 10%: Incomplete relief with treatment (including CPAP).
- 0%: Asymptomatic, fully controlled with or without treatment.
The 30% rating currently available for Veterans with chronic daytime sleepiness despite CPAP use would be eliminated entirely under this structure.
Veterans Are Speaking — And They Are Angry
The VA's public comment period generated an outpouring of responses from Veterans, caregivers, and advocates. The message from the Veteran community was largely unified: this feels like a punishment for getting treatment that works.
“Any recommendation that effectively says a condition is 'cured' by a device is bunk. If someone has sleep apnea, it is NOT cured by a CPAP, it is merely treated. The fact that treatment works shouldn't qualify someone for a zero percent rating.”
— Veteran public commenter, VA Federal Register response
This sentiment that managing a condition is not the same as not having it was one of the most common threads in Veteran feedback. The CPAP does not eliminate sleep apnea. It manages it. Remove the machine, and the condition returns. Veterans argue that rating based on treatment effectiveness penalizes those who are compliant with their care.
“The welfare system is alive and strong, but the VA is trying to undercut veterans who worked to serve their country. Changing ratings of those already evaluated is criminal."
— Veteran public commenter, VA Federal Register response
Others pointed to the practical reality of CPAP compliance that the device is far from comfortable, and that many Veterans with co-occurring conditions like PTSD struggle to use it at all.
“I have to say that I love my CPAP. It's awesome to embrace the feeling of your skull being crushed while you attempt to sleep for four hours. If I'm lucky.”
— Active duty service member preparing to retire, VA Federal Register response
Veterans with PTSD face a particular compounding problem. Research shows that CPAP masks can trigger claustrophobia and hyperarousal responses in Veterans with trauma histories. For this population, "CPAP provides relief" may be a clinical fiction. When the mask goes on, the airway opens, but sleep does not come, and anxiety spikes. Under the proposed criteria, these Veterans could still qualify for a higher rating if a medical opinion documents the inability to tolerate CPAP due to a co-occurring condition like PTSD.
CRITICAL EXCEPTION FOR PTSD + SLEEP APNEA
Veterans who cannot tolerate CPAP therapy due to PTSD, claustrophobia, or another service-connected condition may still qualify for the 50% rating under the proposed rules but only with documented medical evidence establishing that nexus. This documentation does not happen automatically. You must request it.
Who Is Protected — And Who Is Not
One of the most important facts Veterans need to understand is the grandfathering provision. Veterans who already have a service-connected sleep apnea rating will not have their current rating automatically reduced when the new rule takes effect. The VA must follow due process for any proposed reduction, and reductions require evidence of sustained improvement.
Currently rated Veterans: Your existing rating is protected. Do not file for an increase or open your rating for review without a clear strategy. Doing so creates an opportunity for re-evaluation under any applicable criteria.
Veterans who have not yet filed: This is where urgency matters most. Veterans who file their claim before the final rule is published will be evaluated under the current 50% CPAP standard. Once the new rule takes effect, that pathway closes.
Veterans with secondary conditions: If your sleep apnea is rated as secondary to PTSD or another service-connected condition, or if PTSD prevents you from tolerating CPAP, the documentation of that nexus becomes critical and should be established now.
The NVF Position: This Needs to Be Said
The National Veterans Foundation has been a voice for Veterans in crisis since 1985. We believe the Veteran community's concerns about these proposed changes deserve to be heard clearly and plainly.
A treatment that manages a disability is not a cure. A CPAP machine that keeps a Veteran's airway open at night does not restore the sleep architecture that sleep apnea destroyed. It does not undo years of oxygen deprivation. It does not eliminate the cardiovascular risk, the cognitive impact, or the fatigue that service members carried home with them.
Rating a condition at zero percent because a device manages its most acute symptom is inconsistent with how the VA rates other chronic conditions. A Veteran who manages hypertension with medication is not rated at zero percent for hypertension. The principle should be the same here.
We also recognize that the VA has stated these changes are intended to align sleep apnea ratings with actual earning capacity impairment, the stated purpose of the rating schedule. That goal is legitimate. But the mechanism proposed does not adequately account for the significant population of Veterans for whom "treatment" is not the simple success story the proposal implies.
WHAT YOU SHOULD DO RIGHT NOW
If you have service-connected sleep apnea and have not yet filed: file an Intent to File immediately to lock in your effective date. If your sleep apnea is secondary to PTSD: request a medical nexus opinion documenting the connection now. If you cannot tolerate CPAP due to PTSD or another condition: document this with your provider. If you are already rated: do not open your claim for review without guidance from a VSO or an accredited attorney.
The Bottom Line
These proposed changes are not final. They may be modified, delayed, or withdrawn. But Veterans have learned, sometimes the hard way, that the window for protecting benefits can close faster than expected.
If you are or a Veteran you know has sleep apnea, the time to act is now. File the claim. Document the condition. Connect with a VSO. And know that the NVF is here not just with information, but with a real person on the other end of the line.
You earned these benefits. We will help you protect them.
You can be a part of our mission to help Veterans by making a tax-deductible donation!
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