While not all individuals with sleep apnea experience significant impairment, if your sleep apnea does prevent you from working, you may qualify for Social Security disability (SSD) benefits.
Sleep apnea is a respiratory disorder in which you may stop breathing due to malfunction of the respiratory muscles. Episodes last for between 10 and 30 seconds each, but can be quite frequent, with the most severe cases causing breathing to cease as many as 400 times per night. The condition can cause:
- dangerously high levels of carbon dioxide in the blood stream
- an increased risk of high blood pressure
- an increased risk of stroke, heart attacks and heart disease
- muscle pain
What is Sleep Apnea?
There are two different forms of sleep apnea: central and obstructive. Either may qualify for SSD benefits, provided it results in significant impairment and prevents you from maintaining gainful employment.
Obstructive apnea is caused by disruption of airflow through the trachea. It can result from a number of different physical causes, including:
- problems with the muscles of, or collection of fatty tissue in, the throat
- problems with the tonsils, uvula or tongue.
Central apnea is a more rare form of the condition that is caused by central nervous system issues in which the brain doesn’t send proper signals to the muscles responsible for your breathing. Interruption of signals from the brain to these muscles can also be to blame for central sleep apnea, in some cases.
Medically Qualifying for Disability Benefits with Sleep Apnea
Both forms of sleep apnea are evaluated by the Social Security Administration (SSA) under the criteria listed in the “Blue Book” under “Section 3.10: Sleep-related breathing disorders.”
The Blue Book is the manual utilized by the SSA in evaluating potentially disabling conditions. Sleep apnea only qualifies if it causes “Cor pulmonale,” or the enlargement of the right side of the heart due to blood flow problems. Clinical evidence to prove this disability due to sleep apnea must include:
- Average artery blood pressure greater than 40 mm/Hg
- Diagnosed “arterial hypoxemia,” which is an oxygen deficiency in the arteries.
If you have medical documents that prove that you have an enlarged heart due to your sleep apnea, as well as low blood pressure in your arteries or an oxygen deficiency, you could medically qualify for benefits via the Blue Book.
Sleep Apnea and Qualifying for a Medical Vocational Allowance
If your sleep apnea does not meet the Blue Book listing, you could still qualify for disability benefits through a medical vocational allowance. A medical vocational allowance essentially means that some applicants, even though they don’t meet the listing criteria of a condition that appears in the Blue Book, are functionally disabled nonetheless and therefore eligible to receive SSD benefits.
Medical evidence is crucial in any disability claim, especially one that does not meet a Blue Book listing. It is especially important when applying for SSD based on sleep apnea, as most people with the condition don’t suffer severe enough impairment to prevent them from working entirely.
For this reason, the SSA requires extensive documentation of the effects of your sleep apnea on your “residual functional capacity,” which is an exam evaluating how the condition affects you every day, including your ability to perform normal functions in your personal life and on the job.
To evaluate your application for a medical vocational allowance through the assessment of your residual function capacity, the SSA will want to know if your sleep apnea causes issues with the following:
- Difficulty concentrating, focusing or following directions
- Problems staying awake due to fatigue or lack of sleep
- Trouble driving, operating equipment, or completing tasks
- Problems shopping, running errands of doing other everyday activities without the assistance of others
- Difficulty remembering details or interacting socially
It’s also important that you and your physician work together to ensure your medical records are as close to meeting the listed criteria for sleep apnea as possible. This may mean you need to undergo different tests or procedures in order to satisfy the SSA’s criteria for disability eligibility.
Additional Medical Information to Submit
The more medical evidence you submit to the SSA, the higher your odds of being approved for benefits. In the case of sleep apnea SSD applications, there are several components that may increase your odds of being found eligible for benefits, including:
- Thorough records of all the physical examinations, diagnostic tests, and other evaluations you’ve undergone in an effort to diagnose and deal with your sleep apnea.
- A detailed statement from your treating physician that documents your condition, the symptoms you have and how your symptoms affect your everyday life, including your ability to get and keep a job.
- Evidence showing the treatments available for sleep apnea have not been successful in alleviating the symptoms you experience, or at least that the treatments have not been sufficient enough to allow you to be gainfully employed.
Getting Help with Your Sleep Apnea SSD Application
Building a strong disability claim and collect the necessary documentation for supporting your application can be challenging. You must work with your doctor to document your condition and the affects it has on your abilities. You will also want to consider seeking help from a disability advocate or Social Security disability attorney when completing your application and other forms required by the SSA.
Your attorney or advocate can also assist you in:
- compiling supporting documentation
- navigating the review and reevaluation processes
- preparing for and appearing at an appeal hearing if you’re required to do so.