WASHINGTON — Veterans' claims for sleep apnea — a common, treatable ailment often associated with obesity and aging — have spiked nearly 150% since 2009, driving compensation for the disorder likely over $1 billion per year, according to government data and interviews.
Nearly nine of 10 veterans receiving compensation are considered 50% disabled by the condition, in which breathing ceases during sleep. For a single veteran without dependents, the monthly payment is $822.15 for a disability rating of 50%.
About half of Americans who suffer from it are overweight, according to the National Institutes of Health. Aging is also a contributing factor. Untreated, sleep apnea can lead to serious health problems, including heart disease.
Veterans Affairs officials attribute the surge in claims — more than 94% of them from veterans of Gulf War I or the Afghanistan and Iraq wars — to greater awareness of the condition. With that awareness comes treatment and appropriate care, they say.
"Sleep apnea has become more and more known as a disease," said Bradley Flohr, senior adviser for compensation service at the Veterans Benefits Administration. "It can be quite severe. You can die from it."
A change in federal law in 2004, phased in over 10 years and fully implemented in January, also allows veterans who qualify for retirement pay to receive their pensions and disability compensation. Prior to the change in law, the disability compensation had offset pension payments. To receive both payments, a veteran must be considered at least 50% disabled.
USA TODAY first reported on rising sleep apnea claims in June 2010, when only 63,118 veterans were receiving benefits for the condition.
Veterans with sleep apnea are considered by the Department of Veterans affairs to be 50% disabled if they need a Continuous Positive Airway Pressure (CPAP) machine to get a good night's sleep.
The machine and mask increase air pressure in the throat to prevent the airway from collapsing. It eliminates virtually all symptoms of sleep apnea for most people although it is not a cure, said Michael Twery, director of the National Center on Sleep Disorders Research at the National Institutes of Health. Many find the mask uncomfortable to wear.
The underlying condition remains, and that's why veterans are still compensated at the 50% rate, said Thomas Murphy, director of compensation service for the Veterans Benefits Administration. The intent is to offset the average impact on a veteran's earning power.
By comparison, a soldier or Marine who loses a leg below the knee while serving, and receives prosthesis can be attached, they are considered 40% disabled, which qualifies them for a $577.54 monthly payment. All amputees also receive an additional $101 a month, according to 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?" Murphy said. "That's an extreme exaggeration. You have hearing loss, and I put hearing aids in, I still compensate you for that.
The VA's rating schedule makes it impossible to determine precisely how much the department spends annually on sleep apnea compensation, said Steve Westerfeld, a VA spokesman. Veterans often have multiple disabilities, and a rating table determines their compensation. A veteran's dependents also boost compensation.
The rating system for all disabilities, including sleep apnea, is under review; new rules could be in place within two years, Murphy said.
If the 127,713 veterans with a 50% disability rating for sleep apnea in 2013 were paid for that condition alone, assuming no dependents, the cost would have been $1.25 billion.
"Soldiers talk. Marines talk," Murphy said. "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."
Veterans are eligible for disability compensation if the condition developed while they were serving.
Joe Davis, a spokesman for the Veterans of Foreign Wars, said veterans deserve to be compensated for sleep apnea.
"Sleep apnea is a medical evaluation that can't be gamed, and something that must have been documented while in service," Davis said. "The 50% disability evaluation could be because a good night's sleep is critical to everything we do."
Twery, the sleep expert, also noted that some research shows that there could be a link between combat stress and sleep apnea.
Whatever its cause, sleep apnea joins a list of issues that is driving up the VA's budget, said Todd Harrison, a military budget expert at the Center for Strategic and Budgetary Assessments, a non-partisan think tank. Its budget is scheduled to jump from $96 billion in 2009 to $151 billion in 2014, much of the increase associated with caring for the aging Vietnam-era generation, Harrison said.
Sleep apnea, he said, is not the sort of disability most people associate with wounded warriors.
"People who think about disabled veterans have in mind a person who was wounded in combat," Harrison said. "Sleep apnea is not a combat injury, especially if it's caused by obesity."