‘Clear and present danger’ or needed update? Proposed benefit cuts for sweeping veterans bill prompt impassioned responses

WASHINGTON — Vietnam veteran Gary Marnhout, who suffered a facial injury in military service that narrowed his airway, was later diagnosed with sleep apnea, prescribed a CPAP machine and received a 50% disability rating from the Department of Veterans Affairs.

Marnhout, who served as an Air Force medic and now lives in Kentucky, is among more than 760,000 veterans with a disability rating for sleep apnea, the second-most common respiratory condition among veterans receiving disability compensation, according to the Department of Veterans Affairs.

Marnhout strongly supports a bill pending in Congress that slashes disability compensation for sleep apnea and tinnitus for future generations of veterans to cover benefit increases for the nation’s most severely injured and sick veterans, their families and survivors.

But the introduction of the Take Care of America’s Veterans Act, which bundles together 62 bills to improve veterans benefits and services, has led to sharp divisions among veterans and their advocates over its funding mechanism.

While the bill contains popular provisions, including the Major Richard Star Act, backed unanimously by veterans groups, it would cut established VA disability benefits to pay for them.

The funding maneuver was met last week with stiff opposition from many lawmakers, causing House leadership to pull the bill prior to a floor vote.

An estimated 30 million adults in the U.S. have sleep apnea, with the condition more prevalent among men than women, according to the American Medical Association.

Across the general population, 25 million adults experience some form of tinnitus, according to the National Institutes of Health.

Vietnam veteran Gary Marnhout qualified for VA disability compensation for sleep apnea, after suffering a facial injury in military service that narrowed his airway. But Marnhout, a former nurse, criticized the volume of VA awards made for sleep apnea and tinnitus as a “skewed system” that needs reform. (Gary Marnhout)

“Sleep apnea and tinnitus are common among the military and general population,” said Marnhout, a former nurse. “Many of these cases in my view seemed to be preexisting conditions unrelated to military service.”

But Disabled American Veterans, which opposes making reductions to established benefits, said that redirecting disability compensation meant for future veterans sets a “terrible precedent” for how Congress pays for new benefits.

The DAV warned that the proposed changes to the two medical conditions pose a “clear and present danger” to the entire benefits system.

“We reject the premise that the only way to keep the promise made to the men and women who served in the past is by cutting veterans benefits for those who will serve in the future,” said Jim Marszalek, the DAV national executive director in Washington, D.C.

Currently, a single veteran with no dependents diagnosed with service-connected sleep apnea and using a CPAP breathing machine can qualify for a disability rating of 50%, according to the National Veterans Foundation, a nonprofit that helps former service members manage veterans benefits and resources.

A 50% rating translates into more than $1,000 per month in tax-free disability compensation, according to the VA.

“Respiratory conditions — especially sleep apnea — are among the highest-impact claims a veteran can file. A single sleep apnea claim that ends in a CPAP prescription automatically rates at 50% under current rules, instantly worth over $13,500 per year tax-free,” according to VAClaims.US, a commercial business that helps veterans prepare their disability claims.

But the bill would drop the 50% rating to 0% for veterans whose sleep apnea is successfully managed with a CPAP, a medical device that delivers a steady stream of pressurized air through a tube and a mask, according to the bill.

The compensation change would apply only to future claims for benefits, and not to veterans currently with a disability rating for sleep apnea, according to the legislation.

The 0% rating would signify that the veteran is asymptomatic, with or without treatment.

A 10% rating would be applied if there is “incomplete relief” from using a CPAP machine.

Veterans could still get a 50% rating or higher if treatment does not work, or the veteran is unable to use a CPAP machine because of other medical conditions.

More than 3.5 million veterans currently receive disability compensation for tinnitus, according to Hill and Pontoon, a law firm representing veterans with disability claims.

Tinnitus is currently treated as a standalone medical condition with its own VA disability rating.

But that would change under the bill. Tinnitus would be evaluated as a symptom of another underlying condition, such as hearing loss.

“A grade of disability of 10% shall be assigned for tinnitus only when tinnitus is diagnosed as associated with service-connected ... hearing loss,” according to text in the bill.

Rep. Mike Bost, R.-Ill., chairman of the House Veterans’ Affairs Committee and a lead sponsor, said that cutting compensation for tinnitus and sleep apnea aligns with the VA’s plans to update the disability rating schedule to reflect modern treatment and greater knowledge for managing the conditions.

The VA did not respond to a request for comment on the rule change, which was proposed in 2022.

Marszalek said that the DAV is urging Congress to pass the Major Richard Star Act and other critical bills in the Take Care of America’s Veterans Act without adopting the entire legislation and its funding mechanism.

He argued that Congress passed the PACT Act in 2022, which is estimated to cost $250 billion over the next decade, without reducing earned veterans benefits.

Winning a disability claim for sleep apnea requires a formal diagnosis confirmed by a sleep study along with a medical nexus letter, according to CCK Law, a legal firm that helps veterans file disability claims. A nexus letter is a medical opinion that links a veteran’s illness or injury to military service.

The VA requires military records detailing sleep complaints, buddy statements or evidence of toxic exposures to connect a diagnosis of sleep apnea to military service.

Service-connected tinnitus is determined from an audiology exam and medical records that show a history of problems.

Veterans need a current diagnosis of tinnitus, evidence of an in-service event or noise exposure, and a “nexus,” or link, showing that the condition is from military service.

“This has to do with economics,” Marnhout said. “In my view, VA has mishandled the disability system for these conditions by awarding compensation at such a large volume. It is a skewed system.”