Does Social Security Approve Sleep Apnea Disability Claims?

Sleep apnea is a disability that causes you to continuously stop and start breathing while you sleep. Your doctor will diagnose sleep apnea as one of several possible sleep-related breathing disorders. There are two types of sleep apnea: 1) Obstructive sleep apnea and 2) Central sleep apnea. Obstructive sleep apnea disability is the most common type of sleep apnea.

Although not specifically listed in the Social Security Administration SSA Blue Book, under 3.00 Respiratory Disorders Listing of Impairments, there is a sleep-related breathing disorder listing considered a disability by the SSA. A severe sleep apnea disability can cause other breathing disorders or heart conditions in the long term, which can also qualify for disability benefits.

How is Sleep Apnea Diagnosed?

If your doctor suspects you have sleep apnea, they will arrange a sleep evaluation which often includes an overnight sleep study. Common tests include:

Polysomnogram (PSG) as part of an overnight sleep study to test for:

• Electrical activity of the brain
• Eye movements
• Muscle activity
• Heart rate
• Breathing patterns
• Airflow
• Blood oxygen levels

Home Sleep Tests (HST) are also available. However, they are less effective at proving you have severe sleep apnea as they don’t record as many body functions as a PSG.

Sleep apnea symptoms include:

• Loud snoring
• Daytime sleepiness
• Fatigue
• Frequent awakening
• Gasping or choking that causes sudden awakening
• Dry mouth in the morning
• Sore throat in the morning
• Trouble concentrating
• Forgetfulness
• Irritability
• Mood issues such as depression or anxiety
• Night sweats
• Frequent urination at night
• Sexual dysfunction
• Headaches

If your symptoms prevent you from doing what the SSA considers “Substantial Gainful Activity” (SGA), they could find you have severe sleep apnea disability.

Sleep Apnea and Social Security

Can you get disability for sleep apnea? Yes. The SSA refers to the sleep-related breathing disorders section of the blue book to confirm you suffer from transient episodes of interrupted breathing during sleep. This is important to your sleep apnea disability claim, as prolonged attacks of breathing disruptions can result in serious long-term disorders, causing possible complications such as chronic pulmonary hypertension.

Is Obstructive Sleep Apnea a Disability?

The SSA evaluates the complications of sleep-related breathing disorders and requires medical evidence of your condition. Some of the most common complications that help you qualify for benefits include:

• Chronic pulmonary hypertension due to any cause under 3.09
• Chronic heart failure under 4.02
• Disturbances in mood, cognition, and behavior under 12.02

During the assessment of your sleep apnea disability claim, the SSA does not invest in sleep studies. Therefore, it is up to you to ensure you have proof of your condition to help them find your sleep apnea meets their definition of disability. Their assessment considers all aspects of your condition to determine the severity of your sleep disorder and non-medical factors, including your income, age, education level, and past work.

What Sleep Disorders Qualify for Disability?

Along with sleep apnea, there are several categories of sleep disorders that can qualify for disability based on their severity and the health issues they cause, including:

• Insomnia: If you do not have enough restorative sleep, it can lead to behavioral disorders that qualify for benefits. As well insomnia can also be caused by neurological conditions that qualify.
• Narcolepsy: Sudden onset of sleep during the day can lead to injury on the job, making it dangerous to work in almost any capacity.
• REM Disorder: REM Behavioral Disorder often occurs as an early sign of neurological disorders which qualify for disability.

These are a few examples of sleep disorders that are either caused by qualifying disabilities or that can lead to severe conditions that qualify.

Will SSA Approve My Claim If I Have Severe Sleep Apnea?

As mentioned, the SSA considers the severity of common respiratory disorders such as sleep apnea and whether they prevent you from doing any gainful activity. You can be approved if your impairment(s) meets the criteria. However, you can also qualify by providing medical evidence proving you have an impairment(s) that medically equals a listing or impacts other body systems. The SSA is responsible for considering the possible effects of multiple impairments and their impact on your ability to work.

How Does Social Security Evaluate a Disability Claim Based On Sleep Apnea?

SSA adjudicators use a five-step process to evaluate your disability claim for sleep apnea. At each phase of a disability claim, they determine if your claim is denied, qualifies, or needs to move on to the next step to make their decision. At the Initial Application and Reconsideration phases, a DDS Examiner works with a DDS Physician to make their decision. At appeal hearings, an Administrative Law Judge consults with a Medical Expert (ME) to determine if the original decision is withheld or if your case is approved. Here are the five steps followed by the adjudicator:

Step 1: Non-Medical Criteria

The non-medical step is based on income. The adjudicator establishes your SGA Activity level. Your claim is denied if you earn more than $1,090 gross each month. Regardless of the severity or complications of your sleep apnea, this is the end of your claim. An appeal will not impact this decision if your earnings are equal to or above the maximum earnings level.

Step 2: Severity of Your Sleep Apnea – Is Obstructive Sleep Apnea a Disability?

This is where the adjudicator determines if your sleep apnea is severe enough to qualify as a disability. Because medical evidence is crucial to establishing your sleep apnea is severe, the collection of medical history must be conducted in as much detail as possible. A disability advocate understands the required evidence and can ensure you have all the necessary medical records to support your case.

However, it is not just your medical evidence the adjudicator relies on for their review of your claim. They also send out Activities of Daily Living and Vocational Questionnaires for you to fill out so they can decide if your sleep apnea impacts your ability to function normally. At this stage, they might also request you schedule a Consultative Examination (CE) with an SSA doctor to conduct a medical evaluation. At Princeton Disability, we make the process easier by providing our own questionnaires to reduce the need for further exams and forms. This makes it easier for the adjudicator to review the information provided from the beginning, so it is established your symptoms are severe and keep you from performing basic work-like activities. If your evidence does show your sleep apnea is severe, your application proceeds to Step 3. If not, your claim is denied, and a disability advocate can help you appeal.

Step 3: Equaling a Medical Listing

As already explained, your sleep apnea symptoms must meet or equal an SSA blue book medical listing. Because sleep disorders can impact physical and mental health, they will consider both when reviewing the Listing of Impairments. This typically includes:

• Listing 3.09 Cor Pulmonale Secondary to Chronic Pulmonary Vascular Hypertension: You will require clinical evidence of pulmonary heart disease with either arterial hypoxemia or mean pulmonary artery pressure over 40mm Hg.
• Listing 3.10 Sleep-Related Breathing Disorders: Disability under this section requires medical evidence of the above or conditions such as hypoxemia, pulmonary vasoconstriction, chronic pulmonary hypertension, or other complications.
• Listing 12.02 Organic Mental Disorders: Diagnosis requires medical records from a treating physician, preferably specializing in mental health.

If the adjudicator finds your sleep apnea does qualify, your benefits are approved. If not, your application proceeds to Step 4.

Step 4: Past Work Review

If the SSA finds your medical evidence insufficient to show you are disabled, they consider whether your past work can be conducted with limitations caused by your sleep apnea. At this step, your adjudicator uses past work to create a Residual Functional Capacity (RFC). This measures your symptoms against your ability to perform functions required to perform past work. Some of the limitations your RFC might contain include:

• Following short instructions
• Recalling information
• Interacting with the public
• Working with others

Your adjudicator uses your RFC in hand with your Past Relevant Work (PRW) to decide whether your experience allows you to work in a different capacity. The jobs they include are any jobs you held in the past 15 years prior to your sleep apnea’s Alleged Onset Date (AOD). Your PRW is classified based on exertion and skills. If your adjudicator decides you can perform past work, they will deny your claim. Otherwise, you proceed to the final step to consider any other jobs you might be able to perform.

Step 5: Other Work

Here the SSA’s goal is to find other possible types of work you can perform. Using your Residual Functional Capacity (RFC), they then consider the following vocational factors:

Education

Your education level is categorized based on the following:

• Illiterate (or unable to communicate in English)
• Marginal (generally 6th grade or less)
• Limited (generally 7th through 11th grades)
• High school (and above)

It is used to determine the jobs you can perform that are unrelated to your PRW.

Work Experience

Although you can’t perform past work, the SSA wants to establish if you have any transferable skills to fill new roles.

Age

SSA uses the following age categories in Step 5:

• Younger (ages 18-49)
• Closely approaching advanced age (ages 50-54)
• Advanced age (ages 55-59)
• Closely approaching retirement age (ages 60+)

This is an essential factor, as it helps the SSA apply your ability to perform new job roles based on age to the Medical-Vocational Guidelines, or the “Grid Rules.” Age is considered because the younger you are, the more trainable you are. Before deciding whether you are Disabled or Not Disabled, your adjudicator considers all the evidence, including your RFC, PRW, and vocational factors, to determine if you can perform any substantial gainful activity. If it is determined you can work in some capacity, your claim is denied.

How Do I Submit A Disability Claim For Sleep Apnea?

If your sleep apnea has led to complications that interfere with your ability to perform a substantial gainful activity, you can apply for SSDI in three ways:

1. Online
2. At the local SSA office
3. By phone by calling 1-800-772-1213 (TTY 1-800-325-0778)

You require the following information to establish credibility:

• Work history
• Medical evidence
• Testimony from witnesses
• Complaints and symptoms
• Ability to work
• Activity level
• Mental ability

Disability advocate assistance ensures each application detail is completed correctly.  Choosing Princeton Disability ensures you submit a questionnaire with your application to include all the required information to increase your likelihood of approval significantly.

Should I Get Professional Help?

Yes. Only 34 percent of disability applicants qualify for disability without professional assistance. A disability advocate’s job is to ensure you have all the required information to receive the maximum benefits you deserve successfully. Princeton Disability Advocates are here to ensure you file your claim correctly to avoid delays and the risk of denial. Reach out to our team today.