How the SSA Evaluates Sleep Apnea for Disability

The SSA evaluates sleep apnea under its Listing of Impairments, a set of criteria used to determine if a medical condition is severe enough to qualify for disability benefits. To qualify for SSDI or SSI based on sleep apnea, you must show that your condition meets the SSA’s criteria for disability.

While sleep apnea itself is not listed explicitly in the SSA’s Listing of Impairments, it may be considered under respiratory disorders or chronic respiratory failure if it significantly impacts your ability to function.

Listing 3.10: Chronic Obstructive Pulmonary Disease (COPD) or Respiratory Failure

Sleep apnea may be evaluated under the same criteria used for respiratory conditions such as COPD if your sleep apnea is severe and results in chronic respiratory failure. In this case, the SSA would consider your ability to perform basic work activities like walking, standing, and concentrating.

For SSDI or SSI benefits, you must demonstrate that your sleep apnea:

• Causes significant difficulty breathing during both day and night.
• Requires the use of a continuous positive airway pressure (CPAP) machine or other interventions.
• Results in extreme daytime fatigue, making it impossible to work.
• Leads to other complications, such as heart problems or high blood pressure, that further impair your ability to function.

Symptoms and Medical Documentation

The SSA evaluates your sleep apnea by reviewing the medical evidence provided by your healthcare providers. The most important documentation includes:

• Diagnosis of sleep apnea from a sleep specialist or pulmonologist.
• Results of sleep studies (such as a polysomnography or home sleep test) that confirm the severity of your condition.
• Treatment records, including any prescribed therapies (such as CPAP therapy) and their effectiveness.
• Doctor’s notes on how your symptoms (e.g., daytime drowsiness, fatigue, difficulty concentrating) impact your ability to work.

Can I Qualify for Disability Benefits with Sleep Apnea?

You may qualify for disability benefits if you can demonstrate that sleep apnea significantly impairs your ability to work and perform daily tasks. For example:

• If sleep apnea causes severe fatigue, inability to concentrate, or memory problems, it can prevent you from completing work tasks or staying awake during the workday.
• If your sleep apnea is associated with other complications, such as high blood pressure, heart disease, or cognitive issues, these conditions can further support your claim for disability.

However, in many cases, the SSA may initially deny a disability claim for sleep apnea if the condition does not meet the necessary criteria. To improve your chances of approval, it’s important to provide comprehensive medical evidence that shows how your sleep apnea affects your ability to work.

Steps to Apply for Disability with Sleep Apnea

If you believe your sleep apnea is severe enough to qualify for SSDI or SSI, here are the steps to apply:

Step 1: Gather Your Medical Documentation

The most important part of your application is the medical evidence. You should gather:

• Medical records confirming your diagnosis of sleep apnea, including test results from sleep studies.
• Treatment records, such as documentation of CPAP or other treatments you’ve undergone.
• Doctor’s statement explaining how your sleep apnea prevents you from working and its impact on your daily life.

Step 2: Apply for Social Security Disability

There are three main ways to apply for SSDI or SSI benefits:

• Online: Apply online through the SSA’s website at www.ssa.gov. This is often the fastest and most convenient option.
• By Phone: You can apply by calling the SSA at 1-800-772-1213. They can help you complete the application over the phone.
• In Person: Visit your local SSA office to apply. Use the SSA’s office locator to find an office near you.

Step 3: Be Honest and Detailed

When completing your application, be honest and detailed about your condition. Include specific information about how sleep apnea affects your ability to perform daily tasks, including any other medical conditions you may have as a result of sleep apnea.

Step 4: Wait for a Decision

The SSA typically takes 3 to 5 months to review your claim and make a decision. If your claim is denied, which is common for sleep apnea claims, you have the right to appeal the decision.

How to Appeal if Your SSDI Claim is Denied

If your SSDI or SSI claim for sleep apnea is denied, you can appeal the decision. The appeals process involves several steps:

• Request for Reconsideration: You can ask the SSA to review your case again. This is the first stage in the appeals process.
• Request a Hearing: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ).
• Appeals Council: If the ALJ denies your claim, you can appeal to the SSA’s Appeals Council.
• Federal Court: If all else fails, you can take your case to federal court.