{"page":"https://casescribe.ai/explorer/secondary/sleep-apnea-secondary-to-back","generated_at":"2026-10-03T18:34:22.747Z","data_as_of":{"decisions":944125,"first_year":2017,"last_year":2026,"latest_decision":"2026-04-30","cfr":"2026-10-01","m21":"2026-09-29"},"about":{"publisher":"CaseScribe AI (VA Law Explorer)","source":"Public Board of Veterans' Appeals decisions (appeals of VA decisions, not VA's first decisions), M21-1 Adjudication Procedures Manual, 38 CFR Parts 3 and 4.","method":"Outcomes are issue-level: each condition the Board decided in a decision counts once. Decision data is extracted by AI and can contain errors. Rates describe past appeals and do not predict any claim.","disclaimer":"For research only. CaseScribe AI is not a law firm and this is not legal advice. Verify figures against the source decisions and regulations.","attribution":"Cite as: VA Law Explorer, CaseScribe AI, with the page URL."},"data":{"claim":"Sleep apnea secondary to a back condition","secondary_condition":"Sleep apnea","service_connected_disability":"a back condition","decisions":1481,"years":"2017-2026","granted_pct":39.2,"denied_pct":10.8,"remanded_pct":49.1,"granted_on_merits_pct":78.4,"by_year":[{"year":2017,"issues":36,"granted_pct":22.2,"denied_pct":36.1,"remanded_pct":38.9},{"year":2018,"issues":62,"granted_pct":25.8,"denied_pct":16.1,"remanded_pct":54.8},{"year":2019,"issues":102,"granted_pct":28.4,"denied_pct":13.7,"remanded_pct":56.9},{"year":2020,"issues":102,"granted_pct":38.2,"denied_pct":12.7,"remanded_pct":48},{"year":2021,"issues":130,"granted_pct":23.8,"denied_pct":12.3,"remanded_pct":63.1},{"year":2022,"issues":126,"granted_pct":22.2,"denied_pct":6.3,"remanded_pct":71.4},{"year":2023,"issues":151,"granted_pct":35.8,"denied_pct":12.6,"remanded_pct":51.7},{"year":2024,"issues":297,"granted_pct":46.8,"denied_pct":9.1,"remanded_pct":43.4},{"year":2025,"issues":383,"granted_pct":51.4,"denied_pct":7.8,"remanded_pct":39.4},{"year":2026,"issues":95,"granted_pct":42.1,"denied_pct":10.5,"remanded_pct":46.3}],"benefit_of_doubt_in_grants_pct":74.2,"evidence_on_merits":[{"evidence":"va_exam_favorable","decisions_with":135,"granted_pct_with":90.5,"granted_pct_without":76.6},{"evidence":"va_exam_unfavorable","decisions_with":1225,"granted_pct_with":76.1,"granted_pct_without":91.7},{"evidence":"nexus_positive","decisions_with":611,"granted_pct_with":95.7,"granted_pct_without":38.9},{"evidence":"nexus_negative","decisions_with":1077,"granted_pct_with":76.8,"granted_pct_without":83.9},{"evidence":"private_opinion","decisions_with":809,"granted_pct_with":87.4,"granted_pct_without":48.2},{"evidence":"treating_physician","decisions_with":63,"granted_pct_with":86.1,"granted_pct_without":78},{"evidence":"lay_statement","decisions_with":1050,"granted_pct_with":73.1,"granted_pct_without":92.2},{"evidence":"buddy_statement","decisions_with":60,"granted_pct_with":74.1,"granted_pct_without":78.6}],"top_reasons":{"granted":[{"reason":"caused by the service-connected disability","decisions":153},{"reason":"service connection established","decisions":78},{"reason":"current diagnosis established","decisions":74},{"reason":"aggravated by the service-connected disability","decisions":32},{"reason":"va examiner: less likely than not related to service","decisions":23},{"reason":"obesity as intermediate step","decisions":11}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":33},{"reason":"no in-service complaints, treatment or diagnosis","decisions":28},{"reason":"preponderance of the evidence against the claim","decisions":15},{"reason":"aggravated by the service-connected disability","decisions":15},{"reason":"service records negative or silent","decisions":14},{"reason":"caused by the service-connected disability","decisions":7}]},"recent_examples":{"granted":[{"case_id":"A26040444","year":2026,"judge":"KRISTY L. ZADORA","rationale":"Private physician opinion found veteran's lumbar spine disability contributed significantly to obstructive sleep apnea.; Obesity as an intermediate step between service-connected lumbosacral strain and obstructive sleep apnea is recognized.; VA examiner's opinion finding no causal link was afforded … [truncated, 24 chars omitted]"},{"case_id":"A26038153","year":2026,"judge":"K.A. KENNERLY","rationale":"Favorable VA opinion from December 2024 found OSA likely aggravated by lumbar spine disability.; Reasoning: Pain from lumbar spine may lead to poor sleep quality, worsening OSA.; This opinion was found more probative than an August 2022 VA opinion that did not address low back pain's effect on sleep… [truncated, 9 chars omitted]"},{"case_id":"A26038141","year":2026,"judge":"TANYA SMITH","rationale":"Private medical opinion found sleep apnea at least as likely as not due to weight gain from service-connected back and ankle conditions.; Weight gain and obesity were identified as risk factors for sleep apnea.; No contrary VA medical opinion was present."}],"denied":[{"case_id":"A26039213","year":2026,"judge":"BETHANY L. BUCK","rationale":"No current diagnosis of sleep apnea established.; Veteran failed to attend scheduled sleep study.; Private medical opinion insufficient without objective testing."},{"case_id":"A26032225","year":2026,"judge":"W. DAKNIS","rationale":"Private medical opinion lacked specific rationale; Little probative weight given to private opinion; No confirmed OSA diagnosis at time of initial decision; Service treatment records negative for OSA complaints/treatment"},{"case_id":"A26032011","year":2026,"judge":"JOHN J. CROWLEY","rationale":"No in-service onset or aggravation of OSA; Back disability, claimed as primary cause, not service-connected; No reasonable theory of direct service connection raised"}]},"how_argued":{"note":"From keyword matches in each issue's AI summary and rationale, not the full decision. Only issues whose text names a medical link are counted under pathways; one issue can name several. A link named in a denial was often the argument the Board rejected.","issues":1484,"aggravation_discussed":{"issues":620,"granted_pct":28.4},"causation_only":{"issues":864,"granted_pct":46.9},"issues_naming_a_pathway_pct":73.1,"pathways":[{"pathway":"Weight gain or obesity","issues":892,"granted_pct":47.9,"examples":[{"case_id":"26003841","year":2026,"outcome":"GRANTED","quote":"Private opinion found OSA proximately due to service-connected low back disability with obesity as intermediary step."},{"case_id":"A26000793","year":2026,"outcome":"DENIED","quote":"Insufficient evidence that back disability caused obesity or OSA."}]},{"pathway":"Nerve involvement","issues":181,"granted_pct":54.1,"examples":[{"case_id":"A26002032","year":2026,"outcome":"GRANTED","quote":"Service connection for Obstructive Sleep Apnea (OSA) was granted as secondary to the Veteran's service-connected persistent depressive disorder with anxious distress, left ulnar nerve neuropathy, and lumbosacral strain, with obesity as..."},{"case_id":"A25034107","year":2025,"outcome":"DENIED","quote":"The veteran claimed service connection for obstructive sleep apnea (OSA), asserting it was secondary to his service-connected adjustment disorder, musculoskeletal conditions, and radiculopathy."}]},{"pathway":"Sleep disruption","issues":142,"granted_pct":33.1,"examples":[{"case_id":"25014487","year":2025,"outcome":"GRANTED","quote":"Lay testimony from husband and sister regarding sleep disturbances"},{"case_id":"A26010684","year":2026,"outcome":"DENIED","quote":"Separation examination showed denial of sleep problems."}]},{"pathway":"Reduced activity or mobility","issues":104,"granted_pct":72.1,"examples":[{"case_id":"A26012624","year":2026,"outcome":"GRANTED","quote":"Veteran's lay statements supported weight gain and inability to exercise."},{"case_id":"A25027338","year":2025,"outcome":"DENIED","quote":"VA examination found obesity primarily caused by caloric intake, not physical limitations."}]},{"pathway":"Chronic pain","issues":97,"granted_pct":57.7,"examples":[{"case_id":"A26018361","year":2026,"outcome":"GRANTED","quote":"The Veteran claimed obstructive sleep apnea (OSA) secondary to his service-connected lumbar strain, citing chronic pain leading to weight gain and subsequent OSA."},{"case_id":"A25103929","year":2025,"outcome":"DENIED","quote":"The Veteran sought service connection for obstructive sleep apnea, claiming it was secondary to his service-connected IVDS and chronic pain syndrome."}]},{"pathway":"Medication side effects","issues":48,"granted_pct":39.6,"examples":[{"case_id":"25005270","year":2025,"outcome":"GRANTED","quote":"Veteran's DDD led to opioid use, weight gain, and low testosterone, causing OSA."},{"case_id":"A25102261","year":2025,"outcome":"DENIED","quote":"Service connection and a 30 percent rating for central sleep apnea were granted, related to opioid use for the service-connected back disability."}]},{"pathway":"Stress","issues":12,"granted_pct":58.3,"examples":[{"case_id":"A26011244","year":2026,"outcome":"GRANTED","quote":"Service connection for Obstructive Sleep Apnea (OSA) is granted as secondary to the veteran's service-connected lumbar strain with degenerative arthritis and unspecified trauma and stressor-related disorder."}]}]},"how_va_rates":{"citation":"38 CFR 4.97","diagnostic_code":"6847","name":"Sleep Apnea Syndromes (Obstructive, Central, Mixed)","url":"https://www.ecfr.gov/current/title-38/section-4.97","levels":[{"criteria":"Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy","rating":100},{"criteria":"Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine","rating":50},{"criteria":"Persistent day-time hypersomnolence","rating":30},{"criteria":"Asymptomatic but with documented sleep disorder breathing","rating":0}],"notes":[]},"requirements":"38 CFR 3.310: a current diagnosis, a service-connected disability, and medical evidence that it caused (3.310(a)) or aggravated (3.310(b)) the condition."}}