{"page":"https://casescribe.ai/explorer/secondary/sleep-apnea-secondary-to-diabetes","generated_at":"2026-10-03T18:34:28.256Z","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 diabetes","secondary_condition":"Sleep apnea","service_connected_disability":"diabetes","decisions":1116,"years":"2017-2026","granted_pct":21.8,"denied_pct":19.1,"remanded_pct":58.2,"granted_on_merits_pct":53.3,"by_year":[{"year":2017,"issues":65,"granted_pct":7.7,"denied_pct":41.5,"remanded_pct":49.2},{"year":2018,"issues":106,"granted_pct":21.7,"denied_pct":20.8,"remanded_pct":52.8},{"year":2019,"issues":107,"granted_pct":21.5,"denied_pct":19.6,"remanded_pct":57},{"year":2020,"issues":141,"granted_pct":15.6,"denied_pct":27.7,"remanded_pct":56.7},{"year":2021,"issues":131,"granted_pct":13,"denied_pct":19.1,"remanded_pct":67.9},{"year":2022,"issues":173,"granted_pct":14.5,"denied_pct":19.1,"remanded_pct":66.5},{"year":2023,"issues":134,"granted_pct":24.6,"denied_pct":14.2,"remanded_pct":61.2},{"year":2024,"issues":109,"granted_pct":32.1,"denied_pct":11.9,"remanded_pct":56},{"year":2025,"issues":111,"granted_pct":38.7,"denied_pct":11.7,"remanded_pct":48.6},{"year":2026,"issues":41,"granted_pct":43.9,"denied_pct":2.4,"remanded_pct":51.2}],"benefit_of_doubt_in_grants_pct":78.6,"evidence_on_merits":[{"evidence":"va_exam_favorable","decisions_with":87,"granted_pct_with":81.8,"granted_pct_without":49.4},{"evidence":"va_exam_unfavorable","decisions_with":896,"granted_pct_with":50.4,"granted_pct_without":72.1},{"evidence":"nexus_positive","decisions_with":274,"granted_pct_with":90.3,"granted_pct_without":22.5},{"evidence":"nexus_negative","decisions_with":817,"granted_pct_with":48.4,"granted_pct_without":73.9},{"evidence":"private_opinion","decisions_with":446,"granted_pct_with":66.4,"granted_pct_without":35.1},{"evidence":"treating_physician","decisions_with":78,"granted_pct_with":64,"granted_pct_without":52},{"evidence":"lay_statement","decisions_with":743,"granted_pct_with":42.5,"granted_pct_without":80.2},{"evidence":"combat_service","decisions_with":76,"granted_pct_with":51.9,"granted_pct_without":53.4}],"top_reasons":{"granted":[{"reason":"service connection established","decisions":35},{"reason":"current diagnosis established","decisions":34},{"reason":"caused by the service-connected disability","decisions":30},{"reason":"aggravated by the service-connected disability","decisions":8},{"reason":"va examiner: less likely than not related to service","decisions":5},{"reason":"obesity as intermediate step","decisions":4}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":53},{"reason":"service records negative or silent","decisions":44},{"reason":"no in-service complaints, treatment or diagnosis","decisions":37},{"reason":"preponderance of the evidence against the claim","decisions":35},{"reason":"aggravated by the service-connected disability","decisions":11},{"reason":"private opinion lacked rationale","decisions":4}]},"recent_examples":{"granted":[{"case_id":"A26035783","year":2026,"judge":"THOMAS L. ENGLISH","rationale":"Service connection granted secondary to diabetes mellitus; VA examinations found inadequate for failing to address obesity as intermediate step; Private medical opinion found probative, establishing nexus via obesity"},{"case_id":"26004598","year":2026,"judge":"T. MAINELLI","rationale":"Veteran has current diagnosis of obstructive sleep apnea.; Veteran is service-connected for diabetes mellitus, type II, with complications including obesity and diabetic neuropathy.; VA examiner noted bidirectional link between OSA and diabetes.; Subsequent VA addendum was inadequate.; Evidence for … [truncated, 62 chars omitted]"},{"case_id":"A26031847","year":2026,"judge":"SHAUN S. SPERANZA","rationale":"Private examiner found OSA more likely than not related to service-connected diabetes and orthopedic disabilities.; Private examiner reasoned diabetes aggravates OSA and orthopedic symptoms contribute to obesity.; Evidence for and against claim approximately balanced, doubt resolved in Veteran's fav… [truncated, 3 chars omitted]"}],"denied":[{"case_id":"A26034116","year":2026,"judge":"L. HOWELL","rationale":"No in-service incurrence of OSA; VA examiner found no medical evidence linking OSA to toxic exposures; Private consultant's opinion lacked probative value due to speculative reasoning and reliance on associations"},{"case_id":"25014144","year":2025,"judge":"R. BISIGNANI","rationale":"Service treatment records negative for complaints/treatment of obstructive sleep apnea.; VA examiner opined less likely than not related to service, citing overweightness, age, and lack of medical literature.; Private physician opinion deemed speculative.; Weight of evidence against secondary connec… [truncated, 30 chars omitted]"},{"case_id":"A25091660","year":2025,"judge":"H. SEESEL","rationale":"No positive medical opinion linking sleep apnea to service.; VA examiners found sleep apnea more likely due to physical causes (obesity, comorbidities) than service.; Lay statements were not competent to establish medical etiology."}]},"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":1118,"aggravation_discussed":{"issues":570,"granted_pct":16.7},"causation_only":{"issues":548,"granted_pct":27.2},"issues_naming_a_pathway_pct":44.5,"pathways":[{"pathway":"Weight gain or obesity","issues":433,"granted_pct":24,"examples":[{"case_id":"26004598","year":2026,"outcome":"GRANTED","quote":"Veteran is service-connected for diabetes mellitus, type II, with complications including obesity and diabetic neuropathy."},{"case_id":"25000410","year":2025,"outcome":"DENIED","quote":"The Veteran claimed OSA was related to herbicide exposure or, alternatively, that service-connected diabetes caused obesity, which led to OSA."}]},{"pathway":"Nerve involvement","issues":90,"granted_pct":33.3,"examples":[{"case_id":"26004598","year":2026,"outcome":"GRANTED","quote":"Veteran is service-connected for diabetes mellitus, type II, with complications including obesity and diabetic neuropathy."},{"case_id":"25004096","year":2025,"outcome":"DENIED","quote":"The veteran sought service connection for obstructive sleep apnea, claiming it was secondary to his service-connected diabetes mellitus, ischemic heart disease, unspecified anxiety disorder, and related medications, or peripheral..."}]},{"pathway":"Sleep disruption","issues":42,"granted_pct":9.5,"examples":[{"case_id":"A25003356","year":2025,"outcome":"GRANTED","quote":"Lay statements regarding sleep disturbances from neuropathy were considered.."},{"case_id":"A23004600","year":2023,"outcome":"DENIED","quote":"The Veteran claimed service connection for obstructive sleep apnea, asserting it was secondary to or aggravated by his service-connected depressive disorder with insomnia, diabetes mellitus, and hypertension."}]},{"pathway":"Reduced activity or mobility","issues":17,"granted_pct":52.9,"examples":[{"case_id":"25012587","year":2025,"outcome":"GRANTED","quote":"The Veteran has a current diagnosis of OSA, and while service treatment records are silent, the DMII has led to limited mobility, numbness, and weakness impacting occupational tasks."},{"case_id":"A23023055","year":2023,"outcome":"DENIED","quote":"Obesity not shown to be caused by diabetes-related inactivity."}]}]},"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."}}