{"page":"https://casescribe.ai/explorer/secondary/sleep-apnea-secondary-to-knee","generated_at":"2026-10-03T18:34:24.681Z","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 knee condition","secondary_condition":"Sleep apnea","service_connected_disability":"a knee condition","decisions":1084,"years":"2017-2026","granted_pct":45.9,"denied_pct":9.6,"remanded_pct":43.6,"granted_on_merits_pct":82.7,"by_year":[{"year":2018,"issues":33,"granted_pct":36.4,"denied_pct":18.2,"remanded_pct":45.5},{"year":2019,"issues":72,"granted_pct":33.3,"denied_pct":13.9,"remanded_pct":51.4},{"year":2020,"issues":77,"granted_pct":36.4,"denied_pct":11.7,"remanded_pct":51.9},{"year":2021,"issues":78,"granted_pct":24.4,"denied_pct":6.4,"remanded_pct":69.2},{"year":2022,"issues":73,"granted_pct":23.3,"denied_pct":16.4,"remanded_pct":57.5},{"year":2023,"issues":110,"granted_pct":42.7,"denied_pct":10,"remanded_pct":46.4},{"year":2024,"issues":237,"granted_pct":51.5,"denied_pct":6.8,"remanded_pct":41.4},{"year":2025,"issues":321,"granted_pct":59.8,"denied_pct":8.7,"remanded_pct":30.8},{"year":2026,"issues":76,"granted_pct":52.6,"denied_pct":5.3,"remanded_pct":42.1}],"benefit_of_doubt_in_grants_pct":71.9,"evidence_on_merits":[{"evidence":"va_exam_favorable","decisions_with":87,"granted_pct_with":89,"granted_pct_without":81.9},{"evidence":"va_exam_unfavorable","decisions_with":871,"granted_pct_with":80.5,"granted_pct_without":92.7},{"evidence":"nexus_positive","decisions_with":546,"granted_pct_with":95.1,"granted_pct_without":40.9},{"evidence":"nexus_negative","decisions_with":787,"granted_pct_with":80.5,"granted_pct_without":90},{"evidence":"private_opinion","decisions_with":695,"granted_pct_with":88.8,"granted_pct_without":50},{"evidence":"lay_statement","decisions_with":762,"granted_pct_with":77.9,"granted_pct_without":93.9},{"evidence":"buddy_statement","decisions_with":50,"granted_pct_with":69.2,"granted_pct_without":83.3}],"top_reasons":{"granted":[{"reason":"caused by the service-connected disability","decisions":118},{"reason":"service connection established","decisions":68},{"reason":"current diagnosis established","decisions":45},{"reason":"aggravated by the service-connected disability","decisions":22},{"reason":"va examiner: less likely than not related to service","decisions":11},{"reason":"obesity as intermediate step","decisions":6}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":19},{"reason":"no in-service complaints, treatment or diagnosis","decisions":14},{"reason":"caused by the service-connected disability","decisions":13},{"reason":"service records negative or silent","decisions":12},{"reason":"aggravated by the service-connected disability","decisions":6},{"reason":"preponderance of the evidence against the claim","decisions":6}]},"recent_examples":{"granted":[{"case_id":"A26040512","year":2026,"judge":"MICHAEL MARTIN","rationale":"Private medical opinion linked weight gain to service-connected knee/ankle conditions; Weight gain identified as intermediate step to OSA; Evidence in relative equipoise, doubt resolved in Veteran's favor"},{"case_id":"A26038834","year":2026,"judge":"S. B. MAYS","rationale":"Favorable opinions found knee disability aggravated obesity, which caused sleep apnea.; Negative opinions did not adequately address obesity as an intermediate step.; Evidence found in equipoise, with doubt resolved in veteran's favor."},{"case_id":"A26037773","year":2026,"judge":"D. JOHNSON","rationale":"Sleep apnea rated under DC 6847 for use of CPAP machine.; Spicer v. McDonough precedent applied to secondary service connection.; Board resolved reasonable doubt in Veteran's favor for 50% rating."}],"denied":[{"case_id":"A26022920","year":2026,"judge":"S. HENEKS","rationale":"Conflicting medical opinions regarding OSA etiology.; Board found VA examiners' opinions more probative than private opinion.; Lack of in-service documentation of OSA symptoms.; Significant delay between service and diagnosis.; OSA has a known etiology, precluding presumptive service connection as M… [truncated, 5 chars omitted]"},{"case_id":"A26013801","year":2026,"judge":"REBECCA N. POULSON","rationale":"No evidence of current disability; No nexus to service or service-connected disability; No pre-decisional duty to order VA exam; No evidence submitted for secondary claim"},{"case_id":"A26011024","year":2026,"judge":"M. C. GRAHAM","rationale":"November 2023 VA exam found OSA not directly related to service, noting lack of in-service complaints and suggesting post-service factors.; Examiner noted Veteran's assertion of weight gain from knee injury causing OSA but cited other weight management options.; December 2023 VA exam found OSA unrel… [truncated, 339 chars omitted]"}]},"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":1089,"aggravation_discussed":{"issues":445,"granted_pct":36},"causation_only":{"issues":644,"granted_pct":53},"issues_naming_a_pathway_pct":82.2,"pathways":[{"pathway":"Weight gain or obesity","issues":833,"granted_pct":50.5,"examples":[{"case_id":"26001800","year":2026,"outcome":"GRANTED","quote":"Obesity noted as intermediate step between service-connected conditions and OSA."},{"case_id":"A26008466","year":2026,"outcome":"DENIED","quote":"Veteran's theory of weight gain as intermediate step is speculative."}]},{"pathway":"Reduced activity or mobility","issues":117,"granted_pct":68.4,"examples":[{"case_id":"A26001655","year":2026,"outcome":"GRANTED","quote":"Opinion noted Veteran's obesity, chronic pain, limited mobility, and PTSD medication causing weight gain."},{"case_id":"A25002278","year":2025,"outcome":"DENIED","quote":"No persuasive evidence linked OSA to service-connected knee disability or inactivity caused by it."}]},{"pathway":"Sleep disruption","issues":78,"granted_pct":42.3,"examples":[{"case_id":"A26008821","year":2026,"outcome":"GRANTED","quote":"Private opinion found it at least as likely as not that knee disability caused sleep impairment and obesity, contributing to sleep apnea."},{"case_id":"25005229","year":2025,"outcome":"DENIED","quote":"Veteran's testimony indicated no sleep problems during service.."}]},{"pathway":"Chronic pain","issues":69,"granted_pct":63.8,"examples":[{"case_id":"A26001655","year":2026,"outcome":"GRANTED","quote":"Opinion noted Veteran's obesity, chronic pain, limited mobility, and PTSD medication causing weight gain."},{"case_id":"A25008143","year":2025,"outcome":"DENIED","quote":"Veteran remained active post-service and did not report knee pain interfering with exercise."}]},{"pathway":"Nerve involvement","issues":42,"granted_pct":61.9,"examples":[{"case_id":"26001800","year":2026,"outcome":"GRANTED","quote":"Service-connected disabilities (fibromyalgia, cervical degenerative arthritis, lumbar radiculopathy, lumbar degenerative arthritis, right knee degenerative arthritis) met."},{"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":"Medication side effects","issues":28,"granted_pct":57.1,"examples":[{"case_id":"A25015945","year":2025,"outcome":"GRANTED","quote":"Cited weight gain from inactivity and NSAID use as contributing factors"},{"case_id":"21005396","year":2021,"outcome":"DENIED","quote":"The veteran claims service connection for sleep apnea, asserting it is due to medication used to treat service-connected back and knee disabilities."}]}]},"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."}}