Secondary service connection
Sleep apnea secondary to a back condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to a back condition in 1,481 decisions. It granted the issue in 39.2% of them, above the 26.4% grant rate for all sleep apnea issues, denied it in 10.8%, and remanded it in 49.1%. Counting only decisions on the merits, 78.4% were granted.
Decisions
1,481
2017–2026
Granted
39.2%
All sleep apnea: 26.4%
Granted on the merits
78.4%
Granted ÷ (granted + denied)
Remanded
49.1%
Denied: 10.8%
How VA rates sleep apnea
Once service connection is granted, VA assigns a disability rating from the rating schedule: 38 CFR 4.97, diagnostic code 6847 (Sleep Apnea Syndromes (Obstructive, Central, Mixed)). The rating is the same whether the condition is service connected directly or as secondary to another disability.
| Rating | Criteria |
|---|---|
| 100% | Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy |
| 50% | Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine |
| 30% | Persistent day-time hypersomnolence |
| 0% | Asymptomatic but with documented sleep disorder breathing |
Text of 38 CFR 4.97 as of Feb 27, 2026. Confirm the current text at the source before relying on it.
See all sleep apnea decisions, direct and secondary.
Sleep apnea secondary to a back condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 36 | 22.2% | 36.1% | 38.9% | 2.8% |
| 2018 | 62 | 25.8% | 16.1% | 54.8% | 3.2% |
| 2019 | 102 | 28.4% | 13.7% | 56.9% | 1.0% |
| 2020 | 102 | 38.2% | 12.7% | 48.0% | 1.0% |
| 2021 | 130 | 23.8% | 12.3% | 63.1% | 0.8% |
| 2022 | 126 | 22.2% | 6.3% | 71.4% | 0.0% |
| 2023 | 151 | 35.8% | 12.6% | 51.7% | 0.0% |
| 2024 | 297 | 46.8% | 9.1% | 43.4% | 0.7% |
| 2025 | 383 | 51.4% | 7.8% | 39.4% | 1.3% |
| 2026 | 95 | 42.1% | 10.5% | 46.3% | 1.1% |
Each row counts issues (each condition the Board decided), so the shares add up to 100%. Other: dismissed, withdrawn or no clear outcome. Years with fewer than 20 issues are left out.
Evidence in granted and denied sleep apnea decisions
For each kind of supporting evidence: how often the Board granted the sleep apnea issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 611 | 95.7% | 38.9% | +56.8 pts |
| Private medical opinion | 809 | 87.4% | 48.2% | +39.2 pts |
| Favorable VA exam | 135 | 90.5% | 76.6% | +13.9 pts |
| Treating physician opinion | 63 | 86.1% | 78.0% | +8.1 pts |
| Buddy statement | 60 | 74.1% | 78.6% | −4.5 pts |
| Lay statement | 1,050 | 73.1% | 92.2% | −19.1 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 74.2% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 17.6% of grants and 6.9% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often sleep apnea was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 1,077 | 76.8% | 83.9% | −7.1 pts |
| Unfavorable VA exam | 1,225 | 76.1% | 91.7% | −15.6 pts |
How these claims are argued
A secondary claim says a back condition caused sleep apnea or made it worse, and names how. Below: whether the Board's decision discussed aggravation, and the medical link each decision names, with how often those issues were granted.
Aggravation discussed
made worse by the disability, 3.310(b)
28.4%
granted, of 620 issues (41.8% of all)
Causation only
caused by the disability, 3.310(a)
46.9%
granted, of 864 issues (58.2% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Private opinion found OSA proximately due to service-connected low back disability with obesity as intermediary step.” 26003841 (2026) Denied “Insufficient evidence that back disability caused obesity or OSA.” A26000793 (2026) | 892 | 47.9% |
Nerve involvement Granted “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...” A26002032 (2026) Denied “The veteran claimed service connection for obstructive sleep apnea (OSA), asserting it was secondary to his service-connected adjustment disorder, musculoskeletal conditions, and radiculopathy.” A25034107 (2025) | 181 | 54.1% |
Sleep disruption Granted “Lay testimony from husband and sister regarding sleep disturbances” 25014487 (2025) Denied “Separation examination showed denial of sleep problems.” A26010684 (2026) | 142 | 33.1% |
Reduced activity or mobility Granted “Veteran's lay statements supported weight gain and inability to exercise.” A26012624 (2026) Denied “VA examination found obesity primarily caused by caloric intake, not physical limitations.” A25027338 (2025) | 104 | 72.1% |
Chronic pain Granted “The Veteran claimed obstructive sleep apnea (OSA) secondary to his service-connected lumbar strain, citing chronic pain leading to weight gain and subsequent OSA.” A26018361 (2026) Denied “The Veteran sought service connection for obstructive sleep apnea, claiming it was secondary to his service-connected IVDS and chronic pain syndrome.” A25103929 (2025) | 97 | 57.7% |
Medication side effects Granted “Veteran's DDD led to opioid use, weight gain, and low testosterone, causing OSA.” 25005270 (2025) Denied “Service connection and a 30 percent rating for central sleep apnea were granted, related to opioid use for the service-connected back disability.” A25102261 (2025) | 48 | 39.6% |
Stress Granted “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.” A26011244 (2026) | 12 | 58.3% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 73.1% of the 1,484 issues name at least one medical link; the rest only say “secondary to” the disability. One issue can name several links. Granted is the share of those issues granted (remands count as not granted). A link named in a denial was often the argument the Board rejected.
Why the Board granted or denied sleep apnea
Most common reasons in grants
- Caused by the service-connected disability153
- Service connection established78
- Current diagnosis established74
- Aggravated by the service-connected disability32
- VA examiner: less likely than not related to service23
- Obesity as intermediate step11
- Service records negative or silent5
- Obesity found to be substantial factor in causing OSA3
Most common reasons in denials
- VA examiner: less likely than not related to service33
- No in-service complaints, treatment or diagnosis28
- Preponderance of the evidence against the claim15
- Aggravated by the service-connected disability15
- Service records negative or silent14
- Caused by the service-connected disability7
- No current diagnosis7
- Service connection established6
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent sleep apnea decisions
Granted
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 little probative weight.
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 quality.
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
No current diagnosis of sleep apnea established.; Veteran failed to attend scheduled sleep study.; Private medical opinion insufficient without objective testing.
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
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
What VA needs to grant a secondary claim
Secondary service connection means VA disability benefits for a condition caused or made worse by a disability that is already service connected (38 CFR 3.310). The claim needs three things:
- A current diagnosis of sleep apnea.
- A back condition is already service connected.
- Medical evidence linking them (a nexus opinion): sleep apnea was caused by a back condition (3.310(a)), or was made worse beyond its natural progress by it (aggravation, 3.310(b)).
VA's procedures for these claims are in M21-1 V.ii.2.D. When the evidence for and against is about even, VA must decide in the veteran's favor (38 CFR 3.102).
Other conditions secondary to a back condition
- Paralysis of sciatic nerve secondary to a back condition325 decisions · 57.8% granted
- Radiculopathy secondary to a back condition1,181 decisions · 49.9% granted
- Major depressive disorder secondary to a back condition770 decisions · 47.4% granted
- Paralysis of sciatic nerve or external popliteal nerve secondary to a back condition2,436 decisions · 38.7% granted
- Ulnar nerve paralysis secondary to a back condition628 decisions · 34.6% granted
- Peripheral nerve conditions secondary to a back condition307 decisions · 32.2% granted
- Peripheral nerve disorders secondary to a back condition1,204 decisions · 27.8% granted
- Erectile dysfunction secondary to a back condition619 decisions · 27.6% granted
- Degenerative arthritis of the spine secondary to a back condition679 decisions · 23.7% granted
- Urinary incontinence secondary to a back condition408 decisions · 22.8% granted
- Hypertension secondary to a back condition330 decisions · 20.0% granted
- Migraine secondary to a back condition347 decisions · 18.7% granted
- Hip impairment secondary to a back condition1,856 decisions · 13.6% granted
- Knee conditions secondary to a back condition2,083 decisions · 12.3% granted
- Ankle impairment secondary to a back condition322 decisions · 11.2% granted
- Cervical spine limitation of motion secondary to a back condition1,553 decisions · 8.8% granted
- Shoulder impairment secondary to a back condition647 decisions · 7.3% granted
- Foot impairment secondary to a back condition354 decisions · 6.2% granted
Sleep apnea secondary to other conditions
- Sleep apnea secondary to a knee condition983 decisions · 46.2% granted
- Sleep apnea secondary to a psychiatric disorder4,474 decisions · 33.1% granted
- Sleep apnea secondary to PTSD11,479 decisions · 31.7% granted
- Sleep apnea secondary to diabetes994 decisions · 23.0% granted
- Sleep apnea secondary to tinnitus632 decisions · 20.7% granted
- Sleep apnea secondary to hypertension692 decisions · 14.6% granted
See all conditions secondary to a back condition or sleep apnea as a primary or secondary condition.
Rules that apply to secondary sleep apnea claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer - 38 CFR 4.97 · DC 6847
Schedule of ratings: respiratory system
Read it in VA Law Explorer - M21-1 IV.i.3.B.1.l
Reviewing a sleep disorders examination
Read it in VA Law Explorer
Research your sleep apnea case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a sleep apnea issue claimed as secondary to a back condition, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.