Secondary service connection
Sleep apnea secondary to diabetes: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to diabetes in 1,116 decisions. It granted the issue in 21.8% of them, below the 26.4% grant rate for all sleep apnea issues, denied it in 19.1%, and remanded it in 58.2%. Counting only decisions on the merits, 53.3% were granted.
Decisions
1,116
2017–2026
Granted
21.8%
All sleep apnea: 26.4%
Granted on the merits
53.3%
Granted ÷ (granted + denied)
Remanded
58.2%
Denied: 19.1%
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 diabetes: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 65 | 7.7% | 41.5% | 49.2% | 1.5% |
| 2018 | 106 | 21.7% | 20.8% | 52.8% | 4.7% |
| 2019 | 107 | 21.5% | 19.6% | 57.0% | 1.9% |
| 2020 | 141 | 15.6% | 27.7% | 56.7% | 0.0% |
| 2021 | 131 | 13.0% | 19.1% | 67.9% | 0.0% |
| 2022 | 173 | 14.5% | 19.1% | 66.5% | 0.0% |
| 2023 | 134 | 24.6% | 14.2% | 61.2% | 0.0% |
| 2024 | 109 | 32.1% | 11.9% | 56.0% | 0.0% |
| 2025 | 111 | 38.7% | 11.7% | 48.6% | 0.9% |
| 2026 | 41 | 43.9% | 2.4% | 51.2% | 2.4% |
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 Other: dismissed, withdrawn or no clear outcome.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 | 274 | 90.3% | 22.5% | +67.8 pts |
| Favorable VA exam | 87 | 81.8% | 49.4% | +32.4 pts |
| Private medical opinion | 446 | 66.4% | 35.1% | +31.3 pts |
| Treating physician opinion | 78 | 64.0% | 52.0% | +12.0 pts |
| Combat service | 76 | 51.9% | 53.4% | −1.5 pts |
| Lay statement | 743 | 42.5% | 80.2% | −37.7 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.6% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 14.0% of grants and 7.5% 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 |
|---|---|---|---|---|
| Unfavorable VA exam | 896 | 50.4% | 72.1% | −21.8 pts |
| Negative nexus opinion | 817 | 48.4% | 73.9% | −25.5 pts |
How these claims are argued
A secondary claim says diabetes 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)
16.7%
granted, of 570 issues (51.0% of all)
Causation only
caused by the disability, 3.310(a)
27.2%
granted, of 548 issues (49.0% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Veteran is service-connected for diabetes mellitus, type II, with complications including obesity and diabetic neuropathy.” 26004598 (2026) Denied “The Veteran claimed OSA was related to herbicide exposure or, alternatively, that service-connected diabetes caused obesity, which led to OSA.” 25000410 (2025) | 433 | 24.0% |
Nerve involvement Granted “Veteran is service-connected for diabetes mellitus, type II, with complications including obesity and diabetic neuropathy.” 26004598 (2026) Denied “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...” 25004096 (2025) | 90 | 33.3% |
Sleep disruption Granted “Lay statements regarding sleep disturbances from neuropathy were considered..” A25003356 (2025) Denied “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.” A23004600 (2023) | 42 | 9.5% |
Reduced activity or mobility Granted “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.” 25012587 (2025) Denied “Obesity not shown to be caused by diabetes-related inactivity.” A23023055 (2023) | 17 | 52.9% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 44.5% of the 1,118 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
- Service connection established35
- Current diagnosis established34
- Caused by the service-connected disability30
- Aggravated by the service-connected disability8
- VA examiner: less likely than not related to service5
- Obesity as intermediate step4
- Criteria for service connection met3
- Private medical opinion found OSA secondary to diabetes3
Most common reasons in denials
- VA examiner: less likely than not related to service53
- Service records negative or silent44
- No in-service complaints, treatment or diagnosis37
- Preponderance of the evidence against the claim35
- Aggravated by the service-connected disability11
- Private opinion lacked rationale4
- Current diagnosis established4
- No current diagnosis3
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
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
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 and against secondary connection found in approximate balance.
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 favor.
Denied
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
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 connection to hypertension/diabetes.
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.
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.
- Diabetes is already service connected.
- Medical evidence linking them (a nexus opinion): sleep apnea was caused by diabetes (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 diabetes
- Peripheral arterial occlusive disease (buerger's disease) secondary to diabetes335 decisions · 37.3% granted
- Retinal dystrophy (including retinitis pigmentosa macular degeneration) secondary to diabetes416 decisions · 37.0% granted
- Peripheral nerve disorders secondary to diabetes3,602 decisions · 33.6% granted
- Kidney disease secondary to diabetes906 decisions · 26.5% granted
- Erectile dysfunction secondary to diabetes1,811 decisions · 25.8% granted
- Cataract extraction secondary to diabetes372 decisions · 22.6% granted
- Hypertension secondary to diabetes2,809 decisions · 15.2% granted
- Glaucoma secondary to diabetes482 decisions · 10.6% granted
Sleep apnea secondary to other conditions
- Sleep apnea secondary to a knee condition983 decisions · 46.2% granted
- Sleep apnea secondary to a back condition1,166 decisions · 38.2% 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 tinnitus632 decisions · 20.7% granted
- Sleep apnea secondary to hypertension692 decisions · 14.6% granted
See all conditions secondary to diabetes 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 diabetes, 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.