Secondary service connection
Sleep apnea secondary to hypertension: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to hypertension in 819 decisions. It granted the issue in 14.3% of them, below the 26.4% grant rate for all sleep apnea issues, denied it in 14.5%, and remanded it in 70.2%. Counting only decisions on the merits, 49.6% were granted.
Decisions
819
2017–2026
Granted
14.3%
All sleep apnea: 26.4%
Granted on the merits
49.6%
Granted ÷ (granted + denied)
Remanded
70.2%
Denied: 14.5%
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 hypertension: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 44 | 4.5% | 43.2% | 50.0% | 2.3% |
| 2018 | 58 | 3.4% | 15.5% | 79.3% | 1.7% |
| 2019 | 65 | 9.2% | 15.4% | 73.8% | 1.5% |
| 2020 | 76 | 10.5% | 22.4% | 65.8% | 1.3% |
| 2021 | 97 | 7.2% | 18.6% | 74.2% | 0.0% |
| 2022 | 94 | 20.2% | 10.6% | 69.1% | 0.0% |
| 2023 | 85 | 14.1% | 10.6% | 75.3% | 0.0% |
| 2024 | 110 | 20.9% | 8.2% | 70.0% | 0.9% |
| 2025 | 146 | 19.9% | 8.2% | 71.2% | 0.7% |
| 2026 | 45 | 20.0% | 13.3% | 62.2% | 4.4% |
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 Other: dismissed, withdrawn or no clear outcome.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 | 133 | 91.7% | 26.3% | +65.4 pts |
| Favorable VA exam | 57 | 80.6% | 44.9% | +35.8 pts |
| Private medical opinion | 285 | 62.4% | 38.6% | +23.8 pts |
| Buddy statement | 58 | 42.1% | 50.2% | −8.1 pts |
| Lay statement | 611 | 42.0% | 79.2% | −37.1 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 77.8% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 23.9% of grants and 8.4% 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 | 669 | 47.2% | 72.7% | −25.5 pts |
| Negative nexus opinion | 589 | 43.2% | 77.3% | −34.0 pts |
How these claims are argued
A secondary claim says hypertension 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)
6.6%
granted, of 391 issues (47.7% of all)
Causation only
caused by the disability, 3.310(a)
21.2%
granted, of 429 issues (52.3% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “VA examiner provided negative nexus for obesity/age but suggested link to PTSD, hypertension, diabetes.” 24018466 (2024) Denied “A March 2013 sleep study confirmed the diagnosis, noting risk factors like obesity.” A26001133 (2026) | 161 | 6.2% |
Sleep disruption Granted “Service connection for sleep disturbed breathing, including sleep apnea, was granted secondary to service-connected labile hypertension.” A25053853 (2025) Denied “Service treatment records negative for sleep disturbances.” A26018563 (2026) | 50 | 14.0% |
Nerve involvement Granted “Mitchell opined OSA is more likely than not secondary to service-connected cervical spine pain, hypertension, upper extremity nerve pain, and tinnitus.” 22031615 (2022) | 11 | 9.1% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 25.9% of the 820 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
- Current diagnosis established20
- Caused by the service-connected disability12
- Service connection established11
- Aggravated by the service-connected disability6
- VA examiner: less likely than not related to service3
- Service records negative or silent2
- Criteria for service connection met2
Most common reasons in denials
- No in-service complaints, treatment or diagnosis34
- VA examiner: less likely than not related to service25
- Service records negative or silent19
- Preponderance of the evidence against the claim14
- Aggravated by the service-connected disability5
- Current diagnosis established4
- No continuity of symptomatology2
- Negative nexus opinions from VA examiners2
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
Secondary to service-connected hypertension; Evidence in relative equipoise; Reasonable doubt resolved in veteran's favor
Secondary to service-connected hypertension; Private medical opinion provided positive nexus; DeLisio duty to investigate secondary conditions applied
In-service hypertension noted in STRs; Veteran and wife testimony of OSA symptoms; Private physician nexus opinion linking OSA to hypertension/service; Benefit of the doubt applied due to approximate balance of evidence
Denied
Private physician opinions lacked rationale.; VA examiners opined no nexus between OSA and hypertension.; Weight of evidence against claim.
Not a presumptive illness for herbicide exposure; Late onset over 45 years after service; Unfavorable VA medical opinions regarding nexus
Current diagnosis of OSA; No nexus to herbicide exposure; No nexus to hypertension; VA opinions found OSA not related to TERA/AO exposure; OSA not presumed for toxic exposures; OSA due to anatomical changes, not toxic exposure; Medical literature does not support nexus; No nexus to hypertension; Hypertension does not cause OSA; OSA not related to service
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.
- Hypertension is already service connected.
- Medical evidence linking them (a nexus opinion): sleep apnea was caused by hypertension (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 hypertension
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 diabetes994 decisions · 23.0% granted
- Sleep apnea secondary to tinnitus632 decisions · 20.7% granted
See all conditions secondary to hypertension 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 hypertension, 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.