Secondary service connection
Sleep apnea secondary to a psychiatric disorder: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to a psychiatric disorder in 5,568 decisions. It granted the issue in 33.4% of them, above the 26.4% grant rate for all sleep apnea issues, denied it in 11.7%, and remanded it in 54.2%. Counting only decisions on the merits, 74.0% were granted.
Decisions
5,568
2017–2026
Granted
33.4%
All sleep apnea: 26.4%
Granted on the merits
74.0%
Granted ÷ (granted + denied)
Remanded
54.2%
Denied: 11.7%
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 psychiatric disorder: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 108 | 12.0% | 26.9% | 57.4% | 3.7% |
| 2018 | 292 | 28.4% | 13.7% | 56.8% | 1.0% |
| 2019 | 495 | 28.5% | 11.5% | 59.4% | 0.6% |
| 2020 | 517 | 29.4% | 14.3% | 55.9% | 0.4% |
| 2021 | 552 | 22.5% | 18.1% | 58.9% | 0.5% |
| 2022 | 541 | 23.5% | 12.0% | 64.0% | 0.6% |
| 2023 | 672 | 30.7% | 9.1% | 59.8% | 0.4% |
| 2024 | 949 | 35.6% | 10.2% | 53.5% | 0.6% |
| 2025 | 1,088 | 47.2% | 8.2% | 43.8% | 0.8% |
| 2026 | 363 | 44.4% | 11.6% | 43.3% | 0.8% |
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 Other: dismissed, withdrawn or no clear outcome.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 | 2,082 | 94.1% | 37.6% | +56.5 pts |
| Private medical opinion | 2,865 | 85.9% | 43.1% | +42.7 pts |
| Favorable VA exam | 604 | 86.3% | 71.5% | +14.8 pts |
| Treating physician opinion | 254 | 78.1% | 73.7% | +4.4 pts |
| Buddy statement | 277 | 77.2% | 73.8% | +3.5 pts |
| Combat service | 241 | 72.8% | 74.0% | −1.2 pts |
| Lay statement | 4,018 | 67.9% | 91.5% | −23.6 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 74.7% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 19.7% of grants and 7.2% 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 | 3,780 | 70.6% | 83.3% | −12.8 pts |
| Unfavorable VA exam | 4,453 | 71.6% | 85.6% | −13.9 pts |
How these claims are argued
A secondary claim says a psychiatric disorder 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)
29.7%
granted, of 2,539 issues (45.5% of all)
Causation only
caused by the disability, 3.310(a)
36.3%
granted, of 3,038 issues (54.5% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Obesity considered as an intermediate step, with the Board finding the evidence in equipoise regarding its link to service-connected conditions and sleep apnea.” 26001663 (2026) Denied “Examiners cited obesity and macroglossia as primary causes of OSA, with no pathophysiological link to depression..” 26000381 (2026) | 1,658 | 41.6% |
Sleep disruption Granted “In-service complaints of trouble sleeping and fatigue, and reports of snoring, support second element.” 26003457 (2026) Denied “In-service complaints of nightmares and insomnia” 26000916 (2026) | 583 | 25.7% |
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 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) | 79 | 51.9% |
Chronic pain Granted “Service-connected depressive disorder due to chronic pain associated with degenerative arthritis of the lumbar spine.” A25004703 (2025) Denied “VA examiner found OSA less likely than not caused by obesity, depression, or chronic pain.” A24034355 (2024) | 68 | 61.8% |
Stress Granted “in July 2025 found it at least as likely as not related to service, providing a cogent rationale linking in-service sleep issues and operational stressors to the diagnosis.” 26003457 (2026) Denied “The Board found the Veteran's lay statements regarding the alleged stressor to be not credible, and therefore, the claim for secondary service connection could not be established.” 23001273 (2023) | 68 | 44.1% |
Medication side effects Granted “Link to service-connected disabilities (RSD, opioid use)” A26022156 (2026) Denied “Service connection for obstructive sleep apnea is denied as secondary to the veteran's acquired psychiatric disorder or opioid usage.” A25051926 (2025) | 66 | 40.9% |
Reduced activity or mobility Granted “VA opinions found OSA not related to service, attributing it to diet, genetics, and sedentary lifestyle.” A26010544 (2026) Denied “Medical evidence does not support that inability to exercise due to service-connected disabilities caused obesity..” A24034355 (2024) | 61 | 62.3% |
Altered gait or overuse Granted “Greater weight of adequate and probative evidence favored the veteran's claim for secondary service connection..” A25028203 (2025) Denied “Symptoms of sleep impairment compensated within generalized anxiety disorder rating.” A25100748 (2025) | 18 | 55.6% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 40.3% of the 5,577 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 disability264
- Current diagnosis established238
- Service connection established172
- Aggravated by the service-connected disability113
- VA examiner: less likely than not related to service44
- Service records negative or silent20
- Private medical opinion found probative13
- Obesity as intermediate step13
Most common reasons in denials
- VA examiner: less likely than not related to service147
- No in-service complaints, treatment or diagnosis116
- Service records negative or silent96
- Preponderance of the evidence against the claim63
- No current diagnosis27
- Current diagnosis established26
- Aggravated by the service-connected disability25
- Caused by the service-connected disability15
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
Current diagnosis of sleep apnea established.; Private physician opinion found at least as likely as not that sleep apnea was directly attributable to long-term consequences of service-connected PTSD and related conditions.; No contrary medical opinion of record.
Current disability (OSA) demonstrated; Service connection for PTSD with persistent depressive disorder and insomnia established; Private medical opinion linked OSA to PTSD based on literature and PTSD symptomology; Private opinion found OSA at least as likely as not due to PTSD; No conflicting medical opinion in record
Private medical opinion linked OSA to MDD; OSA is but-for caused by MDD; Resolving doubt in favor of veteran
Denied
Service treatment records did not reflect complaints related to sleep apnea.; VA examiner opined condition was less likely than not proximately due to or the result of acquired psychiatric disorder.; Private opinion lacked specifics and was deemed speculative by the Board.
Insufficient evidence of current diagnosis of sleep apnea.; VA sleep study negative for obstructive sleep apnea.; Examiner found no current signs or symptoms attributable to sleep apnea.
No current diagnosis of sleep apnea established.; Veteran failed to attend scheduled sleep study.; Private medical opinion insufficient without objective testing.
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 psychiatric disorder is already service connected.
- Medical evidence linking them (a nexus opinion): sleep apnea was caused by a psychiatric disorder (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 psychiatric disorder
- Migraine secondary to a psychiatric disorder1,181 decisions · 41.2% granted
- Erectile dysfunction secondary to a psychiatric disorder1,061 decisions · 31.9% granted
- Gastroesophageal reflux disease (GERD) secondary to a psychiatric disorder591 decisions · 25.4% granted
- Diabetes mellitus secondary to a psychiatric disorder418 decisions · 21.3% granted
- Hypertension secondary to a psychiatric disorder1,487 decisions · 20.1% 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 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 psychiatric disorder 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 psychiatric disorder, 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.