Secondary service connection
Sleep apnea secondary to tinnitus: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to tinnitus in 856 decisions. It granted the issue in 24.1% of them, below the 26.4% grant rate for all sleep apnea issues, denied it in 15.3%, and remanded it in 60.2%. Counting only decisions on the merits, 61.1% were granted.
Decisions
856
2017–2026
Granted
24.1%
All sleep apnea: 26.4%
Granted on the merits
61.1%
Granted ÷ (granted + denied)
Remanded
60.2%
Denied: 15.3%
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 tinnitus: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2018 | 26 | 30.8% | 23.1% | 46.2% | 0.0% |
| 2019 | 29 | 17.2% | 13.8% | 69.0% | 0.0% |
| 2020 | 38 | 13.2% | 26.3% | 60.5% | 0.0% |
| 2021 | 52 | 13.5% | 17.3% | 69.2% | 0.0% |
| 2022 | 67 | 16.4% | 11.9% | 70.1% | 1.5% |
| 2023 | 87 | 17.2% | 13.8% | 69.0% | 0.0% |
| 2024 | 141 | 22.7% | 12.1% | 64.5% | 0.7% |
| 2025 | 305 | 30.5% | 13.8% | 55.1% | 0.7% |
| 2026 | 103 | 29.1% | 18.4% | 52.4% | 0.0% |
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 Other: dismissed, withdrawn or no clear outcome.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 | 253 | 95.7% | 19.1% | +76.6 pts |
| Private medical opinion | 409 | 79.6% | 24.1% | +55.4 pts |
| Favorable VA exam | 57 | 84.8% | 58.6% | +26.3 pts |
| Buddy statement | 44 | 77.8% | 60.2% | +17.6 pts |
| Lay statement | 592 | 50.8% | 86.6% | −35.8 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 75.7% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 18.4% of grants and 4.6% 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 | 694 | 58.9% | 74.0% | −15.1 pts |
| Negative nexus opinion | 621 | 57.4% | 73.4% | −16.1 pts |
How these claims are argued
A secondary claim says tinnitus 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)
20.8%
granted, of 452 issues (52.8% of all)
Causation only
caused by the disability, 3.310(a)
27.7%
granted, of 404 issues (47.2% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Private medical opinion found thoracolumbar arthritis caused obesity, which caused OSA.” A26001932 (2026) Denied “Other risk factors (age, obesity, anatomy) are more likely etiologies.” 26001045 (2026) | 135 | 18.5% |
Sleep disruption Granted “The Board found the evidence in equipoise, granting service connection based on credible, internally consistent lay statements of sleep disturbance during service, despite no in-service treatment and negative VA nexus opinions.” 26001001 (2026) Denied “VA examiner diagnosed unspecified insomnia disorder” A26004390 (2026) | 116 | 25.0% |
Nerve involvement Granted “Private medical opinion found OSA causally related to service-connected tinnitus and radiculopathy with obesity as intermediate step.” A26019184 (2026) Denied “No medical nexus found between sleep apnea and PTSD, peripheral neuropathy, diabetes mellitus, hearing loss, or tinnitus.” 1726897 (2017) | 13 | 46.2% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 30.0% of the 856 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 disability30
- Current diagnosis established30
- Service connection established29
- Aggravated by the service-connected disability19
- Service records negative or silent4
- VA examiner: less likely than not related to service4
- Private medical opinion found OSA more likely than not caused/aggravated by tinnitus2
- Private medical opinion found probative2
Most common reasons in denials
- VA examiner: less likely than not related to service33
- Service records negative or silent27
- No in-service complaints, treatment or diagnosis23
- Aggravated by the service-connected disability6
- Preponderance of the evidence against the claim6
- No current diagnosis4
- Caused by the service-connected disability4
- Diagnosis occurred years after service3
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; Service-connected for tinnitus; Private opinion found sleep apnea secondary to tinnitus; Private opinion linked tinnitus to REM disruption and pharyngeal muscle paralysis; Private opinion found highly probative due to thoroughness and rationale
Current diagnosis of OSA established.; Service connection for PTSD and tinnitus established.; Private medical opinion found PTSD and tinnitus aggravated OSA via fragmented sleep.
Favorable finding of current disability (OSA); Favorable finding of service-connected tinnitus; Nexus established by private medical opinion linking OSA to tinnitus
Denied
Weight of evidence against service connection for OSA; Weight of evidence against OSA being proximately due to or aggravated by tinnitus; Contemporaneous service records did not mention OSA; VA examiner opinions found less likely than not nexus
Private opinions afforded little weight due to conflation of causation/aggravation standards and suggestion of age/obesity as causes.; VA treatment records noted morbid obesity as a cause for sleep apnea.; VA examiner opined tinnitus does not negatively impact or cause sleep apnea.
Service treatment records silent for sleep disorder complaints, diagnosis, or treatment.; Diagnosis of moderate OSA occurred over 35 years after service.; Private opinion lacked probative value due to speculative reasoning and incomplete literature interpretation.
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.
- Tinnitus is already service connected.
- Medical evidence linking them (a nexus opinion): sleep apnea was caused by tinnitus (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 tinnitus
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 hypertension692 decisions · 14.6% granted
See all conditions secondary to tinnitus 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 tinnitus, 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.