Sleep apnea secondary to a knee condition: Board grants up sharply since 2019

The Board of Veterans' Appeals now grants sleep apnea claimed as secondary to a service-connected knee condition in most of its decisions on the issue. In 2024 and 2025, it granted 56.3% of these claims, up from 32.4% in 2018 and 2019. The grant share rose 23.9 percentage points.

The figures come from 1,084 Board decisions from 2017 to 2026 that decided sleep apnea as secondary to a knee condition under 38 CFR 3.310. Across all years, the Board granted 45.9%, remanded 43.6% and denied only 9.6%.

Share of decisions each year. 2026 is a partial year.

A dip, then a climb

The rise was not steady. Grants fell to 24.4% in 2021 and 23.3% in 2022, years when remands peaked at 69.2% and 57.5%. From 2023 the grant share climbed, reaching 59.9% in 2025 while remands fell to 30.7%. In 2026 so far, the Board has granted 52.7%.

When the Board decided the issue on the merits rather than remanding it, it granted 69.7% of claims in 2018 and 2019 and 87.7% in 2024 and 2025. The data does not show why remands fell or why merits grants rose.

This claim also stands apart from sleep apnea claims generally. Across all sleep apnea decisions, direct and secondary, the Board granted 26.4%. The knee-secondary grant share is 19.5 percentage points above that.

The nexus opinion lines up with the outcome

The strongest association in the records is the nexus opinion. When the record had a positive nexus opinion, the Board granted on the merits in 95.1% of decisions. Without one, the rate was 40.9%.

A private medical opinion showed a similar pattern: 88.8% with one, 50.0% without. An unfavorable VA exam did not end most claims; the merits grant rate with one was 80.5%, against 92.7% without.

In the recordNot in the record

Positive nexus opinion

95.1%

40.9%

Private medical opinion

88.8%

50.0%

Favorable VA exam

89.0%

81.9%

Lay statement

77.9%

93.9%

Merits decisions only (granted or denied). Associations, not causes.

Lay statements went the other way: 77.9% with, 93.9% without. That does not mean lay evidence hurts a claim. These are associations, and records that include lay statements may differ in other ways. The data does not show which.

The Board applied the benefit of the doubt under 38 CFR 3.102 in 71.9% of grants. In those decisions, the Board found the evidence at least in approximate balance rather than clearly in the veteran's favor.

What the decisions say

In grants, the most common reason extracted was that the sleep apnea was "caused by the service-connected disability," cited in 118 grants. "Service connection established" followed in 68, and "current diagnosis established" in 45.

Denials were few. The most common reason, in 19 of them, was a VA examiner's finding that the condition was "less likely than not related to service." Next came "no in-service complaints, treatment or diagnosis," in 14, a reason that speaks to direct rather than secondary service connection. The causation phrase also appears in 13 denials, naming the theory the Board addressed; the data does not show how it was weighed in each.

Read the decisions

Recent examples, with the Board's reasons as summarized by AI:

• A26040512, granted in 2026: private medical opinion linked weight gain to service-connected knee/ankle conditions.
• A26038834, granted in 2026: favorable opinions found knee disability aggravated obesity, which caused sleep apnea.
• A26037773, granted in 2026.
• A26022920, denied in 2026: lack of in-service documentation of OSA symptoms.
• A26013801, denied in 2026: no evidence of current disability.
• A26011024, denied in 2026: november 2023 VA exam found OSA not directly related to service, noting lack of in-service complaints and suggesting post-service factors.

For representatives

• The Board granted on the merits in 95.1% of decisions with a positive nexus opinion and 40.9% without one. A private opinion showed a similar gap, at 88.8% against 50.0%.
• A negative VA examiner opinion is the most cited denial reason, yet an unfavorable exam still came with a merits grant rate of 80.5%. Check whether the examiner addressed the secondary theory under 38 CFR 3.310, not only direct service onset.
• Remands remained common at 35.3% of decisions in 2024 and 2025, so building a complete medical record before the Board decides may matter as much as the merits argument.