Sleep apnea secondary to PTSD: Board grants more than doubled since 2018

In 2018, the Board of Veterans' Appeals granted sleep apnea claimed as secondary to PTSD in 22.6% of its decisions on that issue. In 2026 so far, it granted it in 47.8%: 2.1 times the 2018 rate.

The finding comes from 11,186 Board decisions from 2018 to 2026 that decided sleep apnea as secondary to service-connected PTSD under 38 CFR 3.310.

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

Fewer denials, fewer remands

The rise did not come from one change alone. Denials fell from 19.2% of decisions in 2018 to 9.3% in 2026. Remands fell from 55.9% to 41.6%.

When the Board decided the issue on the merits, not remanding it, it granted 54.0% of claims in 2018 and 83.7% in 2026.

More records came with a private opinion

Over the same years, the evidence in these records changed. The share of decisions that mention a private medical opinion went from 37.1% in 2018 to 55.7% in 2026. The share with a positive nexus opinion, one that links the sleep apnea to PTSD, went from 27.0% to 43.5%.

The Board granted the claim on the merits in 93.5% of decisions that had a positive nexus opinion, and in 35.7% of those without one. With a private medical opinion in the record, the rate was 84.6%; without one, 42.5%.

In the recordNot in the record

Positive nexus opinion

93.5%

35.7%

Private medical opinion

84.6%

42.5%

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

These numbers show association, not cause. A record with a strong private opinion is often a stronger case in other ways too. The data also does not show why the share of private opinions grew.

What the decisions say

The Board's stated reasons point the same way. In denials, 27.7% relied on a VA examiner's opinion that the sleep apnea was less likely than not related to PTSD. In grants, 66.3% mentioned a private opinion, compared with 17.5% of denials, and 22.8% cited medical literature or studies.

Weight comes up often on both sides: in 33.0% of denials and 28.2% of grants. So weight, by itself, does not separate the grants from the denials in this data.

Read the decisions

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

• A26040643, granted in 2026: a private opinion from the treating provider, based on medical literature and the veteran's history, was found more probative.
• A26040792, granted in 2026: a private physician found it at least as likely as not that the sleep apnea resulted from the service-connected PTSD, with no contrary opinion.
• A26040879, granted in 2026: a private opinion linked the sleep apnea to PTSD symptoms, and no medical opinion in the record conflicted with it.
• A26040554, denied in 2026: the VA examiner found the sleep apnea less likely than not related to PTSD and multifactorial.
• A26040339, denied in 2026: the VA examiner attributed it more likely to obesity, and the private opinions did not apply the research to the veteran's own circumstances.

For representatives

• A positive nexus opinion appears in 80.6% of the decisions that granted this claim.
• The VA examiner's negative opinion is the most common reason for denial. Check whether it addresses aggravation under 38 CFR 3.310(b) and the veteran's own history, not only other risk factors such as weight.