Secondary service connection
Sleep apnea secondary to diabetes: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to diabetes in 1,116 decisions. It granted the issue in 21.8% of them, below the 26.4% grant rate for all sleep apnea issues, denied it in 19.1%, and remanded it in 58.2%. Counting only decisions on the merits, 53.3% were granted.
Decisions
1,116
2017–2026
Granted
21.8%
All sleep apnea: 26.4%
Granted on the merits
53.3%
Granted ÷ (granted + denied)
Remanded
58.2%
Denied: 19.1%
See all sleep apnea decisions, direct and secondary.
Sleep apnea secondary to diabetes: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2017 | 65 | 7.7% | 41.5% | 49.2% |
| 2018 | 106 | 21.7% | 20.8% | 52.8% |
| 2019 | 107 | 21.5% | 19.6% | 57.0% |
| 2020 | 141 | 15.6% | 27.7% | 56.7% |
| 2021 | 131 | 13.0% | 19.1% | 67.9% |
| 2022 | 173 | 14.5% | 19.1% | 66.5% |
| 2023 | 133 | 24.1% | 14.3% | 61.7% |
| 2024 | 109 | 32.1% | 11.9% | 56.0% |
| 2025 | 110 | 39.1% | 11.8% | 48.2% |
| 2026 | 41 | 43.9% | 2.4% | 51.2% |
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 | 274 | 90.3% | 22.5% | +67.8 pts |
| Favorable VA exam | 87 | 81.8% | 49.4% | +32.4 pts |
| Private medical opinion | 446 | 66.4% | 35.1% | +31.3 pts |
| Treating physician opinion | 78 | 64.0% | 52.0% | +12.0 pts |
| Combat service | 76 | 51.9% | 53.4% | −1.5 pts |
| Lay statement | 743 | 42.5% | 80.2% | −37.7 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.6% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 14.0% of grants and 7.5% 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 | 896 | 50.4% | 72.1% | −21.8 pts |
| Negative nexus opinion | 817 | 48.4% | 73.9% | −25.5 pts |
Why the Board granted or denied sleep apnea
Most common reasons in grants
- Service connection established35
- Current diagnosis established34
- Caused by the service-connected disability30
- Aggravated by the service-connected disability8
- VA examiner: less likely than not related to service5
- Obesity as intermediate step4
- Criteria for service connection met3
- Private medical opinion found OSA secondary to diabetes3
Most common reasons in denials
- VA examiner: less likely than not related to service53
- Service records negative or silent44
- No in-service complaints, treatment or diagnosis37
- Preponderance of the evidence against the claim35
- Aggravated by the service-connected disability11
- Private opinion lacked rationale4
- Current diagnosis established4
- No current diagnosis3
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
Service connection granted secondary to diabetes mellitus; VA examinations found inadequate for failing to address obesity as intermediate step; Private medical opinion found probative, establishing nexus via obesity
Veteran has current diagnosis of obstructive sleep apnea.; Veteran is service-connected for diabetes mellitus, type II, with complications including obesity and diabetic neuropathy.; VA examiner noted bidirectional link between OSA and diabetes.; Subsequent VA addendum was inadequate.; Evidence for and against secondary connection found in approximate balance.
Private examiner found OSA more likely than not related to service-connected diabetes and orthopedic disabilities.; Private examiner reasoned diabetes aggravates OSA and orthopedic symptoms contribute to obesity.; Evidence for and against claim approximately balanced, doubt resolved in Veteran's favor.
Denied
No in-service incurrence of OSA; VA examiner found no medical evidence linking OSA to toxic exposures; Private consultant's opinion lacked probative value due to speculative reasoning and reliance on associations
Service treatment records negative for complaints/treatment of obstructive sleep apnea.; VA examiner opined less likely than not related to service, citing overweightness, age, and lack of medical literature.; Private physician opinion deemed speculative.; Weight of evidence against secondary connection to hypertension/diabetes.
No positive medical opinion linking sleep apnea to service.; VA examiners found sleep apnea more likely due to physical causes (obesity, comorbidities) than service.; Lay statements were not competent to establish medical etiology.
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 diabetes, 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.