Secondary service connection
Sleep apnea secondary to hypertension: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to hypertension in 819 decisions. It granted the issue in 14.3% of them, below the 26.4% grant rate for all sleep apnea issues, denied it in 14.5%, and remanded it in 70.2%. Counting only decisions on the merits, 49.6% were granted.
Decisions
819
2017–2026
Granted
14.3%
All sleep apnea: 26.4%
Granted on the merits
49.6%
Granted ÷ (granted + denied)
Remanded
70.2%
Denied: 14.5%
See all sleep apnea decisions, direct and secondary.
Sleep apnea secondary to hypertension: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2017 | 44 | 4.5% | 43.2% | 50.0% |
| 2018 | 58 | 3.4% | 15.5% | 79.3% |
| 2019 | 65 | 9.2% | 15.4% | 73.8% |
| 2020 | 76 | 10.5% | 22.4% | 65.8% |
| 2021 | 97 | 7.2% | 18.6% | 74.2% |
| 2022 | 94 | 20.2% | 10.6% | 69.1% |
| 2023 | 85 | 14.1% | 10.6% | 75.3% |
| 2024 | 109 | 21.1% | 8.3% | 69.7% |
| 2025 | 146 | 19.9% | 8.2% | 71.2% |
| 2026 | 45 | 20.0% | 13.3% | 62.2% |
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 | 133 | 91.7% | 26.3% | +65.4 pts |
| Favorable VA exam | 57 | 80.6% | 44.9% | +35.8 pts |
| Private medical opinion | 285 | 62.4% | 38.6% | +23.8 pts |
| Buddy statement | 58 | 42.1% | 50.2% | −8.1 pts |
| Lay statement | 611 | 42.0% | 79.2% | −37.1 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 77.8% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 23.9% of grants and 8.4% 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 | 669 | 47.2% | 72.7% | −25.5 pts |
| Negative nexus opinion | 589 | 43.2% | 77.3% | −34.0 pts |
Why the Board granted or denied sleep apnea
Most common reasons in grants
- Current diagnosis established20
- Caused by the service-connected disability12
- Service connection established11
- Aggravated by the service-connected disability6
- VA examiner: less likely than not related to service3
- Service records negative or silent2
- Criteria for service connection met2
Most common reasons in denials
- No in-service complaints, treatment or diagnosis34
- VA examiner: less likely than not related to service25
- Service records negative or silent19
- Preponderance of the evidence against the claim14
- Aggravated by the service-connected disability5
- Current diagnosis established4
- No continuity of symptomatology2
- Negative nexus opinions from VA examiners2
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
Secondary to service-connected hypertension; Evidence in relative equipoise; Reasonable doubt resolved in veteran's favor
Secondary to service-connected hypertension; Private medical opinion provided positive nexus; DeLisio duty to investigate secondary conditions applied
In-service hypertension noted in STRs; Veteran and wife testimony of OSA symptoms; Private physician nexus opinion linking OSA to hypertension/service; Benefit of the doubt applied due to approximate balance of evidence
Denied
Private physician opinions lacked rationale.; VA examiners opined no nexus between OSA and hypertension.; Weight of evidence against claim.
Not a presumptive illness for herbicide exposure; Late onset over 45 years after service; Unfavorable VA medical opinions regarding nexus
Current diagnosis of OSA; No nexus to herbicide exposure; No nexus to hypertension; VA opinions found OSA not related to TERA/AO exposure; OSA not presumed for toxic exposures; OSA due to anatomical changes, not toxic exposure; Medical literature does not support nexus; No nexus to hypertension; Hypertension does not cause OSA; OSA not related to service
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 hypertension, 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.