Secondary service connection
Sleep apnea secondary to a psychiatric disorder: BVA grant rates and what wins
From 2018 to 2026, the Board of Veterans' Appeals decided sleep apnea claimed as secondary to a psychiatric disorder in 5,461 decisions. It granted the issue in 33.8% of them, above the 26.7% grant rate for all sleep apnea issues, denied it in 11.4%, and remanded it in 54.2%. Counting only decisions on the merits, 74.7% were granted.
Decisions
5,461
2018–2026
Granted
33.8%
All sleep apnea: 26.7%
Granted on the merits
74.7%
Granted ÷ (granted + denied)
Remanded
54.2%
Denied: 11.4%
See all sleep apnea decisions, direct and secondary.
Sleep apnea secondary to a psychiatric disorder: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2018 | 291 | 28.5% | 13.7% | 57.0% |
| 2019 | 493 | 28.6% | 11.6% | 59.2% |
| 2020 | 516 | 29.5% | 14.3% | 55.8% |
| 2021 | 551 | 22.5% | 18.1% | 58.8% |
| 2022 | 541 | 23.5% | 12.0% | 64.0% |
| 2023 | 672 | 30.7% | 9.1% | 59.8% |
| 2024 | 949 | 35.6% | 10.2% | 53.5% |
| 2025 | 1,086 | 47.1% | 8.2% | 43.8% |
| 2026 | 362 | 44.5% | 11.6% | 43.1% |
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 | 2,061 | 94.2% | 38.6% | +55.6 pts |
| Private medical opinion | 2,832 | 86.1% | 44.2% | +41.9 pts |
| Favorable VA exam | 597 | 86.4% | 72.3% | +14.1 pts |
| Treating physician opinion | 248 | 79.0% | 74.4% | +4.6 pts |
| Buddy statement | 273 | 78.3% | 74.5% | +3.8 pts |
| Combat service | 237 | 73.9% | 74.7% | −0.9 pts |
| Lay statement | 3,932 | 68.7% | 91.7% | −23.0 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 74.7% of the decisions that granted sleep apnea.
- The Board found the veteran's statements credible in 19.6% of grants and 7.0% 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 |
|---|---|---|---|---|
| Negative nexus opinion | 3,718 | 71.5% | 83.5% | −12.0 pts |
| Unfavorable VA exam | 4,374 | 72.5% | 85.6% | −13.1 pts |
Why the Board granted or denied sleep apnea
Most common reasons in grants
- Caused by the service-connected disability262
- Current diagnosis established237
- Service connection established172
- Aggravated by the service-connected disability112
- VA examiner: less likely than not related to service42
- Service records negative or silent20
- Private medical opinion found probative13
- Obesity as intermediate step13
Most common reasons in denials
- VA examiner: less likely than not related to service138
- No in-service complaints, treatment or diagnosis109
- Service records negative or silent91
- Preponderance of the evidence against the claim61
- No current diagnosis27
- Current diagnosis established25
- Aggravated by the service-connected disability22
- Caused by the service-connected disability15
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.; Private physician opinion found at least as likely as not that sleep apnea was directly attributable to long-term consequences of service-connected PTSD and related conditions.; No contrary medical opinion of record.
Current disability (OSA) demonstrated; Service connection for PTSD with persistent depressive disorder and insomnia established; Private medical opinion linked OSA to PTSD based on literature and PTSD symptomology; Private opinion found OSA at least as likely as not due to PTSD; No conflicting medical opinion in record
Private medical opinion linked OSA to MDD; OSA is but-for caused by MDD; Resolving doubt in favor of veteran
Denied
Service treatment records did not reflect complaints related to sleep apnea.; VA examiner opined condition was less likely than not proximately due to or the result of acquired psychiatric disorder.; Private opinion lacked specifics and was deemed speculative by the Board.
Insufficient evidence of current diagnosis of sleep apnea.; VA sleep study negative for obstructive sleep apnea.; Examiner found no current signs or symptoms attributable to sleep apnea.
No current diagnosis of sleep apnea established.; Veteran failed to attend scheduled sleep study.; Private medical opinion insufficient without objective testing.
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 a psychiatric disorder, 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 (2018–2026) and can contain errors. It is updated automatically as new decisions are added.