Filing a secondary sleep apnea claim with the VA can be a challenging process. Many veterans experience issues with getting their claims approved—not because they lack a diagnosis or symptoms, but because the connection (or “nexus”) between their sleep apnea and a service-connected condition is often not properly established. This article will guide you through key aspects of secondary sleep apnea claims, including sleep studies, nexus letters, and the role of obesity as an intermediate step.

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Step 1: Getting Diagnosed with Sleep Apnea

The first step in filing a successful claim is obtaining a formal diagnosis of sleep apnea. Your primary care provider will likely start by asking you a series of questions, including:

• Do you snore?
• Do you have restless leg syndrome?
• Have you experienced daytime fatigue or difficulty concentrating?

They may also measure the thickness of your neck—a common screening method for sleep apnea, though somewhat outdated.

Types of Sleep Studies

Once you’ve been referred for a sleep study, you have two options:

1. Sleep Center Study: This is the more thorough option. You’ll spend the night at a sleep center where medical professionals will monitor your breathing, heart rate, and other key indicators while you sleep.
2. At-Home Test: If a sleep center study isn’t available, you may be given an at-home test. While this is less comprehensive, it can still provide enough evidence for a diagnosis.

Whenever possible, push for the sleep center study. It typically provides more objective data, which can strengthen your claim.

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Step 2: Diagnosis and CPAP Prescription

If your sleep study confirms a diagnosis of sleep apnea, your doctor will likely prescribe a CPAP machine. From a VA rating standpoint, simply having the CPAP prescription is enough to qualify for a 50% disability rating—you don’t have to prove that you use it regularly.

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Step 3: Establishing the Nexus (The Hard Part)

The biggest hurdle for most veterans is proving the connection between sleep apnea and an existing service-connected condition. About 95% of secondary sleep apnea claims are denied due to weak or missing nexus evidence.

Understanding the Intermediate Step

VA regulations require a clear medical link between your sleep apnea and a service-connected condition. This is where the intermediate step comes in. An intermediate step is a condition or factor that bridges the gap between your service-connected disability and your sleep apnea.

Example: Obesity as an Intermediate Step

Obesity cannot be claimed as a service-connected disability on its own. However, it can serve as an intermediate step in linking a service-connected condition to sleep apnea under 38 CFR § 3.310. Here’s how it works:

1. Service-Connected Condition Causes Obesity

   • Example: A veteran with a service-connected back injury becomes less active due to chronic pain, leading to weight gain.

2. Obesity Contributes to Sleep Apnea

   • Medical evidence must show that the obesity significantly contributed to the development of sleep apnea.

3. Sleep Apnea Would Not Have Occurred Without the Obesity

   • The claim should argue that the veteran’s sleep apnea wouldn’t have developed if the service-connected injury hadn’t caused obesity.

Other Intermediate Steps

Besides obesity, other potential intermediate steps include:

• Medications – Certain medications prescribed for service-connected conditions (e.g., painkillers) can cause weight gain, respiratory issues, or muscle relaxation that worsens sleep apnea.
• Mental Health Conditions – PTSD, depression, and anxiety can contribute to weight gain, poor sleep patterns, and other factors that lead to sleep apnea.

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Step 4: Crafting a Strong Nexus Letter

A poorly written nexus letter is one of the most common reasons for denial. Your doctor must clearly establish the medical connection between your sleep apnea and a service-connected condition, addressing the intermediate step if necessary. The letter should:

• Confirm your sleep apnea diagnosis.
• Explain how a service-connected condition caused obesity (or another intermediate step).
• Establish that the intermediate step significantly contributed to sleep apnea.
• Conclude that the sleep apnea would not have occurred without the service-connected condition.

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Final Thoughts

Winning a VA secondary sleep apnea claim is not impossible, but it requires strong medical evidence and a well-written nexus letter. If you’re struggling with your claim, seek help from a qualified VA claims expert or an experienced veterans’ advocate. Establishing the intermediate step is often the key to success, especially when obesity or medication is involved.

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Disclaimer: This article reflects the author’s opinion based on experience and research regarding VA sleep apnea claims. It is not legal or medical advice. Veterans should consult with a qualified VA claims specialist or medical professional for guidance specific to their situation.

 

The VA has proposed updates to the disability rating criteria for conditions like sleep apnea. If implemented, the changes would adjust ratings based on the effectiveness of treatments and modern medical knowledge. The proposed criteria for sleep apnea ratings are:

• 0%: Veterans asymptomatic with or without treatment.
• 10%: Veterans with a diagnosis who receive treatment providing incomplete relief.
• 50%: Veterans with a diagnosis receiving ineffective treatment or unable to use treatment due to comorbid conditions without end-organ damage.
• 100%: Veterans with a diagnosis receiving ineffective treatment or unable to use treatment due to comorbid conditions with end-organ damage.

The aim is to reflect advancements in treatment and ensure accurate compensation. Veterans currently rated under the existing system or with pending claims will not be affected. However, future claims will be evaluated under the new criteria. Filing a claim now may secure a rating under current guidelines. Additional evidence can also be submitted through supplemental claims to adjust ratings if warranted​

For more details, visit the VA’s official update page: VA News.

 

In this article, we will explore the top three conditions that VA rating specialists often see veterans claim as secondary to their service-connected sleep apnea.

A Word of Caution:

Before diving in, it’s important to note that nothing is guaranteed in the VA claims process. If someone claims they can guarantee a favorable outcome, they are likely misleading you. There have been many cases where VA rating specialists thought a claim would be approved, only for it to be denied. On the other hand, claims that seemed far-fetched have sometimes been approved. Keep this in mind when submitting claims for secondary conditions.

For secondary conditions, it is essential to provide a Nexus statement—a document prepared by a medical professional that explains how your condition is linked to your military service. Veterans have the option of undergoing a Compensation and Pension (C&P) exam or having their private doctor complete a public Disability Benefits Questionnaire (DBQ), available on the VA’s website.

The Top 3 Conditions Claimed Secondary to Sleep Apnea:

 

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1. Hypertension (High Blood Pressure)

The first condition commonly claimed as secondary to sleep apnea is hypertensive vascular disease, also known as hypertension. Let’s focus on the 10% rating criteria, as this often causes confusion. For a 10% rating, one of the following must be true:

• Diastolic pressure is predominantly 100 or more
• Systolic pressure is predominantly 160 or more
• There is a history of diastolic pressure predominantly 100 or more, and continuous medication is required for control.

It’s essential to meet both requirements for a 10% rating in the third scenario: a history of diastolic pressure of 100 or more and the need for continuous medication. Veterans can track their blood pressure at home and keep a spreadsheet as evidence. If you believe you meet the criteria for a 20% rating (diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more), providing your own records or notes from your doctor is crucial.

Additionally, hypertension or isolated systolic hypertension must be confirmed by readings taken on two or more occasions over at least three different days. So, whether you are monitoring your own blood pressure or having a private doctor or VA doctor take readings, proper documentation is essential.

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2. Diabetes Secondary to Sleep Apnea

The second condition often claimed as secondary to sleep apnea is diabetes mellitus, particularly Type 2 diabetes. For these claims, you need a medical professional to provide a diagnosis and a rationale linking the diabetes to sleep apnea via a Nexus statement.

It’s not a bad idea to research medical studies or literature supporting this connection—sources like the Mayo Clinic often provide valuable insights. Additionally, you can refer to the Diabetes Mellitus Type 2 DBQ, which can guide your claim.

In this form, Section 3A asks if the veteran has any recognized complications of diabetes, such as:

• Diabetic peripheral neuropathy (affecting the upper or lower extremities)
• Diabetic nephropathy or renal dysfunction
• Other complications

Section 3B asks if any of these conditions are “at least as likely as not” caused by diabetes, which constitutes a secondary medical opinion.

If you’re dealing with other conditions like hypertension, stroke, skin conditions, or eye conditions, these can also be linked through secondary conditions, sometimes referred to as “stacking.” In this case, the doctor completing the DBQ must provide a clear rationale in the remarks section explaining how they reached their conclusions.

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3. Depression Secondary to Sleep Apnea

The third common condition linked to sleep apnea is depression. Veterans claiming depression secondary to sleep apnea must clearly explain to the C&P examiner how their sleep apnea contributes to their mental health condition.

For instance, you could describe how severe snoring or breathing issues force you and your spouse to sleep in separate bedrooms, which may impact your emotional well-being and relationship. It’s also important to familiarize yourself with the General Rating Formula for Mental Disorders to determine if you meet the criteria for a 0%, 10%, 30%, 50%, 70%, or 100% disability rating.

There are proposed changes to these criteria coming in April 2025, so be sure to stay updated if you’re pursuing a mental health claim.

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Conclusion:

These are the top three conditions that VA rating specialists frequently see veterans claim as secondary to their service-connected sleep apnea: Hypertension, Diabetes, and Depression. Many veterans succeed in their claims by submitting private evidence or attending a C&P exam.

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Disclaimer:

This article is for informational purposes and should not be considered professional legal or medical advice. While the author has had a successful VA rating outcome, veterans should conduct their own research and apply the relevant findings to their specific cases.