Home › Conditions › Secondary claims › Sleep Apnea ← PTSD
A secondary claim is a condition caused or worsened by one the VA has already service-connected (38 CFR 3.310). The causation fight is already half-won — the VA agreed your ptsd came from service; the question is only whether it caused or aggravated the sleep apnea. That's a medical question with a recognized answer.
The connection
The link runs through several recognized pathways: PTSD fragments sleep architecture through hyperarousal, common psychiatric medications promote the weight gain that drives obstructive apnea, and peer-reviewed literature documents a markedly higher rate of OSA among veterans with PTSD than without it. This is one of the most frequently granted secondary claims in the system — and one of the most valuable, because a prescribed CPAP currently rates at 50%.
How the VA rates sleep apnea
DC 6847 — Sleep Apnea Syndromes (Obstructive, Central, Mixed)
| Rating | Criteria (38 CFR Part 4 wording) |
|---|---|
| 100% | Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy |
| 50% | Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine |
| 30% | Persistent day-time hypersomnolence |
| 0% | Asymptomatic but with documented sleep disorder breathing |
There is no 10, 20 or 40 percent level. A diagnosis by sleep study is required for any rating.
VA has published a proposed rule that would re-key this code to treatment effectiveness rather than CPAP use. Until a final rule takes effect, the criteria above are the law — check eCFR before relying on the 50 percent level.
Full criteria, exam and evidence guide: VA rating for Sleep Apnea. And the anchor: VA rating for PTSD, Depression and Anxiety.
What the claim needs — the three legs
- The anchor: service connection for the ptsd (see how that condition is rated). Not connected yet? File both in the same claim — the VA decides the anchor first, then the secondary against it.
- A current diagnosis of sleep apnea — the VA rates diagnosed conditions. If you only have the symptoms, file them anyway: the C&P exam supplies the diagnosis, and a "no diagnosis" denial is repaired with a supplemental claim that keeps your date.
- The medical link. An opinion stating it is "at least as likely as not" that the ptsd caused or aggravated the sleep apnea. The VA's own C&P examiner supplies this free in most cases; your own doctor can too. A paid independent opinion is the answer to a denial, not the first move.
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See If You Qualify →Frequently asked questions
Can I claim sleep apnea secondary to ptsd?
Yes, if three things hold: the ptsd (or its equivalent) is service-connected, you have a current diagnosis of sleep apnea, and a medical opinion connects the two. The connection described on this page is a recognized pathway raters see regularly.
Do I need to pay for a nexus letter for sleep apnea secondary to ptsd?
Usually not. The VA's own C&P examiner can supply the connecting opinion at your exam for free, and your own treating doctor can also provide it. A paid independent opinion is worth buying only after a denial for lack of nexus — a supplemental claim within one year keeps the original effective date.
What if the primary condition isn't service-connected yet?
File them together in the same claim. The VA decides the primary first and then the secondary against it in the same decision; a secondary filed alone against a condition the VA has not connected fails. Filing both at once under one Intent to File protects the effective date for both.
Last reviewed 2026-09-19.