VA Rating for Sleep Apnea

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Obstructive sleep apnea — breathing stops during sleep — is rated almost entirely on whether a breathing-assistance device (CPAP) is required. This guide quotes the actual rating criteria from 38 CFR Part 4 for diagnostic code 6847, explains what the C&P examiner measures, covers the presumptive and secondary routes to service connection, and lists the reasons these claims come back denied — and how each gets fixed.

How the VA rates sleep apnea in 2026 — the exact criteria

These are the criteria a VA rater applies, quoted from the rating schedule (§ 4.97). Your rating is the highest level whose wording your evidence meets — and evidence that never uses these words tends to be rated at the bottom.

DC 6847 — Sleep Apnea Syndromes (Obstructive, Central, Mixed)

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.

Honest ceiling: 50% once a CPAP is prescribed.

What the C&P examiner measures

The examiner confirms the sleep-study diagnosis, whether a CPAP or other breathing-assistance device is required, and daytime hypersomnolence. Without a sleep study of record, the exam may order one — say clearly that you stop breathing at night (and who has seen it) and that you fall asleep during the day.

The questions that get at the rating criteria — answer them for yourself before the exam:

• Has anyone ever told you that you stop breathing at night?
• Do you wake up feeling like you never slept?
• Ever fallen asleep somewhere you shouldn't have — driving, at work, mid-conversation?

Service connection: presumptive, direct, or secondary

Sleep apnea is not presumptive. The usual routes are direct (in-service witnesses to snoring and apneas, or a sleep study close to separation) and secondary to service-connected PTSD/depression, sinusitis or rhinitis, or weight gain from medication for a connected condition.

Every service-connection claim has three legs: a current diagnosis (the C&P exam can supply it), an in-service event, injury, exposure or an already-connected condition, and a link between the two — which the VA's own examiner addresses at the exam for direct and secondary claims, and which the law supplies for presumptive ones. You do not need a private opinion to file; you need one only if the VA denies for lack of nexus, and a supplemental claim within one year keeps your effective date.

Secondary conditions veterans miss

This condition is more often the secondary in a chain than the anchor — see the secondary-claims guides for the recognized pathways.

Secondary-claim guides for this condition: Sleep Apnea secondary to PTSD →Sleep Apnea secondary to Sinusitis / Rhinitis →

What the medical literature says

Sharafkhaneh A. et al., Sleep 28(11):1405-11 (2005) — Association of psychiatric disorders and sleep apnea in a large cohort
VA cohort of 4M+ veterans: sleep apnea carries significantly higher rates of PTSD, depression and anxiety. Why it matters: OSA secondary to MH — the VA’s own population data.

Colvonen P.J. et al., Journal of Clinical Sleep Medicine 11(5):513-8 (2015) — OSA and PTSD among OEF/OIF/OND veterans
69% of veterans in a VA PTSD clinic screened high-risk for OSA — young vets without classic OSA predictors. Why it matters: Counters "he’s too young / not heavy enough for OSA."

Why sleep apnea claims get denied — and the fix

• No sleep study of record — the VA cannot rate a diagnosis that does not exist; get the study.
• Secondary claim denied because the examiner said obesity is the "sole cause" — the medical literature on PTSD, medications and OSA answers this (Walsh v. Wilkie, 2020, on obesity as an intermediate step).

A denial is a grade on the evidence packet, not a verdict on you. Filed as a supplemental claim within one year, the fix keeps your original effective date.

Filing it right the first time

1. Intent to File first. It locks your effective date for a year — back pay runs from that day, not from the day the package is ready.
2. File everything at once. Every condition with a real symptom and a plausible route — direct, presumptive, secondary, increase — goes in one claim. The VA's duty to assist schedules the exam and pulls your records; a condition held back "for more evidence" only starts its clock later.
3. Your statement in the criteria's words. A Statement in Support of Claim (VA Form 21-4138) that describes your worst days and your typical days using the language in the table above is the evidence the rater reads first.
4. Your records. VA records through Blue Button, decision letters and code sheet from VA.gov, and private records from each doctor's office or patient portal — or a signed 21-4142 so the VA pulls them.
5. Prepare for the exam. Know what the examiner measures (above) and answer honestly, including the bad days.

Frequently asked questions

Related guides: GERD (Acid Reflux)PTSD, Depression and AnxietyHypertensionAll conditionsDenied? The 3 lanesCombined-rating calculator

Rating criteria verified against eCFR (38 CFR Part 4) — last reviewed 2026-09-19. Regulations change; confirm anything decision-critical at ecfr.gov.