VA Rating for Sleep Apnea Explained [Updated Guide]

In this expert’s guide, I’ll break down how to get a VA rating for sleep apnea.

Sleep Apnea VA ratings range from 0% to 100%, with breaks at 30% and 50%.

The highest possible scheduler VA disability rating for Sleep Apnea is 100%, which includes symptoms such as chronic respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy.

Which sleep apnea VA rating you qualify for depends on the frequency, severity, and duration of your symptoms. Generally speaking, the worse your sleep apnea, the higher the rating you qualify for.

Okay, veterans – let’s take a minute to explore the law regarding the symptoms and level of impairment required to warrant a VA disability rating for Sleep Apnea.

Summary of Key Points

Sleep apnea is rated under Diagnostic Code 6847 in Title 38, Chapter 1, Part 4 of the US Code of Federal Regulations.
Available VA disability ratings for sleep apnea are 0%, 30%, 50%, and 100%.
There is a proposed VA rule change that would reduce the 30% rating to 10%.
Which rating you qualify for depends on the frequency, severity, and duration of your symptoms.
There are four things you can do to help prove your sleep apnea is service-connected.
Your best strategy to win a VA rating for sleep apnea is often pursuing it as a secondary condition.
Studies show that sleep apnea is abnormally prevalent in veterans.

Sleep Apnea VA Disability

Sleep Apnea is a VA disability rated under Diagnostic Code 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed).

The most common VA rating for Sleep Apnea is 50%, which requires the use of a breathing assistance device such as a Continuous Positive Airway Pressure (CPAP) machine.

VA Rating for Sleep Apnea

Pursuant to Diagnostic Code 6847, VA disability ratings for Sleep Apnea are as follows:

• A 0% VA rating for Sleep Apnea is warranted if you’re asymptomatic (no symptoms) but with documented sleep disorder breathing.
• A 30% VA disability rating for Sleep Apnea is warranted if you have persistent daytime hypersomnolence but do not require the use of a breathing device.
• The 50% VA rating for Sleep Apnea is warranted if you require the use of a breathing assistance device such as a Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP)
• A 100 percent VA rating for Sleep Apnea is warranted for chronic respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy.

Sleep Apnea VA Rating Chart

Sleep Apnea VA ratings are assigned under diagnostic code 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed):

Is the VA Changing How It Rates Sleep Apnea?

Yes, there are proposed changes to how the VA rates sleep apnea.

The new sleep apnea VA ratings would be 0%, 10%, 50%, and 100%.

The biggest change would be the ending of the “automatic” 50 percent rating for sleep apnea if a veteran requires the use of a breathing device (CPAP machine).

The 30% rating for sleep apnea would also be reduced to 10%.

VA Disability Rating for Sleep Apnea Proposed Changes Chart

NOTE: Qualifying comorbidities are conditions that, in the opinion of a qualified medical provider, directly impede or prevent the habitual use of a recognized form of treatment shown by sleep study to be effective in the affected veteran’s case ( e.g., contact dermatitis where the mask or interface touches the face or nares, Parkinson’s disease, missing limbs, facial disfigurement, or skull fracture).

Pro Tip: If you already have a rating for sleep apnea, you are “grandfathered in” at your current VA rating, regardless of the changes.

How to Service Connect Sleep Apnea

The VA only rates conditions that were caused or made worse by your military service. This is known as service connection.

Proving service connection can be the hardest part of the VA claims process for many veterans. To do so, you need these three things:

1. A current medical diagnosis. The VA can’t rate a condition that a qualified medical professional hasn’t formally diagnosed.
2. Evidence of an in-service event, injury, or illness. You need to have evidence that something happened during and because of your service that caused your disability or made it worse.
3. A medical link between #1 and #2. Does the medical evidence suggest that your in-service event, injury, or illness is most likely the cause of your sleep apnea? If you get a Nexus Letter, the link will be expressed as one of these statements of probability:
   
   “Is due to” = 100% certain 
   “More likely than not” = greater than 50% certain 
   “At least as likely as not” = equal to 50% certain 
   “Not likely due to” = less than 50% certain 
   “Is not due to” = 0% chance

These three things make up what is known as the Caluza Triangle.

If you’re having trouble proving your sleep apnea is service-connected, following the four steps below could help:

1. Get a NEW sleep study (if yours was not in the last 12 months)
2. Confirm a medical diagnosis of sleep apnea with a sleep specialist (or your primary care provider)
3. Obtain a Sleep Apnea Nexus Letter
4. Pursue filing for sleep apnea as secondary to an already service-connected disability (if a diagnosis of OSA or SA was not documented in your service treatment records while on active duty)

Step #1: Get a NEW Sleep Study (within the past 12 months)

If you have symptoms of obstructive sleep apnea (OSA), consider obtaining a sleep study, also known as polysomnography.

Even if you’ve had a sleep study before, it’s important to get one done within the 12 months prior to your VA claim. This will confirm a medical diagnosis and current symptoms, especially if they’ve become more severe over time.

A sleep study is critical to confirming whether you meet the clinical diagnostic criteria for sleep apnea.

The polysomnography study records your brain waves, the oxygen levels in your blood, your heart rate and breathing, and eye and leg movements, among other criteria.

There are three primary ways for veterans to get a sleep study:

1. Discuss your sleep issues with your primary care VA doctor and ask for a referral to a sleep specialist at the VA.
2. Ask your private doctor for a referral to a sleep specialist in your area (a good option if you have private health insurance).
3. Order a sleep apnea at-home test kit.

Step #2: Obtain a medical diagnosis of sleep apnea from a sleep specialist

Once you’ve finished your sleep study, it’s important to review your results with a sleep specialist to confirm whether you have a medical diagnosis of sleep apnea.

You only need to establish that your sleep apnea is “at least as likely as not”:

• caused or made worse by your active duty military service OR
• aggravated beyond its natural progression by another service-connected condition (for secondary service connection).

Step #3: Get a nexus letter for sleep apnea from a credible independent medical professional 

A nexus letter is an evidence-based document prepared by a medical professional that helps to establish a connection between the veteran’s current disability and either military service (for direct service connection) or another rated disability (for secondary service connection).

A nexus letter is often the missing link in a VA claim. In my experience, most VA disability claims are won or lost based on medical evidence.

Related: Obtain a Sleep Apnea Nexus Letter

Step #4: Consider secondary service connection instead of direct service connection

You’ll need to make the call on direct service connection versus secondary service connection. In my opinion, the only time a veteran should pursue direct service connection for sleep apnea is if you had a sleep study performed while on active duty, which confirmed the presence of a sleep apnea condition (medically diagnosed) during active-duty service.

Sleep Apnea and Secondary Service Connection

Secondary service connection applies to secondary conditions. These are conditions that are caused or made worse by a disability that’s already rated by the VA.

For example, if sinusitis is causing your sleep apnea and you have a sinusitis VA rating, you could be eligible for a VA rating for sleep apnea secondary to sinusitis.

The only difference between regular service connection and secondary service connection is part two of the Caluza triangle: Evidence of an in-service event, injury, or illness.

Pro Tip: If you’re claiming secondary service connection, your primary disability that’s already rated by the VA serves as your in-service event, injury, or illness.

Common Links for Secondary Service Connection

In my experience, an upper respiratory disability is one of the most common links.

Both sinusitis and rhinitis are linked to sleep apnea. If you have sleep apnea and sinusitis/rhinitis, your next step would be to get a doctor’s medical opinion supporting that your service-connected sinusitis or rhinitis caused or aggravated your sleep apnea.

This may be even easier for you now because of a recent VA rule as of August 2, 2021. Thanks to additions to the VA presumptive list, you may be able to presumptively service-connect rhinitis, sinusitis, rhinosinusitis, or asthma if you served in particular theaters during specified time periods.

This opens doors for many veterans who were unable to service-connect these respiratory conditions previously.

EXAMPLE: Sleep Apnea Secondary to PTSD

Research shows that combat veterans with PTSD may be at higher risk for sleep apnea than the general population. Both disorders have risk factors that affect both sleep apnea and symptoms of PTSD, and the conditions can aggravate each other.

A study conducted by the VA Healthcare System for San Diego and National Center for PTSD found that between 40 percent and 98 percent (!) of veterans with PTSD also have a co-occurring sleep disturbance, including obstructive sleep apnea (OSA).

If you’re dealing with sleep apnea as a secondary condition to PTSD, you aren’t alone!

Related: How to Obtain a Nexus Letter for Sleep Apnea Secondary to Your PTSD

PTSD—and the side effects of medications taken to address PTSD—can lead to the development of sleep apnea in a few different ways. PTSD is well-known for causing sleep deprivation, chronic stress, and an increase in body mass or obesity due to prescribed medications. All of these can contribute to sleep apnea. For more information on conditions that can cause or aggravate sleep apnea, check out our post 10 Most Common Sleep Apnea Secondary Conditions (The Ultimate Guide).

C&P Exam for Sleep Apnea

A C&P exam for Sleep Apnea might involve a physical examination and review of your medical history and severity of symptoms over time.

However, sometimes, a VA C&P examiner (such as a Nurse Practitioner) will call you on the telephone and conduct an Acceptable Clinical Evidence (ACE) exam review of your Sleep Apnea claim.

You’ll want to explain to the C&P examiner HOW your Sleep Apnea condition is limiting or affecting your work, life, and social functioning.

For example, maybe your Sleep Apnea is so severe that you have difficulty working and lose productivity throughout the day due to frequent napping.

Maybe you’ve gained a significant amount of weight due to your other service-connected disabilities, which has limited your ability to walk, run, or workout, and this is the “interim link” to secondary service connection due to weight gain (obesity).

It’s also important to document whether you have a breathing machine, such as a CPAP or BiPAP, as this is the most common difference between the 30% and 50% VA rating for Sleep Apnea.

Sleep Apnea VA Claim SECRETS (Video)

Sleep Apnea in Veterans

Many veterans suffer from various sleep conditions due to their military service, including Sleep Apnea.

In fact, did you know U.S. military veterans are nearly four times (4x) as likely to have or develop sleep apnea when compared to those who didn’t serve in the military?

Veterans, do you think you might have Sleep Apnea?

Here’s a quick litmus test: If you snore during sleep, are tired during the day (maybe you take frequent naps), and stop/start breathing while sleeping (gasping for air), chances are you might have Sleep Apnea.

According to the Mayo Clinic, “Sleep Apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts.”

The 3 main types of Sleep Apnea are:

• Obstructive Sleep Apnea is the most common form of Sleep Apnea, which occurs when throat muscles relax and block the upper airway.
• Central Sleep Apnea occurs when your brain doesn’t send proper signals to the muscles that control breathing.
• Complex / Mixed Sleep Apnea, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.

Sleep Apnea Symptoms in Veterans

Many veterans have or develop Sleep Apnea, and common signs and symptoms include:

• Loud snoring
• Episodes in which you stop breathing during sleep (usually observed by your spouse or partner)
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Difficulty falling or staying asleep (insomnia)
• Excessive daytime tiredness (hypersomnia)
• Difficulty concentrating
• Anger and irritability

If you suffer from any of these symptoms, it’s highly recommended to see a doctor right away.

You may need to undergo a Sleep Study to determine if you have Sleep Apnea.

Risks with Sleep Apnea

Sleep apnea can cause many complications to one’s health. These complications can include:

• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue, and irritability likely.
• High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).

The condition might also increase your risk of recurrent heart attack, stroke, and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

• An impact on mental health. Having sleep apnea can affect a person’s mental health. It is not uncommon for someone with sleep apnea to feel quick-tempered, moody, or depressed and have anxiety.
• Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.
• Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar, and increased waist circumference, is linked to a higher risk of heart disease.
• Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs.
• Liver problems. People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease)

Why Do So Many Veterans Have Sleep Apnea?

As a veteran, you’re four times more likely than other Americans to develop sleep apnea. According to the VA, 1 in 5 veterans has obstructive sleep apnea. Since 2009, the number of sleep apnea VA claims has increased by over 150%, according to USA Today.

There are many factors during and after service that make veterans vulnerable to this condition. There are also many service-connected conditions that can result in sleep apnea. It can also work in reverse: Sleep apnea can lead to other disabilities.

Sleep apnea can be aggravated by PTSD, which is also an extremely common disorder for veterans. The same goes for depression and anxiety—or any of the 33 mental health conditions rated by the VA—which can be highly disruptive to sleep.

Traumatic brain injury and physical pain are also conditions that affect many veterans and can lead to sleep apnea. Exposure to materials such as dust and fumes, and the resulting rhinitis or sinusitis, is also a common issue for veterans that’s associated with sleep apnea.

Frequently Asked Questions (FAQs)

How many types of sleep apnea are there?

For VA disability purposes, there are three types of sleep apnea:

1. Obstructive Sleep Apnea (OSA): This is the most common type of sleep apnea and occurs when the muscles at the back of the throat relax excessively during sleep, leading to the partial or complete blockage of the airway. OSA is often associated with loud snoring, choking, or gasping for air, and daytime sleepiness.
2. Central Sleep Apnea (CSA): CSA is less common than OSA and is characterized by a failure of the brain to send the appropriate signals to the muscles responsible for breathing. This causes the individual to temporarily stop breathing during sleep. Unlike OSA, there is no physical obstruction of the airway in CSA.
3. Complex or Mixed Sleep Apnea: This type of sleep apnea, sometimes referred to as treatment-emergent central sleep apnea, is a combination of both obstructive sleep apnea (OSA) and central sleep apnea (CSA).

What kind of CPAP machine does the VA use?

The VA prescribes several different types of CPAP machines. These include:

• A basic CPAP, which keeps the pressure constant all night long
• A bilevel device (BiPAP) provides two levels of pressure—more when you breathe in and less when you breathe out
• An auto-CPAP device, which changes pressure throughout the night based on your body position, sleep stage, and snoring

As you’re gathering medical evidence to file your VA claim for sleep apnea, remember that just having a CPAP alone doesn’t meet the VA’s requirements for service connection. You must have a medical statement from a doctor detailing how your sleep apnea is service-connected.

Is a CPAP machine the only treatment for sleep apnea?

No. Sleep apnea treatment depends on the type and severity of the condition. Before or in addition to CPAP therapy, lifestyle changes such as diet, exercise, and stress reduction may be recommended. Some veterans with sleep apnea may experience improvement with lifestyle changes, but CPAP therapy is still among the most common treatments.

Can the VA take away my sleep apnea rating?

A sleep apnea VA rating can be reduced by the VA. When you’re granted a sleep apnea VA rating, you may also be assigned a re-evaluation period (unless the condition is classified as static). Typically, the re-evaluation period is anywhere from two to five years after your initial examination.

At that time, the VA may schedule a re-examination to verify if your sleep apnea symptoms still exist and if they’ve changed.

If your initial rating decision letter says that future examinations are scheduled, or you don’t have a 100% permanent and total rating, then your disability rating is not considered permanent or static by the VA.

There are cases in which your VA rating for sleep apnea would not be re-evaluated. These would include situations in which:

• Your disability is considered permanent by the VA
• Your disability is considered static by the VA
• Sleep apnea symptoms persist without material improvement for five or more years (this is known as a stabilized rating)
• You’re over age 55
• You have a continuous sleep apnea rating for 20 years or more

According to 38 CFR § 3.105(e), a rating reduction (for any condition) may only take place in cases where:

• The VA has reviewed your entire medical history
• You’ve undergone a thorough examination
• The VA has found sustained improvement in your ability to function under the ordinary conditions of life,

The VA is also required to issue a veteran notice of a proposed reduction and give you 60 days to submit evidence and 30 days to request a hearing (unless the reduction would not change your compensation).

Additional Sleep Apnea Guides and Resources

You might also like the following Blog posts about Sleep Apnea:

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About the Author

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Brian Reese

Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).

Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start. 

As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.

He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).