Understanding Your Sleep Apnea VA Rating

If you use a prescribed CPAP and are still rated below 50 percent, that is often a sign the decision missed something, and it can be challenged. You can have your decision be reviewed on the Goodman Allen Donnelly veterans benefits page. 

Why a CPAP usually means 50 percent

Here is the part that surprises veterans: the rating is tied to the treatment, not just the diagnosis. If a doctor has prescribed a CPAP or a similar breathing assistance device and you use it, that alone generally meets the 50 percent criteria, regardless of how well the machine controls your symptoms. That is why 50 percent is the most common sleep apnea rating.

It also explains a common gap. A veteran who was diagnosed years ago, uses a CPAP nightly, but was rated at 0 or 30 percent may simply have a record that never clearly documented the prescription and ongoing use. Getting that documentation in front of the VA, through an appeal or a supplemental claim, is often what moves the rating.

Proving your sleep apnea is connected to service

A rating only matters once the apnea is service-connected, and that is where many claims are denied. You will need three things: a current diagnosis confirmed by a sleep study, evidence of symptoms or onset connected to service, and a medical opinion linking the two. A sleep study is not optional. The VA will not assign a rating without one.

Direct service connection is strongest when the record shows sleep problems during service, loud snoring, choking or gasping at night, exhaustion noted by you or fellow service members, even if a formal diagnosis came later. Lay statements from people who served with you or from a spouse can help establish that the symptoms started in service. The nexus opinion then ties those documented in-service symptoms to the current diagnosis.

When sleep apnea is secondary to another condition

This is the path veterans miss most. Even if your sleep apnea did not clearly begin in service, it can still be recognized to be service-connected if it was caused or aggravated by another condition the VA already recognizes. That is considered to be a secondary service connection, and with sleep apnea it is common and well documented.

The most frequent example is sleep apnea linked to PTSD. The medical literature connecting PTSD, disrupted sleep, and weight gain to obstructive sleep apnea is well established, which makes this a winnable claim when the evidence is built correctly. Weight gain from a service-connected condition or its medication, and chronic sinus or nasal conditions, can also support a secondary claim. As with any secondary condition, the connection is treated as a medical finding, so it needs a doctor’s opinion that explains how the primary condition caused or worsened the sleep apnea, not just a statement that the two are related.

What we see most often with sleep apnea claims

In our experience, sleep apnea claims are lost on the record, not the merits. A veteran plainly needs a CPAP and plainly has the condition, but the file never clearly shows the prescription, the sleep study, or the link to service or to a condition like PTSD. When that record is built and organized, the rating conversation changes.

Goodman Allen Donnelly has focused on veterans benefits since 1998, with attorneys who have worked inside the VA adjudicating appeals and clerked at the U.S. Court of Appeals for Veterans Claims.

Frequently asked questions

What is the VA rating for sleep apnea? The VA rates sleep apnea at 0, 30, 50, or 100 percent under diagnostic code 6847. A rating of 50 percent applies when you need a breathing assistance device such as a CPAP, 30 percent for persistent daytime sleepiness, and 100 percent for chronic respiratory failure or a required tracheostomy.

Does a CPAP mean a 50 percent sleep apnea rating? Generally yes. Under the current rating schedule, needing a prescribed breathing assistance device such as a CPAP meets the 50 percent criteria, even if the device controls your symptoms well. That is why 50 percent is the most common sleep apnea rating.

Can I get sleep apnea service connected secondary to PTSD? Yes. Sleep apnea can be service connected as secondary to PTSD when a medical opinion links the two, often through disrupted sleep and weight gain. It is a common and winnable claim, but it requires a diagnosis, a sleep study, and a supporting nexus opinion.

Do I need a sleep study for a VA sleep apnea claim? Yes. The VA requires a sleep study to confirm the diagnosis before it will service connect or rate sleep apnea. Without a qualifying sleep study, a claim will generally be denied regardless of your symptoms.

Why was my sleep apnea rated 0 percent if I use a CPAP? Usually because the record did not clearly document the prescription and your ongoing use of the device. A decision that overlooks a prescribed CPAP can often be challenged through an appeal or a supplemental claim with the right evidence.

Where to start if your sleep apnea rating is too low

Your sleep apnea VA rating comes down to two things: proving the condition is connected to service, directly or secondary to something like PTSD, and making sure the record reflects the treatment you actually need. A CPAP generally supports 50 percent, and a decision that ignores it is not the last word. A denied or underrated decision can be challenged through an appeal.

Goodman Allen Donnelly represents veterans and their dependents, and only veterans and their dependents, in VA disability appeals, with attorneys who have worked inside the VA and the U.S. Court of Appeals for Veterans Claims and served veterans since 1998. If your sleep apnea was denied or rated too low and you want to understand your options, Goodman Allen Donnelly offers a free consultation for veterans and their families: https://www.goodmanallen.com/contact-us/.

About The Author

This article was contributed by Nancy Foti, Managing Partner of Goodman Allen Donnelly. With over 20 years of experience, Nancy has represented disabled veterans and their families before the Department of Veterans Affairs, the U.S. Court of Appeals for Veterans Claims, and the U.S. Court of Appeals for the Federal Circuit. She clerked for the Honorable Ronald Holdaway of the U.S. Court of Appeals for Veterans Claims and previously served as a staff attorney with the National Veterans Legal Services Program.