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Veterans Law

VA Secondary Conditions to Sleep Apnea

April Donahower

November 17, 2021

Updated: June 20, 2024

VA Secondary Conditions to sleep apnea

What is Sleep Apnea?

Sleep apnea is sleep disorder that affects a person’s breathing during the course of the night.  Generally, there are three types of sleep apnea:

  • Obstructive Sleep Apnea – the most common form of sleep apnea; occurs when the throat muscles intermittently relax and block your airway during sleep
  • Central Sleep Apnea –occurs when your brain does not send the proper signals to the muscles that control breathing
  • Complex (Mixed) Sleep Apnea Syndrome –occurs when someone has both obstructive sleep apnea and central sleep apnea
How to WIN Your Sleep Apnea VA Disability Claim

Symptoms of Sleep Apnea

  • Loud snoring
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Hypersomnolence, or excessive daytime sleepiness
  • Difficulty concentrating

Oftentimes, the symptoms of the three types of sleep apnea can overlap, making diagnosis more difficult.

Diagnosing Sleep Apnea

To confirm a sleep apnea diagnosis for VA disability compensation purposes, VA requires that a sleep study be conducted.

If the veteran has previously been diagnosed with sleep apnea, but has not undergone a sleep study, VA will not consider that diagnosis enough evidence to verify eligibility for compensation.

Usually, a sleep specialist will monitor the veteran’s breathing overnight for a sleep study.

Treating Sleep Apnea

Sometimes, certain lifestyle changes can help to minimize the symptoms of sleep apnea, such as losing weight or quitting smoking.  In other, more severe cases, a doctor may need to prescribe a Continuous Positive Airway Pressure (CPAP) Machine.  A CPAP machine delivers air pressure, which is greater than the surrounding air, through a mask while the veteran is sleeping.  This machine then allows the upper airway passages to remain open, preventing sleep apnea and snoring.

How Does VA Rate Sleep Apnea?

VA Service Connection for Sleep Apnea

Generally, to establish service connection, the veteran needs to submit three things to VA:

  • A current diagnosis of sleep apnea, as confirmed by a sleep study;
  • An in-service event, injury, or illness; and
  • A medical nexus (i.e., link) between their sleep apnea and the in-service event, injury, or illness.

Veterans can submit a claim for service connection on VA From 21-526EZ.

VA Secondary Service Connection and Sleep Apnea

In addition to primary service connection for sleep apnea, veterans can receive secondary service connection for any conditions that were caused or aggravated by their already service-connected sleep apnea.  Filing a claim for secondary service connection is largely the same as filing a claim for primary service connection.

For secondary service connection to sleep apnea, veterans will need:

  • To be service-connected for sleep apnea;
  • To have a diagnosis for a secondary condition to sleep apnea; and
  • To be able to provide a nexus linking their sleep apnea to the secondary condition.

When filing a claim for secondary service connection, veterans can use the same form as primary service connection (VA Form 21-526EZ).

Secondary Service Connection and Aggravation (VA Claims)

Compensation and Pension Exams for Secondary Service Connection

After veterans file a claim for secondary service connection, VA may request that the veteran undergo a Compensation and Pension (C&P) exam.  This type of exam is meant to assess the cause and the severity of the veteran’s condition, as well as the connection to the primary service-connected disability.

These exams are usually performed by a VA examiner or a VA-contracted third-party medical professional.  Prior to the exam, the examiner will review the veteran’s c-file so they are familiar with the veteran’s case.

During the exam, the examiner may evaluate both the primary and secondary condition.  This may seem redundant, especially if the primary condition has already been assessed, however it is still important to attend the exam and cooperate with the examiner.  If a veteran does not attend the exam, their claim can be denied.

Common Secondary Conditions to Sleep Apnea

There are many common conditions that can be caused or aggravated by sleep apnea.  Below is a non-exhaustive list of common conditions linked to sleep apnea:

Asthma Secondary to Sleep Apnea

Asthma is a condition that affects a person’s airways and makes it difficult for them to breathe.  With asthma, the airways narrow and produce extra mucus.  This can often interfere with daily life.  Symptoms of asthma can include:

  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping caused by shortness of breath, coughing, or wheezing
  • A whistling or wheezing sound when exhaling
  • Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Research has indicated that people who have asthma are more likely to develop obstructive sleep apnea.  This could be because both asthma and sleep apnea affect the upper and lower respiratory tracts.  When the throat muscles are weakened due to asthma, there is a greater likelihood for the throat to collapse and create an obstruction of the airway.

GERD Secondary to Sleep Apnea

Gastroesophageal Reflux Disease, or GERD, is a digestive disorder that occurs when stomach acid flows back up from the stomach into the esophagus.  This causes discomfort and inflammation.  Symptoms of GERD include:

  •  Nausea
  • Vomiting
  • Heartburn
  • Difficulty breathing
  • Coughing
  • Painful swallowing
  • Chest pain
  • Stomachaches or other abdominal pain

Veterans who suffer from sleep apnea may find that the condition aggravates or causes GERD.  This is because, while asleep, the body may not clear the veteran’s esophagus as it would when the veteran is awake, thereby exacerbating the veteran’s GERD.

Additionally, GERD may contribute to sleep apnea, as acid in the esophagus can cause spasms in the vocal cords which may prompt sleep apnea.  Therefore, veterans who are service connected for sleep apnea can become secondary service-connected for their GERD, and vice versa.

GERD VA Disability Ratings Explained

Hypothyroidism Secondary to Sleep Apnea

Hypothyroidism, or an underactive thyroid, occurs when the thyroid gland does not produce sufficient thyroid hormone.  Symptoms can include:

  • Fatigue
  • Weight gain
  • Cold intolerance
  • Puffy face
  • Constipation
  • Dry skin
  • Hair loss
  • Heavy or irregular menstrual cycles
  • Depression
  • Slowed heart rate

Hypothyroidism can cause changes to the upper airway, which can lead to or aggravate sleep apnea.  As such, veterans can establish secondary service connection for hypothyroidism relating to sleep apnea.

Post-Traumatic Stress Disorder Secondary to Sleep Apnea

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can affect people who have experienced or witnessed trauma, such as a distressing or shocking event.  Common examples of PTSD symptoms include the following:

  • Re-experiencing the trauma through recurrent memories, flashbacks, and nightmares
  • Avoidance of people, places, and activities that are reminders of the trauma
  • Increased arousal such as difficulty sleeping and concentrating
  • Hypervigilance
  • Irritable or aggressive behavior
  • Difficulty maintaining relationships with others

Research shows that veterans with PTSD have a higher risk of developing sleep apnea.  Additionally, the more severe a veteran’s PTSD is, the more severe their sleep apnea can become.

The link between sleep apnea and PTSD is likely due to the fact that many factors which aggravate PTSD also aggravate sleep apnea.  Some of these symptoms include sleep deprivation, insomnia, hyperarousal, and daytime sleepiness.

As such, veterans who are service-connected for PTSD are eligible for secondary service connection for their sleep apnea.  The relationship can also work in the reverse, with sleep apnea being the primary service-connected condition.

VA Rating for Sleep Apnea Secondary to PTSD


Mental Health Conditions Secondary to Sleep Apnea

Like PTSD, other conditions rated as mental health conditions can be related to sleep apnea.  Specifically, both anxiety and depression can be linked to sleep apnea.

Anxiety and depression can interfere with a person’s sleep patterns, as well as cause symptoms of hyperarousal or hypervigilance.  As such, a veteran with anxiety and depression faces a higher risk of sleep apnea.

If a veteran is service-connected for anxiety or depression, they may be able to receive secondary service connection for their sleep apnea.  Veterans may also receive secondary service connection for anxiety and depression if they are already service-connected for sleep apnea.

VA General-Ratings-for-Mental-Health-Disorders

Sinusitis Secondary to Sleep Apnea

Sinusitis is a condition where a person’s sinuses become swollen and inflamed for three months or longer, despite treatment.  Symptoms of sinusitis often include:

  • Nasal inflammation
  • Thick, discolored discharge from the nose
  • Drainage down the back of the throat (postnasal drainage)
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Pain, tenderness, and swelling around your eyes, cheeks, nose, or forehead
  • Reduced sense of smell and taste
  • Ear pain
  • Aching in your upper jaw and teeth
  • Cough or throat clearing
  • Fatigue

Chronic sinusitis can also cause nasal polyps, deviated nasal septum, and recurring respiratory tract infections.  Chronic sinusitis has also been linked to military burn pit exposure and is a presumptive condition for veterans who served in qualifying locations and time periods.

Sinusitis also affects the nose, throat, and head, much like sleep apnea.  As such, the two conditions have been linked and veterans can receive secondary service connection for sinusitis linked to sleep apnea.

Allergic Rhinitis & Sinusitis VA Disability Ratings

Tinnitus Secondary to Sleep Apnea

Tinnitus is known as the perception of noise or ringing in the ears.  Most often, tinnitus is a symptom of an underlying condition, such as hearing loss, ear injury, or a circulatory system disorder.  People with tinnitus may hear phantom noises, such as:

  • Ringing
  • Buzzing
  • Roaring
  • Clicking
  • Hissing
  • Humming

Tinnitus is one of the most frequently claimed conditions for service connection.  This is likely due to a variety of factors related to service, such as exposure to noise, possibility of traumatic brain injury, and exposure to explosive devices like IEDs.

Research has found that veterans who have chronic tinnitus also prevalently experience sleep apnea.  As such, veterans who are service connected for tinnitus may be eligible for secondary service connection for sleep apnea, and vice-versa.

Tinnitus VA Disability Claims and Ratings

Other Conditions Linked Sleep Apnea

There are many conditions that have been linked to sleep apnea that veterans can receive benefits for through secondary service connection.  Some of the following conditions can be secondary to sleep apnea, while others may be the primary condition to which sleep apnea is secondary.

Was Your VA Claim Denied?

If your VA claim was denied, we may be able to assist you. Contact the VA-accredited veterans’ disability attorneys and claims agents at CCK today at 800-544-9144.

About the Author

Bio photo of April Donahower

April joined Chisholm Chisholm & Kilpatrick in August of 2016 as an Associate Attorney. She currently serves as the Appellate Supervisor in our Veterans Law practice. April’s practice focuses on representing disabled veterans before the Court of Appeals for Veterans Claims.

See more about April