VA Rating for Sleep Apnea: Complete Compensation Guide

Sleep apnea affects an estimated 30-40% of post-9/11 veterans, making it one of the fastest-growing service-connected disability claims. Unlike tinnitus with its fixed 10% rating, sleep apnea can earn anywhere from 10% to 100% depending on severity. If you snore loudly, experience daytime fatigue, or have been diagnosed with sleep apnea during or after military service, you likely qualify for VA disability compensation.

Understanding Sleep Apnea and Military Service Connection

Sleep apnea is a sleep disorder characterized by repeated pauses in breathing during sleep. Each pause can last from seconds to minutes, and some individuals experience 30-100 breathing interruptions per hour. These interruptions prevent restful sleep, depriving the brain and body of oxygen.

Types of Sleep Apnea

Obstructive Sleep Apnea (OSA) - Accounts for 90% of cases. The airway physically collapses during sleep despite the brain's breathing effort.

Central Sleep Apnea (CSA) - The brain fails to send proper breathing signals to respiratory muscles.

Complex Sleep Apnea - Combination of both obstructive and central patterns.

Most service-connected sleep apnea is obstructive type. Veterans develop OSA from:

Obesity (common in post-service life)
Deviated septum from combat injuries
Enlarged tonsils
Excess neck tissue
Allergies and nasal congestion
Sleeping position and muscle tone changes

The VA connects sleep apnea to military service through several pathways:

Direct diagnosis during active duty
Documented sleep problems noted in military medical records
Service-connected conditions causing sleep apnea (TBI, PTSD, obesity from service)
Secondary to other rated conditions (back pain, anxiety limiting sleep position)

VA Rating Percentages for Sleep Apnea

The VA uses Diagnostic Code 6847 for sleep apnea with a five-tier rating system based on severity:

0% (Not Rated) - Sleep apnea not recognized as service-connected or mild cases not meeting rating criteria

10% Rating - Mild sleep apnea with minimal daytime symptoms. Typically:

Apnea-Hypopnea Index (AHI) under 5 events per hour
Minimal oxygen desaturation
Mild snoring, infrequent pauses
Little impact on daily function

30% Rating - Moderate sleep apnea with significant symptoms:

AHI of 5-14.9 events per hour
Some daytime somnolence or fatigue
Regular snoring with noted pauses
Sleep disruption affecting quality of life

50% Rating - Moderately severe sleep apnea:

AHI of 15-29.9 events per hour
Significant daytime somnolence
Frequent oxygen desaturation (below 80%)
Noticeable impact on daily activities and work

100% Rating (TDIU) - Severe sleep apnea with extreme impact:

AHI over 30 events per hour
Severe daytime somnolence affecting employment
Significant oxygen desaturation episodes
Medical documentation of severe functional limitation
Often supported by additional service-connected conditions

Understanding AHI Scores

The Apnea-Hypopnea Index measures breathing disruptions per hour of sleep. The higher the AHI, the more severe the sleep apnea and typically the higher the VA rating:

AHI < 5: Generally mild (10% or non-rated)
AHI 5-15: Usually moderate (30%)
AHI 15-30: Often moderately severe (50%)
AHI > 30: Typically severe (50-100%)

Your sleep study (polysomnography report) will show your specific AHI score.

Monthly Compensation Amounts for Sleep Apnea

Sleep apnea compensation varies by rating percentage and dependent status. As of 2025:

10% Rating:

Veteran alone: $175-$185/month
With spouse: $195-$210/month
With child: $210-$230/month

30% Rating:

Veteran alone: $330-$350/month
With spouse: $365-$390/month
With child: $395-$425/month

50% Rating:

Veteran alone: $605-$625/month
With spouse: $665-$690/month
With child: $720-$755/month

100% Rating:

Veteran alone: $3,737-$3,850/month
With spouse: $4,095-$4,230/month
With child: $4,450-$4,600/month

These amounts increase annually with Cost of Living Adjustment. Your effective date (usually your diagnosis or discharge date) determines your rate, with back pay calculated from that point.

Combined Ratings Impact

Sleep apnea combines with other disabilities using the VA formula. For example:

10% sleep apnea + 10% hearing loss = 19% combined
30% sleep apnea + 20% back pain = 44% combined
50% sleep apnea + 30% PTSD = 65% combined

If you have multiple conditions, your sleep apnea rating may result in a higher combined rating than the individual percentages suggest.

Evidence Requirements for Sleep Apnea Claims

Medical Documentation

Sleep Study Report (Polysomnography)

Most crucial evidence piece
Shows AHI (Apnea-Hypopnea Index) score
Oxygen saturation levels during sleep
Must be performed in a sleep lab or with home sleep apnea test
Should be dated and contain physician interpretation

Physician Diagnosis

Letter from sleep medicine specialist confirming sleep apnea diagnosis
Date diagnosis established
Recommended treatment (CPAP, oral appliance, surgery)
Clinical opinion on severity

Treatment Records

CPAP machine compliance data if applicable
Oral appliance fitting records
Surgical records if procedures performed
Follow-up sleep study results

Baseline Medical Records

Military service medical records mentioning sleep problems
Previous sleep studies from service
Waist circumference measurements (obesity is contributing factor)
Blood pressure readings showing hypertension (common with sleep apnea)

Lay Evidence

Written statements describing:

When you first noticed sleep problems
Frequency of snoring or breathing interruptions
Daytime fatigue and functional limitations
Impact on work performance
Relationship between military service and condition onset
Witness statements from family or service members

Nexus Letter Guidance for Sleep Apnea

A nexus letter from a sleep medicine physician or primary care doctor is critical for most sleep apnea claims, establishing the connection between military service and current condition.

Essential Nexus Letter Components

1. Medical Opinion on Service Connection The nexus must state that sleep apnea is "at least as likely as not" caused by or significantly aggravated by military service.

2. Specific Service-Related Cause Examples include:

PTSD causing sleep disruption leading to OSA development
TBI affecting airway control
Obesity from military physical stress and post-service lifestyle
Combat stress causing sleep problems aggravating pre-existing sleep apnea

3. Review of Medical Evidence Reference your sleep study findings and diagnostic criteria supporting service connection.

4. Timeline Explain when sleep problems started relative to military service or when current condition developed.

Quality Nexus Letter Providers

VA Sleep Medicine Specialists: Free through VA; request explicitly
Private Sleep Medicine Doctors: Board-certified sleep specialists with access to military occupational knowledge
Veterans-Focused Providers: Telehealth companies specializing in VA claims ($400-$800)
VA Service Organizations: VSOs can connect you with approved providers

The strongest nexus letters come from providers familiar with military PTSD and other service-connected conditions commonly causing sleep disruption.

C&P Exam Process for Sleep Apnea

The VA frequently schedules C&P exams for sleep apnea claims to assess severity and functional impact.

What to Expect

Exam Duration: 30-60 minutes with a VA or contracted physician or physician assistant

Examination Components:

Medical history review focusing on sleep problems
Description of daytime symptoms and functional impact
Physical examination (weight, blood pressure, airway assessment)
Discussion of current treatments and compliance
Mental status evaluation to assess alertness and cognition
Work capacity assessment

Key Questions You'll Be Asked

When did sleep problems start?
How many hours do you sleep nightly?
Do you snore or experience pauses in breathing (per spouse/family)?
Do you wake gasping for air?
How fatigued are you during the day?
What tasks does fatigue prevent you from performing?
Are you using CPAP or other treatment? Compliance level?
Has sleep apnea affected your job performance?
Have you had a formal sleep study?

Preparation Tips

Bring Sleep Study: Provide actual polysomnography report showing AHI score
Document Daytime Impact: Prepare specific examples of fatigue affecting work or daily activities
Note Treatment Attempts: Discuss CPAP use, side effects, and compliance
Mention Witnesses: Reference family members observing breathing pauses
Be Detailed on Impact: "Extremely fatigued" is better than "tired." Specify: Can't concentrate at work, nearly fell asleep while driving, missed social events due to exhaustion.

The examiner will review your sleep study results and assess your current functional status. They're evaluating both the objective findings (AHI score) and subjective symptoms (daytime impact).

Real Claim Examples

Case 1: Combat PTSD with Secondary Sleep Apnea

A former Army infantryman (Sergeant E-5) with PTSD (70% rating) filed for sleep apnea. His combat-related hypervigilance prevented sleep; he developed severe sleep apnea from sleep deprivation consequences. He provided:

Sleep study showing AHI of 42 (severe)
Nexus letter from VA psychiatrist connecting PTSD-induced sleep disruption to sleep apnea
Sleep medicine specialist report

Outcome: 50% sleep apnea rating. Combined with 70% PTSD = 85% overall. Monthly compensation increased from $2,100 to $2,894. Back pay: $8,400.

Case 2: TBI-Related Sleep Apnea

A Navy pilot with documented TBI from aircraft accident filed sleep apnea claim with:

Military brain injury documentation
Sleep study (AHI 28)
Neuropsychology report noting sleep regulation problems from TBI
Private sleep medicine nexus letter

Outcome: 50% rating with effective date from TBI diagnosis. Monthly compensation: $625. Combined with 10% hearing loss = 55% overall.

Case 3: Obesity Secondary to Service

A former Navy engineer with 20 years service filed for sleep apnea related to military-connected weight gain. He had:

Sleep study showing AHI of 8 (mild-moderate)
Military weigh-in records from service showing normal weight
Current BMI of 33 (obese category)
Physician statement that military occupational stress contributed to weight gain

Outcome: 30% rating. Combined with 20% back pain = 44% overall. Monthly compensation: $350.

Common Mistakes to Avoid

Mistake 1: Insufficient Sleep Study Documentation

Many claims fail because the sleep study is too old, incomplete, or lacks crucial AHI measurements.

Solution: Obtain a recent, comprehensive polysomnography report with clear AHI scoring.

Mistake 2: No Clear Service Connection

Simply having sleep apnea isn't enough if you don't explain military service's role.

Solution: File nexus letter specifically addressing how military service caused or aggravated sleep apnea.

Mistake 3: Downplaying Daytime Impact

Saying "I'm tired sometimes" won't justify 50% or 100% rating.

Solution: Document specific functional limitations: "Unable to work day shift," "Fall asleep while driving," "Can't perform job duties without sleep treatment."

Mistake 4: Poor CPAP Compliance Documentation

If you have CPAP but don't use it, the VA questions severity.

Solution: Use CPAP consistently; request compliance reports from machine for exam.

Mistake 5: Missing Secondary Conditions

Sleep apnea causes hypertension, heart problems, and worsens existing conditions.

Solution: File for secondary conditions (hypertension, atrial fibrillation) related to sleep apnea.

Step-by-Step Filing Process

Step 1: Obtain Sleep Study

Schedule sleep study through VA sleep medicine or civilian provider
Ensure complete polysomnography report with AHI scoring
Request copy for your records

Step 2: Gather Medical Evidence

Collect all sleep-related medical records
Obtain baseline doctor's statements about diagnosis
If military medical records exist mentioning sleep issues, request them
Document current symptoms and functional limitations

Step 3: Obtain Nexus Letter

Request from VA sleep medicine specialist (free but may be delayed)
Or obtain private sleep medicine physician nexus letter
Letter must explicitly connect sleep apnea to military service

Step 4: Complete VA Form 21-526EZ

Download from VA.gov or request from Regional Office
Describe sleep problems in detail
Explain military service connection
List all supporting documents

Step 5: Submit Claim

Online: VA.gov portal (recommended, fastest processing)
Mail: VA Regional Office
In-Person: Local VA office with VSO assistance

Step 6: Attend C&P Exam (if scheduled)

Arrive early with sleep study and medical records
Describe sleep patterns and daytime functional impact
Be specific about work/life limitations

Step 7: Await Rating Decision

VA responds within 30-120 days
Rating Decision letter explains approval and assigned percentage
First payment arrives 30-45 days after approval

Timeline Expectations

Initial Claim to Decision: 60-120 days Effective Date: Usually diagnosis date or service discharge date First Payment: 30-45 days after approval Back Pay: Calculated from effective date; may take 60-90 days for lump sum processing

Appeal Strategies if Denied

Denial is not permanent. Many sleep apnea claims succeed on appeal with stronger evidence.

Option 1: Supplemental Claim

If denied for insufficient evidence, file Form 21-0995 with:

More recent sleep study
Better nexus letter
Additional medical documentation
Detailed functional limitation statements

Option 2: Higher-Level Review

Request a senior reviewer examine the original decision for errors. No new evidence needed, but you can submit it.

Option 3: Appeal to Board of Veterans' Appeals

For denials with questionable reasoning, request board hearing. You can present new evidence and arguments before an appeals officer.

Appeal Tips

Identify specific reason for denial
Provide better evidence addressing denial reason
File quickly (one year from decision)
Consider VSO or attorney assistance
Document appeal timeline and submission dates

Secondary Conditions Related to Sleep Apnea

Veterans with sleep apnea commonly develop secondary conditions warranting additional ratings:

Hypertension (20-60% rating) - Sleep apnea causes sustained high blood pressure

Atrial Fibrillation (50-100% rating) - Chronic oxygen deprivation triggers irregular heartbeat

Pulmonary Hypertension (50-100% rating) - Right heart stress from sleep apnea

Cor Pulmonale (100% rating) - Heart failure from untreated sleep apnea

Depression/Anxiety (10-100% rating) - Sleep deprivation effects on mental health

Filing secondary conditions dramatically increases total compensation through combined ratings.

Frequently Asked Questions

Q: Can I get 100% rating for sleep apnea without TDIU? A: Rarely. 100% is typically assigned through TDIU (Total Disability Individual Unemployability) when sleep apnea prevents work.

Q: Does using CPAP affect my rating? A: Using CPAP shows you're treating the condition, which doesn't lower your rating—it demonstrates severity and compliance.

Q: What AHI score guarantees 50% rating? A: AHI over 15 typically warrants 50%, but VA also considers daytime functional impact.

Q: Should I file immediately after diagnosis? A: Yes. Your effective date starts when diagnosed or when service ends; delaying filing costs back pay.

Q: Can I combine sleep apnea with PTSD ratings? A: Yes, if both are service-connected, they combine using VA formula.

Conclusion

Sleep apnea represents one of the most winnable VA disability categories, particularly for post-9/11 veterans. With proper sleep study documentation and a clear nexus letter establishing military service connection, approval rates exceed 70%.

The key to maximum compensation is obtaining comprehensive sleep study evidence, securing a strong nexus letter, and clearly documenting daytime functional limitations. If you haven't filed yet, do so immediately to establish your effective date and begin receiving compensation.

Start your claim through VA.gov, your VA Regional Office, or with assistance from a veterans' service organization. With persistence and proper documentation, you can achieve the sleep apnea rating and compensation you've earned through military service.