How to file a VA sleep apnea claim — direct, secondary and aggravation routes, and how DC 6847 rates it
Sleep apnea can be service-connected three ways: directly, when it began in service; secondarily under 38 CFR 3.310, when a service-connected condition caused or aggravated it, supported by a medical opinion; or by aggravation of a pre-service condition. Every route needs a diagnosis from a sleep study. VA rates sleep apnea syndromes (obstructive, central or mixed) under 38 CFR 4.97, diagnostic code 6847: 0% when documented but asymptomatic, 30% for persistent daytime hypersomnolence, 50% when a breathing assistance device such as a CPAP machine is required, and 100% for chronic respiratory failure with carbon dioxide retention, cor pulmonale or a tracheostomy. File on VA Form 21-526EZ; VA usually schedules a claim exam.
What you'll need
- VA Form 21-526EZ
- A sleep study report (in-lab polysomnography or a home sleep apnea test) with the diagnosis
- Your CPAP or other breathing-device prescription, if you have one
- For a direct claim: service treatment records or lay statements about snoring, witnessed pauses in breathing or daytime sleepiness in service
- For a secondary claim: your rating decision for the primary condition and a medical opinion linking the two
- A free accredited representative (CVSO or VSO)
Step-by-step
Step 1: Get the diagnosis
VA needs a current diagnosis from a sleep study — in-lab polysomnography or a home sleep apnea test ordered by a provider. If you are enrolled in VA health care, ask your primary care team for a sleep referral; a private study ordered through your own insurance is also accepted. Pulse-oximetry screening alone is not a diagnosis. If a breathing device such as CPAP is prescribed, keep the prescription and the equipment records.
Step 2: Choose the route to service connection
Direct: the condition began in service — service treatment records mentioning sleep complaints, or statements from people who served with you describing loud snoring, witnessed pauses in breathing or falling asleep on duty, plus a medical opinion that the current diagnosis is at least as likely as not related to those in-service symptoms. Secondary (38 CFR 3.310): a service-connected condition caused the apnea or made it worse — the claim needs a medical opinion from a physician explaining the link; conditions commonly cited include PTSD, traumatic brain injury, chronic rhinitis or sinusitis, and weight gain from medication prescribed for a service-connected condition. Aggravation: a condition that existed before service and was permanently worsened by it.
Step 3: Get the medical opinion for a secondary claim
Ask the physician who treats you (VA or private) for a written opinion that it is "at least as likely as not" that your sleep apnea was caused or aggravated by the service-connected condition, with the medical reasoning. VA applies the benefit of the doubt (38 CFR 3.102) when the evidence is evenly balanced, so the opinion needs to explain why, not just conclude. VA may also obtain its own opinion at the claim exam.
Step 4: File VA Form 21-526EZ
File online, by mail to the Claims Intake Center (PO Box 4444, Janesville, WI 53547-4444), in person or through a free accredited representative. Name the condition and the route ("obstructive sleep apnea, secondary to service-connected PTSD"), and submit the sleep study, the device prescription, any opinion and any lay statements. VA will usually schedule a claim exam; bring the device prescription and describe daytime sleepiness and how you function.
Reference: https://www.va.gov/disability/file-disability-claim-form-21-526ez/
Step 5: How DC 6847 rates it
Under 38 CFR 4.97: 0% — asymptomatic but with documented sleep-disordered breathing; 30% — persistent daytime hypersomnolence; 50% — requires use of a breathing assistance device such as a CPAP machine; 100% — chronic respiratory failure with carbon dioxide retention or cor pulmonale, or a tracheostomy is required. A prescription for a breathing device is the evidence for the 50% level. If VA assigns a lower rating than the evidence supports, the decision-review options (Higher-Level Review, Supplemental Claim, Board Appeal) apply within one year.
Critical tips
- A sleep study done years after discharge is fine for a secondary claim — the question is the link to the service-connected condition, not when the study was done.
- Veterans enrolled in VA health care can receive the CPAP machine and supplies through VA regardless of whether the apnea is service-connected.
- VA has proposed changes to the sleep apnea rating criteria in the past; the criteria above are the ones in force in 38 CFR 4.97 — check the regulation when you file.
- A county veterans service officer can file the claim for free: warriorsfund.org/find-cvso.
- In crisis: dial 988 then press 1, or text 838255.