Sleep apnea has no 10%, no 20%, no 40%, and no 70%. It goes 0, then 30, then 50, then 100 — and the jump from 30 to 50 turns on a single word in the regulation.
That word is “requires.” Not “uses,” not “owns.” The distinction decides thousands of claims a year.
The Four Levels
| Rating | What the criteria require |
|---|---|
| 100% | Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or requires a tracheostomy |
| 50% | Requires use of a breathing assistance device such as a continuous airway pressure (CPAP) machine |
| 30% | Persistent day-time hypersomnolence |
| 0% | Asymptomatic, but with documented sleep disorder breathing |
These are the criteria under Diagnostic Code 6847, which covers obstructive, central, and mixed sleep apnea syndromes together.
For practical purposes 50% is the ceiling. The 100% level describes respiratory failure or a tracheostomy — genuinely severe disease, not ordinary CPAP-managed apnea.
“Requires” Is Doing the Work
The 50% criterion asks whether the device is medically required, not whether you happen to be using one.
Two consequences follow, and they cut in opposite directions.
- Trouble tolerating the machine doesn’t disqualify you. Plenty of veterans are prescribed CPAP and struggle to sleep with it. The requirement is clinical — if a physician has determined you need it, the criterion is about that determination.
- Buying a machine yourself doesn’t qualify you. An over-the-counter device without a prescription and a diagnosis behind it isn’t evidence that treatment is required.
What VA looks for is a prescription, a documented diagnosis, and treatment notes that show the device is part of your care plan.
You Need the Sleep Study
Even the 0% level requires “documented sleep disorder breathing.” There’s no route to a sleep apnea rating on symptoms alone.
A sleep study — in a lab or an approved home test — is what produces that documentation. Snoring reported by a spouse, daytime exhaustion, and morning headaches are all useful supporting evidence, but they don’t substitute for the study.
If you’ve never had one and suspect apnea, that’s the first step, ahead of any paperwork.
Most Sleep Apnea Claims Are Secondary
Proving apnea began in service is difficult. Very few veterans had a sleep study on active duty, and without one there’s usually nothing in the service record to point at.
That’s why the majority of successful claims run through secondary service connection instead.
| Primary service-connected condition | Why it’s linked to sleep apnea |
|---|---|
| PTSD or another mental health condition | Well-documented association with disrupted sleep and sleep-disordered breathing |
| Rhinitis, sinusitis, or deviated septum | Upper airway obstruction contributing directly |
| Orthopedic conditions limiting activity | Reduced mobility leading to weight gain, a major apnea risk factor |
| Asthma or other respiratory conditions | Coexisting airway disease |
| Medication for a service-connected condition | Some medications affect respiratory drive or weight |
Each of these requires a medical opinion connecting the two — the nexus. A letter that simply asserts a link without explaining the mechanism carries little weight.
Describing “Persistent Day-Time Hypersomnolence”
The 30% level uses clinical language for something ordinary: being persistently sleepy during the day despite sleeping at night.
Vague descriptions cost ratings here. Specific ones help.
- Falling asleep at a desk, in a waiting room, in front of the television during conversation
- Nodding off while driving, or pulling over to sleep
- Naps that are necessary rather than optional
- Morning headaches and waking unrefreshed after a full night
- Concentration failures that your family or supervisor has noticed
A spouse’s statement is unusually valuable for this condition, because the person who witnesses the breathing pauses is almost never the veteran. Our guide to writing a buddy letter raters credit covers what makes those statements land.
A Proposed Change, Not Yet in Effect
VA has proposed revising how the respiratory system is rated, including Diagnostic Code 6847. The direction of the proposal is to rate sleep apnea on how well treatment works rather than on whether a device has been prescribed.
That proposal was published in the Federal Register in February 2022 and remains a proposed rule. The criteria in the table above are the ones currently in force.
Two practical notes. Proposed rules can change substantially before they’re finalized, so don’t plan around numbers that haven’t been adopted. And when VA revises a rating schedule, existing ratings are generally not reduced solely because criteria changed — but check the current text of 38 CFR 4.97 before relying on any of this.
Where Sleep Apnea Claims Go Wrong
The denials cluster around a handful of avoidable problems.
- No sleep study in the file. A diagnosis noted in passing by a primary care provider isn’t the documented sleep-disordered breathing the criteria call for.
- A study done years ago and never updated. If your treatment has changed, the current record should reflect it.
- Claiming it as direct service connection with nothing in the service record. Filing under the wrong theory wastes a decision cycle — say plainly which condition it’s secondary to.
- A nexus letter with no reasoning. “Sleep apnea is related to his PTSD” asserts a conclusion. Explaining the physiological mechanism is what gives it weight.
- Losing the CPAP prescription. The prescription and the supply records are the documentary backbone of the 50% level. Keep copies.
If a claim has already been denied, the reasons-and-bases section of the decision letter tells you which of these applied — our guide to the three ways to challenge a VA decision covers what to do next.
What the Rating Is Worth Beyond the Percentage
A 50% rating on its own is significant, and it does more than raise the monthly payment.
It moves your combined rating substantially — our guide to how VA combines ratings shows why a 50% added early counts for more than one added late. Combined with other conditions it can reach the TDIU thresholds, and crossing 30% switches on compensation for dependents.
Frequently Asked Questions
What rating does CPAP get?
50%, when the criteria are met — the level is for requiring use of a breathing assistance device such as a CPAP machine.
Is there a 10% or 20% rating for sleep apnea?
No. Diagnostic Code 6847 provides 0%, 30%, 50%, and 100% only.
Do I need a sleep study?
Effectively yes. Even the 0% level requires documented sleep disorder breathing, which a sleep study provides.
What if I can’t tolerate the CPAP machine?
The criterion is whether the device is medically required, not whether you sleep well with it. Keep the prescription and treatment notes in the record.
Can sleep apnea be secondary to PTSD?
Yes, and it’s one of the most commonly claimed secondary routes. It needs a medical opinion explaining the connection.
Have the sleep apnea rating rules changed?
Not yet. A revision was proposed in February 2022 and remains a proposed rule. The 0/30/50/100 criteria are still in effect.
Start With the Study, Then the Nexus
If you don’t have a sleep study, nothing else in the claim can work. If you do, the question becomes which service-connected condition it connects to.
An accredited service officer can look at your rated conditions and tell you which secondary theory fits. Our guide to free help from an accredited service officer explains how to reach one, or call Post 51 at (541) 451-1351.