Sleep Apnea: VA Rating Criteria

Plain-language guide

What this rating actually turns on

One prescription decides most sleep apnea ratings: whether a doctor has put you on a CPAP. Sleep apnea is rated under 38 CFR 4.97, Diagnostic Code 6847, where the 50 percent level turns on whether you require a breathing assistance device such as a CPAP machine, the 30 percent level on persistent daytime hypersomnolence, and 100 percent on chronic respiratory failure with carbon dioxide retention, cor pulmonale, or a required tracheostomy. Your apnea-hypopnea index does not set the percentage, a veteran with moderate OSA on a prescribed CPAP and one with severe OSA on a prescribed CPAP sit at the same level.

Because of that structure, the contested ground in most sleep apnea claims is service connection, not the percentage. Sleep apnea is frequently diagnosed years after separation, so you need evidence of in-service incurrence or aggravation plus a medical nexus to the current diagnosis under 38 CFR 3.303, or a link to an already service-connected condition, since 38 CFR 3.310 allows service connection for disabilities proximately due to, or aggravated by, a service-connected disability.

A worked example

A retired Navy chief is diagnosed with obstructive sleep apnea eight years after he separates. The hard part is service connection, so he builds it: his service treatment records show two visits for loud snoring and morning headaches, two shipmates submit statements that he stopped breathing in his rack on deployment, and his physician writes a nexus opinion tying the current apnea to those in-service symptoms. With the connection in place, the percentage comes down to one line on the DBQ. His overnight sleep study confirms the diagnosis, and his pulmonologist has prescribed a CPAP that he uses nightly, with the prescription and treatment notes in the file. That single fact, a medically required breathing assistance device, is the 50 percent criterion in DC 6847 word for word. His apnea-hypopnea index reads as moderate, but it never enters the calculation, the prescribed CPAP sets him at 50 percent whether his OSA is moderate or severe. See the pay table on this page for what that pays once it combines with his other ratings.

What the C&P exam measures

The Sleep Apnea DBQ tracks the rating criteria almost line by line. The examiner documents whether a sleep study has been performed (date, facility, and results), whether continuous medication is required, and checks boxes for the exact findings the schedule rates: persistent daytime hypersomnolence, cor pulmonale, carbon dioxide retention, chronic respiratory failure, and tracheostomy, plus the condition’s functional impact on your ability to work. The DBQ is on VA’s public list, so a private physician who treats you can complete it.

What to have in your file

• The sleep study report. Even the 0 percent criterion requires “documented sleep disorder breathing” (DC 6847), and the DBQ asks for the study by name, date, and results.
• Documentation that the device is medically required, the prescription and treatment notes. The 50 percent criterion reads “requires use of breathing assistance device,” so the record must show medical necessity, not just ownership of a machine.
• In-service evidence: service treatment records noting snoring, apneic episodes, or chronic fatigue, and lay statements from people who served with you describing what they observed.
• A nexus opinion from a physician connecting the current diagnosis to service or to a service-connected condition, with reasoning.

Common mistakes

• No sleep study. A symptom-based diagnosis without a confirming study leaves nothing for the rater to anchor under DC 6847’s wording.
• Assuming CPAP use alone settles it. Without records showing the device is prescribed and required, the 50 percent criterion isn’t documented.
• Filing with a current diagnosis and nothing else. A post-service diagnosis without in-service evidence or a nexus opinion fails the § 3.303 elements regardless of severity.
• Stacking respiratory ratings. Under 38 CFR 4.96(a), ratings under DCs 6600–6817 and 6822–6847 are not combined with each other; coexisting respiratory conditions get a single rating under the predominant disability, with possible elevation to the next level.

Worth knowing

VA published a proposed rule on February 15, 2022 (87 FR 8474) that would rebuild DC 6847 around treatment effectiveness: 0 percent if asymptomatic with or without treatment, 10 percent where treatment yields incomplete relief, 50 percent only where treatment is ineffective or cannot be used due to comorbid conditions, and 100 percent only with end-organ damage. No final rule has been published, and the criteria currently in the CFR remain the law. Claims are decided under the criteria in effect, but this is the single most consequential pending change for this condition and worth watching.

If your rating came back lower than this

A decision that ignores the criteria above is a frequent reason veterans are underpaid. Line your decision up against the levels on this page. If the evidence supports a higher level than VA assigned, you have three ways to challenge it, and the right one depends on why it went wrong:

• Something was missing from the record (an exam finding, a prescription, a flare-up statement, a nexus letter): add it with a Supplemental Claim.
• The evidence was already there and VA misread it: ask for a Higher-Level Review by a more senior rater, with no new evidence needed.
• A legal or judgment error: take it to the Board of Veterans' Appeals.

Before you file, recombine this rating with your others (VA math does not add ratings), check how long each lane is taking right now, and remember a VA-accredited representative or VSO will help you for free. You can also browse every other condition's criteria to make sure you are claiming everything you are owed.