October 14, 2025 • 10 mins
Leah breaks down why so many veterans’ VA sleep apnea claims get denied and how to strengthen them. She explains what sleep apnea is, why it’s especially common among veterans, and the two main service connection paths—primary and secondary. Leah then highlights the top reasons for denials, including lack of a sleep study, missing or weak service connection, negative nexus opinions, obesity or other non-service-related factors, and weak supporting evidence. She emphasizes that denials aren’t the end of the road—strong medical opinions, buddy statements, and accredited legal help can often turn a case around.
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About:
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
The purpose of this channel is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
Understanding the unique challenges veterans face our commitment lies in delivering exceptional service and support.
Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
Prestige Veteran Medical Consulting is not a law firm, accredited claims agent, or affiliated with the Veterans Administration or Veterans Services Organizations. However, we are happy to discuss your case with your accredited VA legal professional.
⚠️ DISCLAIMER
This video is not medical or legal advice and should not be substituted for advisement from your VSO, accredited agent, or Attorney.
#vadisability #va #veteransbenefits
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
leah bucholz (00:01):
Hey, guys. It's Leah Bee from Prestige Veteran
Medical Consulting. I am a USarmy veteran, physician
assistant, and formercompensation and pension
examiner. So welcome back to ourchannel, and today, we're going
to dive into a big one. Why areso many VA sleep apnea claims
denied?
If you've ever filed and gottenthe dreaded denial letter, you
are not alone. In fact, this isone of the most commonly denied
(00:23):
claims out there. We've done aton of videos on sleep apnea, so
I hope you guys have enjoyedsome of those. And if you
haven't seen them yet, please gocheck them out. We've got a ton
of information on sleep apnea.
So let's just go ahead and breakdown the most common mistakes,
the evidence VA actually looksfor, and how you can support
your case. But before we getinto denials, let's start with
the basics. What is sleep apnea,and why is it so common among
(00:46):
veterans? So sleep apnea is adisorder where your breathing
repeatedly stops and startswhile you sleep. Obstructive
sleep apnea is one of the mostcommon types that I see and and
many veterans suffer from.
That is when your airwayactually collapses during your
sleep. So central sleep apnea,the brain doesn't send the right
signals to breathe. K? And thenyou can also have a mixed
(01:08):
version of this where you canhave a combination of central
sleep apnea and obstructivesleep apnea where that airway
collapses. Symptoms can includeloud snoring, choking, or
gasping during sleep, anddaytime fatigue.
And it's not just about beingtired. Untreated sleep apnea
raises your risk for things likehigh blood pressure, heart
disease, diabetes, and stroke.So sleep apnea in veterans.
(01:33):
Let's talk about veteransspecifically. So studies show
sleep apnea is far more commonamong veterans than the general
population.
A 2014 study in the Journal ofClinical Sleep Medicine found
that nearly sixty percent ofpost nine eleven veterans
screened were at high risk forsleep apnea. A VA health
(01:53):
services research anddevelopment report showed that
more than one in five veteransreceiving VA care have a sleep
apnea diagnosis, and that numberjust keeps rising. Veterans with
PTSD are significantly at ahigher risk. A 2015 study found
that seventy to ninety percentof vets with sleep apnea, I'm
(02:14):
sorry, with PTSD symptoms alsoscreen positive for sleep apnea.
Military service comes withunique risk factors, irregular
sleep schedules, exposure todust and burn pits, weight gain
from step stress andmedications, and, of course,
PTSD.
All of this makes veterans muchmore likely to develop sleep
apnea later in life. So let'stalk about primary versus
(02:36):
secondary service connection.And, again, we have a ton of
videos on primary and secondaryservice connection for sleep
apnea. Really, just a ton ofvideos on that secondary sleep
apnea and a couple on thatprimary. So this is where the
most claims can hit a roadblock.
So service connection. There aretwo main paths. Primary service
(02:57):
connection. So if your sleepapnea began in service, that can
mean documented snoring,fatigue, or a sleep study during
active duty that supported thatdiagnosis. So secondary service
connection, your sleep apneadeveloped because of another
service connected condition.
Some of the most common ones arethings like PTSD, hypertension,
(03:17):
GERD, weight gain frommedication, TBI, or traumatic
brain injury is often related tocentral sleep apnea, and we've
got a good video on that aswell. So the evidence
requirements are a little bitdifferent for primary versus
secondary service connection.And if you don't clearly
establish which one applies toyou, the VA may deny your claim.
(03:39):
So common reasons sleep apneagets denied. So let's hit the
big reasons claims for sleepapnea often get denied.
So you don't number one, youdon't have an official sleep
study. So the VA wants to seethat polysomnogram or that sleep
study report that confirms thediagnosis. That can be ordered
by your primary care doctor.They can send you to a sleep
(04:01):
lab. You can have a home sleepstudy test.
Both of these types of sleepstudies are pretty common. So
number two, there's no provenservice connection. Even if
you're diagnosed now, the VAwants to see that link or that
nexus between your service andthe sleep apnea. So simply
having sleep apnea is notenough. A lot of veterans will
come through and they'll say,you know, VA diagnosed me with
(04:23):
sleep apnea.
Why aren't they giving me arating for it? Well, VA can
diagnose a lot of things. Right?So you can be you know, there's
you're receiving veterans healthcare. Yes.
They may diagnose you with sleepapnea, but you might have
retired twenty years ago. Sojust because they diagnosed you
with it now doesn't mean thatthere's a link to your service,
and that's the thing that youneed to be able to show is how
(04:43):
how is that current medicalcondition linked to your service
or another service connectedcondition. So that leads us to
that missing or weak nexus. K?So a medical professional has to
explain how your sleep apnea isat least as likely as not caused
by your service.
Without that, you don't have alot of support. Now you can you
(05:03):
don't have to necessarily havea, nexus letter, like a big
robust nexus letter fromsomebody like me or, your
treating doctor. The C and Pexaminer is able is capable. If
you file a claim for sleepapnea, you go to your C and P
exam if if VA orders you one,and that that nurse
practitioner, PA, or doctor isgoing to provide an excess if
(05:24):
they believe there's arelationship. They're going to
state that there is aconnection.
Now it's not up to them. Right?It's up to the adjudicators, but
they give a medical opinionwhether or not they believe it
is related to your service. Nowthey may not give that opinion.
They may say it's not related toyour service, and that's that's
kind of the tricky part.
Sometimes the C and P examinerwill actually provide a negative
(05:45):
Nexus statement. They may blameyour sleep apnea on things like
obesity unrelated to yourservice. Now that is that is not
to kinda get confused withpeople that can have sleep apnea
related to weight gain as anintermediate step. And I'm not
gonna jump off on a huge tangenton that because we've got some
other videos that talk aboutthat. But if the VA is saying,
(06:06):
hey.
This person is obese, andthat's, like, the number one
cause of one of the number onecauses of sleep apnea, and
there's and and they're obesebecause of their own personal
lifestyle choices, not becauseof their service, then, you
know, that may be pretty tough.So obesity related, unrelated to
service, they'll say it's, yourage may be a risk factor. You
(06:28):
have a naturally crowded airway.So maybe you have a really big
tongue. You have you know, maybeyou've got some kind of upper
airway obstruction.
Maybe you had a septal deviationunrelated to your service. Male
gender is another big riskfactor. So when that happens,
you don't have to stop there.You can fight back with using an
VA accredited medical I'm sorry.Not medical professional.
(06:50):
A VA accredited legalprofessional, like an attorney,
a VSO, or accredited claimsagent. If you're comfortable
doing the appeals through theAppeals Modernization Act that
VA outlines on their website,you can try that. There's a lot
of options, and there are a lotof people out there that can
assist you. You can get amedical opinion. You can get a
private doctor can review yourhistory and connect those dots
(07:12):
for you if if they believethere's a, or attempt to connect
those dots from you, yourtreating doctor, or whatever.
You can get a private DBQ ordisability benefit
questionnaire, that has amedical opinion in it as well.
You can ask your doctor toreview the medical literature,
and you can include that, likestudies linking, OSA to PTSD,
(07:33):
TBI, medications, etcetera. Nowmaybe you had the symptoms in
service. You know, there was notalways sleep sleep apnea was not
super common decades ago. Somaybe you had those symptoms in
service, it went undiagnosed foryears.
And then you get some buddystatements. I see this all of
the time. You have a buddystatement from somebody who
observed you snoring in service,having apneic events where
(07:56):
you're gasping for air, you stopbreathing while you're sleeping.
Maybe it's your wife. Maybe youwere married to your your
current spouse, you know, twentyyears ago, and she can attest to
that in a in a written statementfor you.
So a negative C and P examdoesn't have to be the end of
the road. So strong credibleevidence can help support your
you overturning that in somecases. So another thing that can
(08:18):
be misunderstood is a CPAPrequirement. So the CPAP
requirement is not or abreathing device requirement is
not necessarily gonna prohibityou from getting a connection.
Right?
But that currently, so this issubject to change. Okay? So
we've already done a video, onthe new sleep apnea ratings that
has not changed yet that I'maware of, but it's been pending
(08:42):
for a while. But, currently,that 50% rating requires
documented the the need for abreathing assistance device. K?
So maybe your doctor says youdon't require it. You may
benefit from it. That may bringyou down to that 30% level. It
just depends on how theadjudicators look at that and
whether you are required to usea device. That doesn't mean you
(09:03):
have to use it.
You should use it, right, ifyou're prescribed it, but, not
wearing your device doesn'tnecessarily prohibit you from
you know, you still have thedisorder. So another thing that
can be detrimental is weaksupporting evidence. So buddy
statements and spousal testimonycan help your case in some
circumstances. If they're notincluded, especially if it's
(09:24):
that direct service connection,something like that can be
helpful in some cases. So sleepapnea is a serious condition,
especially common amongveterans, but VA claims get
denied all the time because ofthings like we mentioned,
missing evidence, missingmedical evidence, unclear
service connection, weak nexus,and misunderstanding of the
rating system, you know, whenyou look at those specific
(09:45):
ratings once you get connected.
So the good news is is theseissues are fixable. If you know
what the VA is looking for, youcan help support your claim and
improve your chances ofapproval. Again, always seeking
that advice from an accreditedlegal professional can be very
beneficial. So if you found thishelpful, make sure to hit that
like button, subscribe, andshare this with another veteran
who might be struggling withsleep apnea. Let me know in the
(10:07):
comments if you enjoyed this.
Have you had your sleep apneaclaim denied? What your reason
was? Check out some of thoseother videos we've made on sleep
apnea, and they may be helpfulas well. So until next time,
take care of yourselves, and asalways, thank you for your
service.
Hey, guys. It's Leah Bee from Prestige Veteran
Medical Consulting. I am a USarmy veteran, physician
assistant, and formercompensation and pension
examiner. So welcome back to ourchannel, and today, we're going
to dive into a big one. Why areso many VA sleep apnea claims
denied?
If you've ever filed and gottenthe dreaded denial letter, you
are not alone. In fact, this isone of the most commonly denied
(00:23):
claims out there. We've done aton of videos on sleep apnea, so
I hope you guys have enjoyedsome of those. And if you
haven't seen them yet, please gocheck them out. We've got a ton
of information on sleep apnea.
So let's just go ahead and breakdown the most common mistakes,
the evidence VA actually looksfor, and how you can support
your case. But before we getinto denials, let's start with
the basics. What is sleep apnea,and why is it so common among
(00:46):
veterans? So sleep apnea is adisorder where your breathing
repeatedly stops and startswhile you sleep. Obstructive
sleep apnea is one of the mostcommon types that I see and and
many veterans suffer from.
That is when your airwayactually collapses during your
sleep. So central sleep apnea,the brain doesn't send the right
signals to breathe. K? And thenyou can also have a mixed
(01:08):
version of this where you canhave a combination of central
sleep apnea and obstructivesleep apnea where that airway
collapses. Symptoms can includeloud snoring, choking, or
gasping during sleep, anddaytime fatigue.
And it's not just about beingtired. Untreated sleep apnea
raises your risk for things likehigh blood pressure, heart
disease, diabetes, and stroke.So sleep apnea in veterans.
(01:33):
Let's talk about veteransspecifically. So studies show
sleep apnea is far more commonamong veterans than the general
population.
A 2014 study in the Journal ofClinical Sleep Medicine found
that nearly sixty percent ofpost nine eleven veterans
screened were at high risk forsleep apnea. A VA health
(01:53):
services research anddevelopment report showed that
more than one in five veteransreceiving VA care have a sleep
apnea diagnosis, and that numberjust keeps rising. Veterans with
PTSD are significantly at ahigher risk. A 2015 study found
that seventy to ninety percentof vets with sleep apnea, I'm
(02:14):
sorry, with PTSD symptoms alsoscreen positive for sleep apnea.
Military service comes withunique risk factors, irregular
sleep schedules, exposure todust and burn pits, weight gain
from step stress andmedications, and, of course,
PTSD.
All of this makes veterans muchmore likely to develop sleep
apnea later in life. So let'stalk about primary versus
(02:36):
secondary service connection.And, again, we have a ton of
videos on primary and secondaryservice connection for sleep
apnea. Really, just a ton ofvideos on that secondary sleep
apnea and a couple on thatprimary. So this is where the
most claims can hit a roadblock.
So service connection. There aretwo main paths. Primary service
(02:57):
connection. So if your sleepapnea began in service, that can
mean documented snoring,fatigue, or a sleep study during
active duty that supported thatdiagnosis. So secondary service
connection, your sleep apneadeveloped because of another
service connected condition.
Some of the most common ones arethings like PTSD, hypertension,
(03:17):
GERD, weight gain frommedication, TBI, or traumatic
brain injury is often related tocentral sleep apnea, and we've
got a good video on that aswell. So the evidence
requirements are a little bitdifferent for primary versus
secondary service connection.And if you don't clearly
establish which one applies toyou, the VA may deny your claim.
(03:39):
So common reasons sleep apneagets denied. So let's hit the
big reasons claims for sleepapnea often get denied.
So you don't number one, youdon't have an official sleep
study. So the VA wants to seethat polysomnogram or that sleep
study report that confirms thediagnosis. That can be ordered
by your primary care doctor.They can send you to a sleep
(04:01):
lab. You can have a home sleepstudy test.
Both of these types of sleepstudies are pretty common. So
number two, there's no provenservice connection. Even if
you're diagnosed now, the VAwants to see that link or that
nexus between your service andthe sleep apnea. So simply
having sleep apnea is notenough. A lot of veterans will
come through and they'll say,you know, VA diagnosed me with
(04:23):
sleep apnea.
Why aren't they giving me arating for it? Well, VA can
diagnose a lot of things. Right?So you can be you know, there's
you're receiving veterans healthcare. Yes.
They may diagnose you with sleepapnea, but you might have
retired twenty years ago. Sojust because they diagnosed you
with it now doesn't mean thatthere's a link to your service,
and that's the thing that youneed to be able to show is how
(04:43):
how is that current medicalcondition linked to your service
or another service connectedcondition. So that leads us to
that missing or weak nexus. K?So a medical professional has to
explain how your sleep apnea isat least as likely as not caused
by your service.
Without that, you don't have alot of support. Now you can you
(05:03):
don't have to necessarily havea, nexus letter, like a big
robust nexus letter fromsomebody like me or, your
treating doctor. The C and Pexaminer is able is capable. If
you file a claim for sleepapnea, you go to your C and P
exam if if VA orders you one,and that that nurse
practitioner, PA, or doctor isgoing to provide an excess if
(05:24):
they believe there's arelationship. They're going to
state that there is aconnection.
Now it's not up to them. Right?It's up to the adjudicators, but
they give a medical opinionwhether or not they believe it
is related to your service. Nowthey may not give that opinion.
They may say it's not related toyour service, and that's that's
kind of the tricky part.
Sometimes the C and P examinerwill actually provide a negative
(05:45):
Nexus statement. They may blameyour sleep apnea on things like
obesity unrelated to yourservice. Now that is that is not
to kinda get confused withpeople that can have sleep apnea
related to weight gain as anintermediate step. And I'm not
gonna jump off on a huge tangenton that because we've got some
other videos that talk aboutthat. But if the VA is saying,
(06:06):
hey.
This person is obese, andthat's, like, the number one
cause of one of the number onecauses of sleep apnea, and
there's and and they're obesebecause of their own personal
lifestyle choices, not becauseof their service, then, you
know, that may be pretty tough.So obesity related, unrelated to
service, they'll say it's, yourage may be a risk factor. You
(06:28):
have a naturally crowded airway.So maybe you have a really big
tongue. You have you know, maybeyou've got some kind of upper
airway obstruction.
Maybe you had a septal deviationunrelated to your service. Male
gender is another big riskfactor. So when that happens,
you don't have to stop there.You can fight back with using an
VA accredited medical I'm sorry.Not medical professional.
(06:50):
A VA accredited legalprofessional, like an attorney,
a VSO, or accredited claimsagent. If you're comfortable
doing the appeals through theAppeals Modernization Act that
VA outlines on their website,you can try that. There's a lot
of options, and there are a lotof people out there that can
assist you. You can get amedical opinion. You can get a
private doctor can review yourhistory and connect those dots
(07:12):
for you if if they believethere's a, or attempt to connect
those dots from you, yourtreating doctor, or whatever.
You can get a private DBQ ordisability benefit
questionnaire, that has amedical opinion in it as well.
You can ask your doctor toreview the medical literature,
and you can include that, likestudies linking, OSA to PTSD,
(07:33):
TBI, medications, etcetera. Nowmaybe you had the symptoms in
service. You know, there was notalways sleep sleep apnea was not
super common decades ago. Somaybe you had those symptoms in
service, it went undiagnosed foryears.
And then you get some buddystatements. I see this all of
the time. You have a buddystatement from somebody who
observed you snoring in service,having apneic events where
(07:56):
you're gasping for air, you stopbreathing while you're sleeping.
Maybe it's your wife. Maybe youwere married to your your
current spouse, you know, twentyyears ago, and she can attest to
that in a in a written statementfor you.
So a negative C and P examdoesn't have to be the end of
the road. So strong credibleevidence can help support your
you overturning that in somecases. So another thing that can
(08:18):
be misunderstood is a CPAPrequirement. So the CPAP
requirement is not or abreathing device requirement is
not necessarily gonna prohibityou from getting a connection.
Right?
But that currently, so this issubject to change. Okay? So
we've already done a video, onthe new sleep apnea ratings that
has not changed yet that I'maware of, but it's been pending
(08:42):
for a while. But, currently,that 50% rating requires
documented the the need for abreathing assistance device. K?
So maybe your doctor says youdon't require it. You may
benefit from it. That may bringyou down to that 30% level. It
just depends on how theadjudicators look at that and
whether you are required to usea device. That doesn't mean you
(09:03):
have to use it.
You should use it, right, ifyou're prescribed it, but, not
wearing your device doesn'tnecessarily prohibit you from
you know, you still have thedisorder. So another thing that
can be detrimental is weaksupporting evidence. So buddy
statements and spousal testimonycan help your case in some
circumstances. If they're notincluded, especially if it's
(09:24):
that direct service connection,something like that can be
helpful in some cases. So sleepapnea is a serious condition,
especially common amongveterans, but VA claims get
denied all the time because ofthings like we mentioned,
missing evidence, missingmedical evidence, unclear
service connection, weak nexus,and misunderstanding of the
rating system, you know, whenyou look at those specific
(09:45):
ratings once you get connected.
So the good news is is theseissues are fixable. If you know
what the VA is looking for, youcan help support your claim and
improve your chances ofapproval. Again, always seeking
that advice from an accreditedlegal professional can be very
beneficial. So if you found thishelpful, make sure to hit that
like button, subscribe, andshare this with another veteran
who might be struggling withsleep apnea. Let me know in the
(10:07):
comments if you enjoyed this.
Have you had your sleep apneaclaim denied? What your reason
was? Check out some of thoseother videos we've made on sleep
apnea, and they may be helpfulas well. So until next time,
take care of yourselves, and asalways, thank you for your
service.
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