Sleep apnea is a serious and often life-altering condition that disrupts breathing during sleep, leading to chronic fatigue, cardiovascular strain, and cognitive problems. For many veterans, sleep apnea does not exist in isolation it develops alongside or worsens due to mental health conditions like depression and anxiety.
Because depression and anxiety are among the most commonly service-connected mental health conditions for veterans, an important question arises: can sleep apnea be granted VA disability benefits as a secondary condition to depression or anxiety?
The answer is yes under the right circumstances.
In this 2026 guide, we break down the medical connection, explain how the VA evaluates secondary service connection, outline the evidence you need, and review the VA rating criteria for sleep apnea secondary to depression and anxiety.
Understanding Secondary VA Disability Claims
The Department of Veterans Affairs allows veterans to receive compensation for disabilities that are caused or aggravated by an already service-connected condition.
In a secondary claim:
- The primary condition is already service-connected (depression, anxiety, or both)
- The secondary condition develops because of or is worsened by the primary condition (sleep apnea)
“Secondary claims are not about when the condition started they’re about causation or aggravation,” explains a VA-accredited disability consultant.
Is There a Medical Connection Between Depression, Anxiety, and Sleep Apnea?
Yes. Medical research and clinical practice increasingly recognize a bidirectional relationship between mental health disorders and sleep-disordered breathing.
Veterans with depression and anxiety experience physiological, neurological, and behavioral changes that can cause or worsen sleep apnea, especially obstructive sleep apnea (OSA).
Brian Reese explains:
“Sleep apnea secondary to mental health conditions is one of the most misunderstood VA claims but the medical link is very real when properly documented.”
How Depression and Anxiety Can Cause or Aggravate Sleep Apnea?
Below are the primary mechanisms the VA and medical professionals consider when evaluating secondary service connection.
1. Disruption of Sleep Architecture
Anxiety causes hyperarousal, preventing full relaxation of the airway muscles during sleep. Depression disrupts REM and non-REM sleep cycles, increasing nighttime awakenings and shallow sleep conditions that raise the risk of airway collapse.
2. Impact on Respiratory Control
Chronic stress alters central nervous system regulation, including the brain centers responsible for breathing. This can contribute to both obstructive sleep apnea (OSA) and central sleep apnea (CSA).
3. Weight Gain and Physical Risk Factors
Depression and anxiety are frequently associated with:
- Reduced physical activity
- Emotional eating
- Metabolic changes
Weight gain especially around the neck and torso is a major risk factor for obstructive sleep apnea.
4. Medication Side Effects
Common medications for depression and anxiety (such as sedatives or certain antidepressants) can:
- Relax upper airway muscles
- Suppress respiratory drive
- Worsen apnea severity
5. Inflammatory Response
Mental health disorders are linked to systemic inflammation, which can cause swelling in upper airway tissues and worsen obstruction during sleep.
6. The Vicious Cycle Effect
Sleep apnea worsens depression and anxiety by depriving the brain of restorative sleep, creating a self-reinforcing loop where each condition aggravates the other.
Evidence Requirements for VA Secondary Service Connection
To grant sleep apnea as secondary to depression or anxiety, the VA and C&P examiner focus on specific questions.
Key Evidence the VA Will Review
- Confirmed diagnosis of sleep apnea via sleep study
- Type of sleep apnea (obstructive, central, or mixed)
- Service-connected depression and/or anxiety (rated at 0% or higher)
- Medical opinion explaining causation or aggravation
- Current symptoms and treatment, including CPAP use
“Without a medical opinion clearly linking the conditions, most secondary sleep apnea claims fail,” notes a VA claims examiner.
How to Establish Secondary Service Connection?
To win a VA claim for sleep apnea secondary to depression or anxiety, you must submit two essential forms of evidence.
1. Current Diagnosis of Sleep Apnea
- Must be documented by a qualified provider
- Requires a sleep study
- Must identify the type and severity of apnea
2. Medical Nexus Evidence
This is the most critical element.
A nexus letter explains that your sleep apnea is:
- “At least as likely as not” caused by or
- Permanently aggravated by your service-connected depression and/or anxiety
Why a Nexus Letter Is So Important?
While not legally required, a nexus letter often makes or breaks a secondary sleep apnea claim.
What a Strong Nexus Letter Includes?
- Review of medical history
- Discussion of mental health symptoms
- Explanation of physiological connection
- Clear causation or aggravation language
Pro Tip: Submitting a completed Sleep Apnea DBQ from a private provider along with your nexus letter and a Fully Developed Claim (FDC) can significantly strengthen your case.
VA Rating Criteria for Sleep Apnea Secondary to Depression and Anxiety
Sleep apnea is rated under Diagnostic Code (DC) 6847.
VA Disability Ratings for Sleep Apnea
| Severity & Treatment | VA Rating |
|---|---|
| Requires assisted ventilation or severe complications | 100% |
| Requires CPAP or breathing assistance | 50% |
| Persistent daytime hypersomnolence | 30% |
| Diagnosed but asymptomatic | 0% |
Understanding Each VA Rating Level
100% VA Rating
Granted when sleep apnea causes severe systemic impact or requires assisted ventilation beyond standard CPAP.
50% VA Rating (Most Common)
Assigned when sleep apnea requires the use of a CPAP or similar breathing device.
30% VA Rating
Applies when sleep apnea causes chronic daytime sleepiness but does not require a CPAP.
0% VA Rating
Sleep apnea is diagnosed but does not significantly impair functioning or require treatment.
Why Secondary Sleep Apnea Claims Matter?
A successful secondary claim can:
- Increase your combined VA rating
- Raise monthly compensation
- Strengthen eligibility for other benefits
“Secondary conditions are often the key to moving from a moderate rating to a life-changing one,” says a veteran service advisor.
Common Mistakes Veterans Make
- Filing without a sleep study
- Assuming the VA will “connect the dots”
- Not submitting a nexus letter
- Minimizing symptoms during exams
Final Thought
Sleep apnea secondary to depression and anxiety is a legitimate and medically supported VA disability claim. When properly documented with a sleep study, nexus letter, and clear medical reasoning, veterans may qualify for substantial additional compensation.
Understanding the connection and presenting it correctly can make the difference between denial and approval.
FAQs
Can depression or anxiety really cause sleep apnea?
Yes. Medical evidence supports both causation and aggravation pathways.
Does sleep apnea have to start after depression?
No. It can be aggravated by depression or anxiety.
Is a nexus letter required?
Not legally but practically, it’s essential.
What rating is most common for sleep apnea?
50%, when CPAP use is required.
Can I file sleep apnea as secondary to both depression and anxiety?
Yes, if both are service-connected.
Can untreated sleep apnea worsen mental health ratings?
Yes. The conditions often compound each other.
