Sleep apnea is far more than loud snoring or restless nights. For many veterans, it is a serious medical condition that disrupts oxygen flow, strains the cardiovascular system, and interferes with the body’s ability to regulate critical metabolic processes.
One of the most important and often overlooked connections is between sleep apnea and diabetes, particularly type 2 diabetes. Emerging medical evidence shows that untreated or poorly controlled sleep apnea can cause, worsen, or aggravate diabetes, opening the door for secondary VA disability compensation.
In this 2026 guide, VA disability expert Brian Reese explains how sleep apnea and diabetes are linked, what evidence the VA looks for, how to establish secondary service connection, and how the VA rates diabetes when it is secondary to sleep apnea.
Understanding Secondary VA Disability Claims
The Department of Veterans Affairs allows veterans to receive compensation for conditions that are proximately due to or aggravated by an already service-connected disability.
In a secondary claim:
- Primary condition: Sleep apnea (already service-connected at 0% or higher)
- Secondary condition: Diabetes mellitus (type 1 or type 2)
The key issue is not when diabetes began, but whether sleep apnea caused or permanently worsened it.
“Secondary service connection is about medical cause and effect,” explains a VA-accredited disability consultant.
“If sleep apnea makes diabetes worse, that connection matters.”
Can Sleep Apnea Cause or Aggravate Diabetes?
Yes. Medical research strongly supports a link especially between obstructive sleep apnea (OSA) and type 2 diabetes.
Sleep apnea affects oxygen levels, hormone balance, and inflammation, all of which play major roles in blood sugar regulation.
Brian Reese explains:
“When sleep apnea is untreated, it puts the body into a chronic stress state. That environment is ideal for insulin resistance and poor glucose control.”
How Sleep Apnea Contributes to Diabetes?
Here are the primary medical mechanisms the VA and medical professionals consider.
1. Disrupted Sleep and Glucose Regulation
Sleep apnea causes repeated breathing pauses, known as apneas, which reduce oxygen levels and fragment sleep. This intermittent hypoxia interferes with insulin sensitivity, making it harder for the body to control blood sugar.
Poor-quality sleep alone is a known risk factor for diabetes.
2. Elevated Stress Hormones (Cortisol)
Chronic sleep disruption leads to increased cortisol production. Cortisol is a stress hormone that:
- Raises blood sugar
- Promotes insulin resistance
- Interferes with glucose metabolism
Persistently high cortisol levels significantly increase diabetes risk.
3. Systemic Inflammation
Sleep apnea triggers widespread inflammation throughout the body. Inflammation:
- Damages blood vessels
- Impairs insulin signaling
- Worsens metabolic dysfunction
This creates a feedback loop where sleep apnea and diabetes continuously aggravate each other.
4. Aggravation of Pre-Existing Diabetes
For veterans who already have diabetes, service-connected sleep apnea can:
- Worsen blood sugar control
- Increase insulin resistance
- Contribute to complications like neuropathy or fatigue
This aggravation alone can qualify for secondary VA service connection.
“Aggravation is just as valid as causation under VA law,” notes a veterans’ law expert.
Evidence Requirements for Secondary Service Connection
When reviewing a claim for diabetes secondary to sleep apnea, the VA and C&P examiner focus on specific questions.
Key Questions the VA Will Evaluate
- Do you have a confirmed diagnosis of diabetes mellitus (type 1 or type 2)?
- Do you have service-connected sleep apnea rated at 0% or higher?
- Is diabetes at least as likely as not caused or aggravated by sleep apnea?
- Are diabetes symptoms worsened by untreated or poorly controlled sleep apnea?
- Does sleep apnea treatment (such as CPAP use) impact diabetes management?
“The VA wants to see a clear medical narrative,” says a VA examiner familiar with secondary claims.
How to Establish Secondary Service Connection?
To win a VA claim for diabetes secondary to sleep apnea, veterans must submit two critical forms of evidence.
1. Current Diagnosis of Diabetes
You must have a documented diagnosis in your medical records, including:
- Date of diagnosis
- Lab results (A1C, glucose levels)
- Current treatment (insulin, medication, diet)
2. Medical Nexus Evidence
This is the most important part of the claim.
A nexus letter explains how your service-connected sleep apnea:
- Caused diabetes or
- Permanently worsened diabetes beyond natural progression
The letter should use VA-standard language such as “at least as likely as not.”
Pro Tip: A strong nexus letter often determines whether a secondary diabetes claim is approved or denied.
Why a Nexus Letter Matters?
Although not legally required, a nexus letter significantly strengthens your claim.
What a Strong Nexus Letter Includes?
- Review of sleep apnea diagnosis and severity
- Explanation of metabolic effects of sleep apnea
- Discussion of insulin resistance and inflammation
- Clear medical reasoning linking both conditions
“The nexus letter connects the science to the law,” explains a veteran disability consultant.
VA Disability Ratings for Diabetes Secondary to Sleep Apnea
The VA rates diabetes under Diagnostic Code (DC) 7913.
VA Rating Overview for Diabetes (DC 7913)
| Diabetes Severity & Treatment | VA Rating |
|---|---|
| Restricted diet only | 10% |
| Insulin or oral medication + restricted diet | 20% |
| Insulin + diet + regulation of activities | 40% |
| Insulin + complications + hospitalizations | 60% |
| Severe complications, frequent hospitalizations | 100% |
Understanding Each VA Rating Level
100% VA Rating
Requires multiple daily insulin injections, restricted diet, activity regulation, frequent hospitalizations, and severe complications.
60% VA Rating
Assigned when diabetes requires insulin, diet control, activity restriction, and causes hospitalizations or frequent medical visits.
40% VA Rating
Granted when insulin, restricted diet, and regulated activities are all medically required.
20% VA Rating
Most common rating, requiring insulin or oral medication with dietary restrictions.
10% VA Rating
Diabetes managed by restricted diet alone.
Why Secondary Diabetes Claims Matter?
A successful secondary claim for diabetes can:
- Increase your combined VA rating
- Significantly raise monthly compensation
- Support future secondary claims (neuropathy, kidney disease, vision loss)
“Diabetes often becomes a gateway condition to additional VA benefits,” says a veteran service advisor.
Common Mistakes Veterans Make
- Filing without a nexus letter
- Not documenting aggravation
- Assuming the VA will infer causation
- Downplaying symptoms during exams
Final Thought
Diabetes secondary to sleep apnea is a legitimate and medically supported VA disability claim. When supported by a diagnosis, sleep study, and strong nexus evidence, veterans may qualify for meaningful additional compensation.
Understanding the connection and proving it correctly can make a life-changing difference.
FAQs
Can sleep apnea really cause diabetes?
Yes. Medical research supports a strong link, especially with obstructive sleep apnea.
Does diabetes need to start after sleep apnea?
No. Diabetes can be service-connected if sleep apnea aggravates it.
Is a nexus letter required?
Not required by law, but practically essential.
Can CPAP treatment improve diabetes?
Yes. Improved oxygenation can help stabilize blood sugar control.
Can diabetes lead to additional VA ratings?
Yes. Complications may qualify for separate ratings.
