If you’ve filed a VA disability claim for sleep apnea secondary to PTSD, there’s a strong chance the Department of Veterans Affairs will schedule you for a Compensation & Pension (C&P) exam. For many veterans, this exam becomes the make-or-break moment in the claim process.
Sleep apnea and PTSD frequently coexist in veterans, particularly those exposed to combat stress, traumatic events, or long-term hyperarousal. However, while medical research shows a meaningful association between the two conditions, proving secondary service connection can be challenging without the right preparation.
According to Brian Reese, “Most sleep apnea secondary to PTSD claims fail not because the link is impossible, but because veterans don’t clearly explain how PTSD caused or worsened the condition.”
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This guide walks you through what to expect at your C&P exam, how VA examiners evaluate sleep apnea secondary to PTSD, and how to prepare so your claim has the strongest possible foundation.
What Is the Connection Between PTSD and Sleep Apnea?
Medical research increasingly supports a significant association between PTSD and sleep apnea, especially among military veterans.
Key Medical Findings
- Higher prevalence in veterans: Veterans with PTSD are diagnosed with sleep apnea at significantly higher rates than the general population.
- Neurobiological overlap: PTSD alters stress hormones and nervous system activity, which can disrupt breathing patterns during sleep.
- Shared risk factors: Obesity, smoking, aging, and chronic stress are common to both conditions.
- Symptom amplification: Untreated sleep apnea can worsen PTSD symptoms like nightmares, hypervigilance, and daytime irritability.
- Treatment interaction: CPAP treatment for sleep apnea has been shown to improve PTSD symptom severity in some veterans.
“When sleep apnea fragments sleep, PTSD symptoms intensify. It becomes a cycle that feeds itself,” explains Reese.
What the VA Must Prove for Secondary Service Connection?
To grant sleep apnea secondary to PTSD, the VA must establish three elements:
- A current diagnosis of sleep apnea confirmed by a sleep study
- A service-connected PTSD rating
- Medical evidence showing sleep apnea is caused or aggravated by PTSD
VA Requirements
| Requirement | What the VA Looks For |
|---|---|
| Sleep apnea diagnosis | Polysomnography sleep study |
| PTSD service connection | Existing VA PTSD rating |
| Medical nexus | Opinion linking PTSD to sleep apnea |
| Functional impact | Daytime fatigue, work impairment |
| Consistency | Records match reported symptoms |
What to Expect at Your C&P Exam for Sleep Apnea Secondary to PTSD?
The purpose of this exam is to determine causation or aggravation, not just diagnosis.
Types of Exams You May Receive
- In-person exam
- Telehealth exam
- ACE exam (records-only review)
Pro Tip: Many secondary claims are decided via ACE exams, meaning you may not be contacted at all.
What the Examiner Reviews?
- PTSD treatment history and symptom severity
- Sleep apnea diagnosis and sleep study results
- CPAP prescription and compliance (if applicable)
- Overlap of PTSD symptoms and sleep disturbances
- Submitted Nexus Letters or Independent Medical Opinions
Common Areas the Examiner Will Evaluate
Medical History Review
The examiner analyzes how long you’ve had PTSD, how severe it is, and when sleep apnea symptoms began.
Symptom Overlap
Expect questions about:
- Nightmares and insomnia
- Daytime sleepiness
- Snoring and breathing pauses
- Morning headaches
- Hyperarousal and fragmented sleep
Functional Impairment
The VA wants to know how both conditions affect:
- Work performance
- Concentration and memory
- Relationships
- Daily functioning
Medical Opinion
The examiner must answer one key question:
Is it at least as likely as not (50% or greater probability) that PTSD caused or aggravated sleep apnea?
Common Questions Asked During the Exam
Medical History
- When were you diagnosed with PTSD?
- When did sleep apnea symptoms begin?
- Did sleep issues start after PTSD symptoms worsened?
Symptom Details
- How often do nightmares interrupt sleep?
- Do you experience gasping or choking at night?
- How severe is daytime fatigue?
Treatment History
- Are you prescribed a CPAP?
- Are PTSD symptoms controlled with treatment?
- Has CPAP therapy helped PTSD symptoms?
Daily Impact
- Has poor sleep affected your ability to work?
- Do symptoms limit social activities?
- Has your quality of life declined?
“Consistency is critical. If your answers don’t match your records, the VA will side with the paperwork,” Reese warns.
How to Prepare for Your C&P Exam?
1. Gather Medical Evidence
Include:
- Sleep study results
- PTSD treatment records
- CPAP prescriptions and compliance reports
- Nexus Letter (if available)
2. Document Symptom History
Write down:
- When symptoms started
- How PTSD affects sleep
- How sleep apnea worsens PTSD
3. Review DBQs
Familiarize yourself with:
- PTSD DBQ
- Sleep Apnea DBQ
4. Practice Clear Explanations
Avoid vague answers. Focus on:
- Cause-and-effect timelines
- Functional limitations
- Aggravation, not just existence
5. Be Honest
Do not exaggerate or minimize symptoms. Accuracy builds credibility.
Why These Claims Are Often Denied?
| Common Denial Reason | How to Avoid It |
|---|---|
| No medical nexus | Submit expert opinion |
| Obesity blamed instead | Show PTSD contribution |
| Inconsistent records | Review file beforehand |
| No aggravation explained | Describe symptom worsening |
| ACE exam denial | Submit strong written evidence |
Why This Exam Matters?
A successful secondary service connection can lead to:
- 30%, 50%, or even 100% sleep apnea ratings
- Higher combined VA disability rating
- Eligibility for TDIU
- Increased monthly compensation
“Winning sleep apnea secondary to PTSD isn’t about luck. It’s about preparation,” says Reese.
Final Thought
A C&P exam for sleep apnea secondary to PTSD can feel intimidating, but preparation puts you back in control. Understanding what examiners evaluate, documenting symptom progression, and clearly explaining how PTSD contributed to or worsened sleep apnea can dramatically improve your odds.
Remember: the VA doesn’t require certainty only that the connection is at least as likely as not. With solid evidence and clear communication, many veterans succeed.
FAQs
Is sleep apnea automatically secondary to PTSD?
No. You must prove causation or aggravation with medical evidence.
Do I need a sleep study?
Yes. A confirmed diagnosis via sleep study is required.
What if I get an ACE exam?
Ensure your records and nexus letters are strong, since no interview may occur.
Can CPAP use strengthen my claim?
Yes, especially if prescribed and documented.
Can this qualify me for TDIU?
Yes, if combined symptoms prevent substantially gainful employment.
