Sleep apnea: 0%, 30%, 50%, or 100%, and what decides it.

The four levels

• 100%: chronic respiratory failure with carbon dioxide retention or cor pulmonale, or the condition requires a tracheostomy.
• 50%: requires use of a breathing assistance device such as a continuous airway pressure (CPAP) machine.
• 30%: persistent daytime hypersomnolence (falling asleep or fighting sleep during the day).
• 0%: asymptomatic but with documented sleep-disordered breathing.

That is the schedule in force as of September 2026. The VA has proposed changing how it rates sleep apnea, so check the current criteria when you file.

What the evidence has to show

1. A sleep study. The VA wants sleep apnea confirmed by a sleep study, in a lab or at home. A doctor's note saying "probable sleep apnea" is not a diagnosis for rating purposes.
2. The prescription. For the 50% level, a record that a doctor prescribed the CPAP or similar device. Whether you use it every night matters less than the fact that it was prescribed as medically necessary.
3. The connection to service. This is the hard part. See below.

Connecting it to service

Sleep apnea rarely shows up in service records, because most veterans are not diagnosed until years later. There are three usual paths:

• Direct: symptoms in service (snoring, gasping, daytime sleepiness noted in records or by people who bunked with you) with a diagnosis afterward and a medical opinion linking them.
• Secondary: the most common successful path. Sleep apnea caused or aggravated by a service-connected condition, most often PTSD, depression, or anxiety (and their medications), sometimes sinus or nasal conditions, sometimes weight gain tied to a service-connected orthopedic condition. Needs a medical opinion.
• Presumptive: sleep apnea is not on the PACT Act list. It is not presumed for any group of veterans.

How we help

We check your file for the sleep study and the prescription, and we look at which of your service-connected conditions could support a secondary link. If a medical opinion is needed we tell you exactly what it would have to address.