Heart disease secondary to sleep apnea

In the Board decisions we have indexed since 2019, heart disease appeared as secondary to sleep apnea in 67 issues. The Board granted 18, denied 8, and sent 38 back for more work. Of the ones it decided, it granted 69 percent.

Every decision counted here is an appeal. The regional office decided the claim first, the veteran disagreed, and the Board is the next step after that. These are not the odds on a first claim.

Since 2019

2 were reopened for a fresh look, which is not a grant and is not counted as one. 1 were dismissed or withdrawn.

Across every year we have indexed, that is 115 issues, 70 percent granted of the ones decided, and 57 percent sent back for more work.

What a secondary claim needs

In a secondary claim, the Board reads for three things. A diagnosis of the second condition. A first condition that is already service connected. And a medical opinion that says the first condition led to the second, or made it worse, and explains why. The rule itself is shorter than that. Here is the part that matters.

… disability which is proximately due to or the result of a service-connected disease or injury shall be service connected.

38 CFR 3.310(a), from the middle of its first sentence

Proximately due to means the first condition led to the second. The other route is aggravation, where the first condition made the second worse. The rule for that route is in the next paragraph of the same section, and it says increase in severity.

Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected.

38 CFR 3.310(b), first sentence

That paragraph goes on to say the VA will not concede aggravation without a baseline. A baseline is medical evidence of how bad the second condition was before the first one started making it worse, or the earliest record after that and before the evidence of how bad it is now. If you claim aggravation, find the earliest record you have of the second condition, from either window. Without a baseline from one of them, the VA will not concede aggravation. The other route, that the first condition led to the second, does not need a baseline.

A remand is not a yes or a no. The Board sends the claim back to the regional office for more work, such as a new exam or a record that was not in the file. The claim is decided again later, and that later decision is a separate document.

Recent decisions on these claims

• August 26, 2025Granted

  Entitlement to service connection for valvular heart disease, to include as secondary to service-connected sarcoidosis and obstructive sleep apnea (OSA)

  Read the decision at VA.gov
• August 14, 2025Denied

  Entitlement to service connection for a heart disability, to include hypertensive heart disease and tachycardia, to include as secondary to service-connected obstructive sleep apnea

  Read the decision at VA.gov
• April 18, 2024Granted

  Entitlement to service connection for coronary artery disease (CAD), to include as secondary to posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA)

  Read the decision at VA.gov
• November 8, 2023Granted

  Entitlement to service connection for a heart disability, claimed as arrhythmias, as secondary to obstructive sleep apnea

  Read the decision at VA.gov
• March 1, 2023Denied

  Entitlement to service connection for coronary artery disease (CAD), to include as secondary to posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA)

  Read the decision at VA.gov