Sleep Apnea Secondary to Tinnitus

If your tinnitus is service connected and a sleep study has diagnosed sleep apnea, you can claim the sleep apnea as secondary to the tinnitus. It is one of the conditions veterans most often claim secondary to tinnitus at the Board, and the Board has granted it. It is also a claim built on thin medical ground. Tinnitus is a hearing condition, sleep apnea is a breathing disorder, and the research linking them mostly runs from apnea toward tinnitus. If your real problem is that the ringing keeps you awake, read insomnia secondary to tinnitus too, because it may fit your facts better.

Can tinnitus cause sleep apnea?

No study shows that tinnitus causes or worsens sleep apnea. The studies that link the two find them together, and when they suggest a direction, it points from apnea toward tinnitus.

• A 2024 meta-analysis of eight case-control and cross-sectional studies covering 132,292 adults (Gao and colleagues, Ear, Nose & Throat Journal) found that sleep apnea went with more tinnitus (odds ratio 1.65). The link was significant for severe sleep apnea but not for mild or moderate apnea.
• A 2025 analysis of U.S. national survey data on 4,871 people (Wang and colleagues, Sleep and Breathing) found an association between tinnitus and a questionnaire-based estimate of sleep apnea (odds ratio 1.43). No sleep studies confirmed the apnea, and the authors concluded that sleep apnea is a risk factor for tinnitus.
• A 2025 Korean national study (Lee and colleagues, Journal of Clinical Medicine) found more tinnitus among people at high risk for sleep apnea, but the difference disappeared once the groups were matched on factors that cause tinnitus. The authors concluded that tinnitus is affected not by sleep apnea itself but by the hearing loss that accompanies it.

Tinnitus does disturb sleep. A 2022 meta-analysis of 3,041 tinnitus patients (Gu and colleagues, European Archives of Oto-Rhino-Laryngology) put the pooled rate of sleep impairment at 53.5%. But poor sleep is not the same problem as obstructive sleep apnea, which the National Heart, Lung, and Blood Institute describes as conditions that block airflow through the upper airway during sleep. In a small 2025 study of 51 sleep apnea patients with similar hearing (Choi and colleagues, Brazilian Journal of Otorhinolaryngology), tinnitus was tied more closely to how patients rated their sleep than to their sleep study measurements.

One theory sometimes offered is that sleep medicine taken because of tinnitus made the apnea worse. In the Choi study, 44.4% of the obstructive apnea patients with tinnitus used medicine that might affect sleep, against 16.7% of those without tinnitus. But a 2024 meta-analysis of randomized trials (Messineo and colleagues, American Journal of Respiratory and Critical Care Medicine) found that common sleep medicines did not change sleep apnea severity. An opinion that relies on that theory needs evidence from your own records. A doctor can still conclude that the link is at least as likely as not in your case, but the opinion has to explain a mechanism in your records rather than cite a general association.

How VA decides sleep apnea secondary to tinnitus

Secondary service connection is in 38 CFR § 3.310. VA grants it in two ways:

• Caused by. Your service-connected tinnitus caused the sleep apnea, at least as likely as not.
• Aggravated by. Your sleep apnea is aggravated by your service-connected tinnitus, meaning it would be less severe but for the tinnitus (M21-1 V.ii.2.D). VA rates only the part above the baseline, so the opinion should describe the baseline.

For this pair, causation is the harder theory, because tinnitus does not change the airway. Aggravation is often the question that decides the claim. The file needs three things: a sleep apnea diagnosis confirmed by a sleep study, service-connected tinnitus, and a medical opinion that links the two with reasoning.

The Board case citation most veterans look for

The Board granted sleep apnea secondary to tinnitus in citation A23033748 (November 29, 2023). The veteran's tinnitus had been service connected since 2000, and a 2010 sleep study showed severe obstructive sleep apnea. A March 2021 VA examiner wrote that constant tinnitus could impair sleep and cause daytime sleepiness, but that "tinnitus does not cause anatomical changes in the larynx to cause apnea." The examiner did not address aggravation, and the Board gave the opinion low probative value for that reason. A private physician, relying on the records, medical literature and the veteran's statements, concluded that the apnea was more likely than not caused by or aggravated by the tinnitus. The Board gave that opinion great probative weight and granted the claim.

Two cautions keep this decision in proportion. The private opinion's literature, as the Board summarized it, was mostly about how often tinnitus patients report sleep problems, which does not show that tinnitus blocks the airway. And the grant turned on the VA examiner's failure to answer aggravation. A VA opinion that answers both questions with reasons is harder to outweigh. The decision involved tinnitus alone, not hearing loss, and Board decisions are not precedential.

If you also have service-connected hearing loss, note what the Korean study found: hearing loss goes along with sleep apnea and appears to explain the tinnitus link. That does not show hearing loss causes apnea, so an opinion naming hearing loss as a cause needs its own reasoning.

VA rating for sleep apnea secondary to tinnitus

Sleep apnea secondary to tinnitus is rated the same way as any sleep apnea, under Diagnostic Code 6847 in 38 CFR § 4.97:

• 100%: chronic respiratory failure with carbon dioxide retention or cor pulmonale, or a tracheostomy
• 50%: requires a breathing assistance device such as a CPAP machine
• 30%: persistent daytime hypersomnolence
• 0%: no symptoms, but a sleep study documents the disorder

Most veterans with a CPAP prescription land at 50%. The sleep apnea VA rating page covers what "requires" a CPAP means and where VA's proposed changes to these criteria stand.

VA rates the sleep apnea separately from the tinnitus, which carries a single 10 percent rating under Diagnostic Code 6260. The two combine under 38 CFR § 4.25. A 50 percent sleep apnea rating and the 10 percent tinnitus rating combine to 55, which VA rounds up to 60 percent. A 30 percent sleep apnea rating and the 10 percent tinnitus rating combine to 37, which rounds to 40 percent.

The C&P exam for sleep apnea secondary to tinnitus

VA usually orders an exam or a medical opinion for this claim. The examiner is asked whether your sleep apnea is at least as likely as not caused by your tinnitus and, separately, whether the tinnitus aggravated it. Both questions matter. An opinion that answers only the first one is inadequate under El-Amin v. Shinseki (2013), and the 2023 Board grant turned on exactly that gap.

What the examiner looks at:

• Your sleep study: whether the apnea is obstructive, central or mixed, how severe it is, and when it was diagnosed
• When your tinnitus started and was service connected, compared with the apnea timeline
• Other risk factors the National Heart, Lung, and Blood Institute lists, such as age, obesity, large tonsils, neck or tongue, alcohol and smoking
• Medicines you take for sleep, and whether your CPAP is required

Unfavorable VA opinions on this claim usually say that tinnitus does not change the airway and stop there, without addressing aggravation. Others credit weight or age without explaining why those factors account for the whole picture. The C&P exam prep tool can help you prepare, and the Board section below shows how the Board ruled on these appeals.

Why sleep apnea secondary to tinnitus claims get denied

The usual reasons:

• The only medical opinion is a negative VA opinion, and nothing in the file answers it.
• A private opinion relies on the fact that tinnitus disturbs sleep, without explaining how that affects the airway or the apnea.
• No opinion addresses aggravation or describes the baseline before the worsening.
• The sleep study is missing, or the record does not say what type of apnea you have.
• Weight, age and other risk factors in the file go unaddressed.

The Board section below breaks down the evidence that decided the grants and the denials.

Nexus letter for sleep apnea secondary to tinnitus

A strong nexus letter for this claim does six things:

1. States that the doctor reviewed your records, including the full sleep study report, hearing tests and tinnitus history.
2. Names the type and severity of sleep apnea from the sleep study.
3. Gives an opinion on causation, with a mechanism drawn from your records rather than a general association.
4. Gives a separate opinion on aggravation: your sleep apnea is aggravated by your service-connected tinnitus, meaning it would be less severe but for the tinnitus, and describes the baseline from earlier sleep studies or CPAP records.
5. Cites the research honestly, including the studies that point from apnea toward tinnitus.
6. Deals with your other risk factors directly and explains why they do not account for the whole picture.

What the opinion language looks like

People search for a sample nexus letter for this claim. No template wins it, and a letter with no reasons tied to your records adds little. What VA looks for is a set of statements like these, each backed by reasons:

• "I reviewed [records and dates], including the [date] sleep study showing [type and severity]."
• "It is at least as likely as not that the veteran's sleep apnea was caused by the veteran's service-connected tinnitus, because [mechanism in this veteran's records]."
• "The veteran's sleep apnea is aggravated by the veteran's service-connected tinnitus, meaning it would be less severe but for the tinnitus. The baseline before the aggravation was [level, from records dated ...]."
• "I considered [weight, age, alcohol, medicines] and [why they do or do not explain the condition]."

A doctor has to decide whether those statements are true for you. Before you pay for a letter, ask the clinician:

• Does my sleep study show obstructive apnea, central apnea, both, or something else?
• Is there a medically supported path from my tinnitus to my apnea, based on findings in my record rather than disturbed sleep alone?
• If the apnea came first, would it be less severe today but for the tinnitus, and what earlier evidence shows its baseline?
• Would a missing study or record change your conclusion?

A clinician may conclude the link is not supportable, and that answer is worth having early. The Raven Nexus tool shows what your records, such as your sleep study, already contain and what is still missing.

Where these opinions break down at the Board is predictable: no rationale, a conclusion with no reasoning behind it, an incomplete review of the records, or reliance on sleep complaints alone.

DBQ for sleep apnea secondary to tinnitus

VA's Sleep Apnea Disability Benefits Questionnaire, in the version on VA's public DBQ page (updated July 19, 2024), records the facts that set the rating. It notes that the diagnosis "must be confirmed by a sleep study," and it asks for:

• the type of sleep apnea (obstructive, central or mixed) and the date of diagnosis
• the history, including onset and course, and any continuous medication
• whether you require a breathing assistance device such as a CPAP machine
• findings such as persistent daytime hypersomnolence
• the sleep study date, facility and results
• whether the sleep apnea affects your ability to work

The DBQ does not ask whether tinnitus caused or aggravated the apnea. That goes in a separate medical opinion. In the 2023 Board case, the VA examiner recorded the opinion on a medical opinion DBQ, and it failed because it skipped aggravation.

Questions veterans ask about sleep apnea secondary to tinnitus

Can I claim sleep apnea secondary to tinnitus?

Yes, if your tinnitus is service connected and a sleep study has diagnosed sleep apnea. You also need a medical opinion that explains how the tinnitus caused or worsened the apnea, and that is the hard part.

Is sleep apnea secondary to tinnitus?

Not as a general medical rule. The research shows the two often occur together, but it suggests the apnea or the hearing loss that comes with it drives the tinnitus, so the link has to be shown in your own records.

Can tinnitus be secondary to sleep apnea?

If your sleep apnea is service connected, tinnitus can be claimed secondary to it under the same rule, 38 CFR § 3.310. The research leans that way: a 2025 U.S. study concluded that sleep apnea is a risk factor for tinnitus, though a Korean study tied the link to hearing loss.

What is the VA case citation for sleep apnea secondary to tinnitus?

Board citation A23033748 (November 29, 2023) granted it because the VA examiner did not address aggravation and a private opinion did. It involved tinnitus, not hearing loss, and it binds only that appeal.

What is the VA rating for sleep apnea secondary to tinnitus?

The same as any sleep apnea under Diagnostic Code 6847: 0, 30, 50 or 100 percent, with 50 percent when you require a CPAP. It combines with your 10 percent tinnitus rating.

Sources

• 38 CFR § 3.310, secondary service connection; M21-1 V.ii.2.D, aggravation of a nonservice-connected disability by a service-connected one.
• 38 CFR § 4.97, Diagnostic Code 6847, sleep apnea syndromes; 38 CFR § 4.87, Diagnostic Code 6260, tinnitus; 38 CFR § 4.25, combined ratings table.
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013), an opinion must address aggravation.
• Board of Veterans' Appeals citation A23033748 (November 29, 2023, granted). Board decisions are not precedential.
• VA Disability Benefits Questionnaire, Sleep Apnea, updated July 19, 2024.
• National Heart, Lung, and Blood Institute, "What causes sleep apnea?" (sleep apnea causes and risk factors page).
• Gao J, Tan P, Liu Y, Chen S, Liu J. Association Between Sleep Apnea and Tinnitus: A Meta-Analysis. Ear, Nose & Throat Journal. Published online 2024; 2026;105(9):NP696-NP707. PMID 38321723.
• Wang C, Shi M, Xie L, et al. Association between obstructive sleep apnea and Tinnitus in the United States: NHANES 2005-2020. Sleep and Breathing. 2025;29(1):86. PMID 39841314.
• Lee SJ, Park SI, Choi IS, Lee HJ, Lee JM. Exploring a Possible Link Between Tinnitus and the Risk of Obstructive Sleep Apnea: A National Population-Based Cohort Study Using Propensity Score Matching Analysis. Journal of Clinical Medicine. 2025;14(21):7492. PMID 41226889.
• Gu H, Kong W, Yin H, Zheng Y. Prevalence of sleep impairment in patients with tinnitus: a systematic review and single-arm meta-analysis. European Archives of Oto-Rhino-Laryngology. 2022;279(5):2211-2221. PMID 34708282.
• Choi S, Park SH, Kim SY, et al. Association of tinnitus with obstructive sleep apnea and rapid eye movement-related obstructive sleep apnea in similar hearing threshold groups. Brazilian Journal of Otorhinolaryngology. 2025;91(5):101661. PMID 40633516.
• Messineo L, Sands SA, Labarca G. Hypnotics on Obstructive Sleep Apnea Severity and Endotypes: A Systematic Review and Meta-Analysis. American Journal of Respiratory and Critical Care Medicine. 2024;210(12):1461-1474. PMID 39042859.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.