Evidence Checklist: Central Sleep Apnea

Sleep study (polysomnography) confirming central apnea eventsCritical

In-lab polysomnography (PSG) documenting central apnea events (absent respiratory effort with airflow cessation), AHI, and the proportion of central vs. obstructive events. Home sleep tests are insufficient for CSA diagnosis.

Nexus opinion linking central sleep apnea to service or service-connected conditionCritical

A medical opinion connecting CSA to a service-connected condition such as TBI, brainstem injury, opioid use for service-connected pain, PTSD, or congestive heart failure secondary to a service-connected cardiac condition.

Cardiac evaluation if Cheyne-Stokes breathing or heart failure is the cause

Records from cardiology evaluation if the CSA occurs in the context of heart failure with Cheyne-Stokes respiration, documenting the cardiac etiology and its service-connected basis.

PAP therapy prescription and compliance records (CPAP, BiPAP, or ASV)Critical

Documentation that positive airway pressure therapy has been prescribed and compliance data from the PAP device. Prescription of PAP therapy is the threshold for the 50% rating under 38 CFR § 4.97.

Documentation of persistent daytime sleepiness (Epworth Sleepiness Scale)

Epworth Sleepiness Scale results or treating physician documentation of hypersomnolence not resolved by PAP therapy, which may support a higher rating or additional functional impairment documentation.

Buddy statement from spouse, family, or fellow service member

A statement from a spouse or roommate describing witnessed apnea episodes, gasping, nighttime awakenings, and daytime fatigue caused by central sleep apnea.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Sleep ApneaCritical

Standardized form capturing sleep study results, PAP therapy requirements, and daytime symptoms of central sleep apnea.

TBI or brainstem injury records (if applicable)

Military records or medical documentation of traumatic brain injury, blast exposure, or other neurological injury affecting brainstem respiratory control as the underlying cause of CSA.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.