VA Form 21-0960L-2, the Sleep Apnea Disability Benefits Questionnaire, is completed by a medical provider — not by you — to document the severity of your sleep apnea for a VA disability claim. The form records your diagnosis, sleep study results, treatment device, and current symptoms, and each of those answers maps directly to a rating tier under Diagnostic Code 6847. You can have a VA examiner complete it at a Compensation and Pension exam, or bring the blank PDF to your own treating physician and submit the finished form as private medical evidence.1VA News. How to Avoid DBQ Fraud Scams
What Each Answer on the Form Is Worth
The VA rates obstructive, central, and mixed sleep apnea under a single diagnostic code, DC 6847. The rating depends on symptoms and treatment, not the diagnosis alone, and the tiers are:2eCFR. Schedule of Ratings — Respiratory System
- 0 percent: documented sleep-disordered breathing with no active symptoms.
- 30 percent: persistent daytime sleepiness (hypersomnolence).
- 50 percent: requires a breathing assistance device such as a CPAP.
- 100 percent: chronic respiratory failure with carbon dioxide retention or cor pulmonale, or a tracheostomy is required.
The 50 percent rating is the one most veterans on CPAP receive. The step from 50 to 100 percent requires evidence of a life-threatening complication, not just worse symptoms. Because the physician’s answers translate one-for-one into these tiers, accuracy on the form is the single thing that most affects your rating.
What to Bring to the Appointment
The form asks for clinical findings, so gathering records ahead of time prevents blank fields and keeps the VA from returning the form as incomplete.
Sleep Study Results
A diagnosis must be backed by a sleep study. Polysomnography, the in-lab test, records brain wave activity, eye movements, heart rhythm, oxygen saturation, and respiratory effort over several hours.3Department of Veterans Affairs. CHAMPVA Operational Policy Manual Chapter 2 Section 28.1 – Diagnostic Sleep Studies The DBQ asks for the study type, date, and findings. If the study was done outside the VA, bring the full report, not just the summary letter.
CPAP or Other Device Documentation
Section 2C asks whether you require a breathing assistance device.4Department of Veterans Affairs. VA Form 21-0960L-2 Sleep Apnea Disability Benefits Questionnaire A “yes” here is what qualifies you for 50 percent. Bring your CPAP prescription, equipment receipts, and any compliance data the machine records. Most current CPAP machines log nightly usage, and your supplier can print it. Data logs are not required on the form, but they give the examiner a stronger basis for marking the device medically necessary.
Records for Current Symptoms
Section 3 has checkboxes for persistent daytime hypersomnolence, cor pulmonale, carbon dioxide retention, tracheostomy, and chronic respiratory failure.4Department of Veterans Affairs. VA Form 21-0960L-2 Sleep Apnea Disability Benefits Questionnaire Each box corresponds to a rating tier. Bring cardiology reports, pulmonary function tests, or blood gas results that document these complications. Include hospitalization records or any surgical interventions on your airway.
Section by Section
The physician fills in the clinical sections. Your job is making sure they have what they need to answer every question. Walk through the form with them so nothing is left blank.
Section 1 — Diagnosis. The examiner selects the type of sleep apnea (obstructive, central, or mixed) and records the date of diagnosis.
Section 2 — Medical history and treatment. This covers the sleep study results, the date of testing, and whether a breathing device is prescribed. The examiner should identify the specific device.
Section 3 — Current symptoms. The examiner checks every applicable finding. An unchecked box on a symptom you actually have is the fastest way to get underrated.
Clinician signature block. The examiner must sign, date, and provide credentials and contact information. Every field in this block must be completed. An unsigned or undated form will be rejected, and the VA may disregard the entire submission.1VA News. How to Avoid DBQ Fraud Scams
Where to Get the Form and Who Should Complete It
The form is available as a PDF from the VA’s website. Download it, print it, and bring it to your treating physician.4Department of Veterans Affairs. VA Form 21-0960L-2 Sleep Apnea Disability Benefits Questionnaire If the VA schedules a C&P exam, the examiner uses their own copy. Submitting a privately completed DBQ alongside a VA exam gives the rater two data points and can help when your own doctor knows the condition better than a one-time examiner does.
Even when a private physician completes the DBQ, the VA may still schedule its own C&P exam. That is normal. It does not mean your private evidence was discarded; the VA just wants an independent look.
Submitting the Completed Form
The DBQ is supporting evidence. It goes with your disability claim application (VA Form 21-526EZ), not instead of it. If you have not filed the 21-526EZ yet, submit both together. If your claim is already pending, add the DBQ as evidence.
- Online: If you already have a pending disability claim, upload the DBQ through the claim status tool at VA.gov. For evidence tied to a decision review or appeal, use the QuickSubmit tool through AccessVA.5Veterans Affairs. Upload Evidence To Support Your Disability Claim
- By mail: Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444. Use certified mail or a trackable method so you have proof of delivery.6Veterans Affairs. How To File A VA Disability Claim
If you are still waiting on a sleep study or nexus opinion, file an Intent to File (VA Form 21-0966) first. It locks in your effective date for back pay for up to a year while you complete the rest of the application.7Department of Veterans Affairs. Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC
A Note on Nexus for Secondary Claims
The DBQ documents severity. It does not, on its own, establish service connection when you are claiming sleep apnea as secondary to another condition such as PTSD, rhinitis, deviated septum, or weight gain from an orthopedic injury. For those claims you also need a separate medical opinion stating your sleep apnea is “at least as likely as not” caused or aggravated by the service-connected condition. That specific phrase represents the 50 percent probability threshold the VA requires; weaker phrasing like “could be related” will not meet the standard.8Veterans of Foreign Wars. The Medical Nexus Letter Secondary service connection is governed by 38 C.F.R. § 3.310, which also covers aggravation of pre-existing sleep apnea by a service-connected condition.9eCFR. 38 CFR 3.310 – Disabilities That Are Proximately Due To, or Aggravated By, Service-Connected Disease or Injury
If You Have Another Respiratory Condition
If you are already service-connected for asthma, COPD, chronic bronchitis, or a similar condition, the VA will not stack a separate rating for sleep apnea on top. Under 38 C.F.R. § 4.96, ratings for diagnostic codes 6600 through 6817 and 6822 through 6847 cannot be combined. The VA assigns a single rating under whichever code reflects the most severe disability, with the possibility of elevating to the next higher rating when the overall severity warrants it.10eCFR. 38 CFR 4.96 – Special Provisions Regarding Evaluation of Respiratory Conditions Before the DBQ appointment, talk with your doctor about which respiratory diagnosis is predominant, and make sure the form captures the condition that produces the highest rating.