ptsd Sleep Apnea Granted

[brokensoldier244th]

My sleep apena claim, started in Oct 2011 has been approved. My contention was that my apnea is aggravated by my weight caused by inactivity and drugs used for depression and chronic pain. When I get the decision I will analyze it and its relevant notes for the decision to see if I can identify anything that might be helpful to others. I was not diagnosed before discharge with apnea, nor was I receiving treatment in service. I didn't even get checked for it until September of last year, when a CPAP was issued. I've read so much on here about how difficult it is to get sleep apnea service connected, especially if you don't have an in service finding. Here's to hoping that my decision renders some insight into what their rationale was. Many others here and on VPN have tried to service connect apnea with varying degrees of success and failure, but the arrow seems to point more towards failure if there is no in service finding.

In True VA Fashion ™ it makes little sense. I submitted all sorts of documentation, because id read on here that it is such an uphill battle to get this service connected especially with no in service diagnosis.

My finding letter came, and despite the list of reviewed material, the actual Reasons and Basis is about 2 sentences long:

"We have assigned a 50 % evaluation for your obstructive sleep apnea based on:

0-Requires use of breathing assitance device such as continuous airway pressure machine."

Thats it, folks. No quoting my material, no quoting of things in my Dr's letter, not quoting of the record itself or the sleep tech's finding.

I claimed it secondary to weight gain, pain and inactivity due to chronic pain, depression, and intervertebral disc syndrome.

Ill post my Dr's letter below that was submitted. The rest of what I turned in was pretty standard. A statement from my wife, the sleep tech records, there was a C&P that was about 20 minutes long.

I had some treatment notes that had been submitted for ED that I mentioned my issues sleeping with her as well, but I can't find those.

Mr. Satterfield has been a patient of mine since October of 2000. The conditions that I examined him for are chronic lower back pain and sleep difficulties.

I personally reviewed Mr. Satterfield's medical history including his service medical records from April 2001 to February 2002; and his VA rating decision rating decision C-file and C & P final report for service connection for degenerative disc disease dated September July 2002. His contention today is that he is having difficulty sleeping and that his wife says that he stops breathing several times a night during sleep. Mr. Satterfield was prescribed Elavil (10Mg) for sleep difficulties after his injury by Kenner Army Health Clinic, Ft. Lee, VA, and continued to take them after his discharge from service, and also takes Ultram, Flexaril, and Ibuprofen for pain, as prescribed by the VA. Currently he is prescribed Hydrocodone, Meloxicam, Gabapentin, Temazepam, Seretraline, and Omeprazole.

It is my opinion that it is likely that Mr. Satterfield’s sleep difficulties are aggravated by his service connected degenerative disc disorder and chronic pain, and the weight gained because of it. I also feel that it is at least as likely as not that Mr. Satterfield’s continued obesity is aggravated by his service connected degenerative disc disorder and pain, since his continued efforts to consume fewer calories over several months have resulted in very little loss.

Sleep disruption caused by obstructive sleep apnea can certainly be exacerbated by certain narcotic pain medicines, SSRI’s, and increasing weight. Mr. Satterfield has no prior symptoms of thyroid or metabolic issues, and had no reported sleep difficulties or weight related health problems prior to enlisting into the Army in April of 2001. He has been eating below maintenance for his weight and build, but continues to have difficulty losing weight. Because of these things, and the observations of his spouse it is likely that Mr. Satterfield has undiagnosed obstructive sleep apnea with an onset that started after his service connected injury and the weight gained as a side effect.

Sincerely,

CLAIM: Sleep Apnea W/CPAP secondarily aggravated by medications, pain, obesity, and depression due to service connected lower back injury.

In Aug 2001 I was diagnosed with a lower back trauma that was LOD directly to an injury incurred during training at Ft. Jackson SC. At that time I was still actively serving, under profile with a weight of 192-195 lbs. I was transferred to Ft. Lee, VA for AIT to await a decision about a MEB/PEB. As I was under strict PT restrictions and duty restrictions, and in a state of constant (albeit treated) pain, my activity level plummeted and my weight started to increase. Being that I was in a training environment at Ft. Lee my diet and activities were still restricted as that of any other trainee. I left Ft. Lee in January of 2002, still just under 200 lbs.

In the later part of 2001 I was prescribed Elevil to help with sleep disturbance issues by either Doctor _________ (Kenner Army Health Clinic) or Dr. ________(Kenner Army Health Clinic). I was not diagnosed with sleep difficulties prior to this time-having been married before enlistment, this would have been noticed by my wife. This prescription for elavil was filled to excess before I processed out of Ft. Lee, VA so that I would have time to set up civilian or VA health care. I continued to take Elavil for sleep disturbances, along with Ultram, Flexaril and Ibuprofen for pain until my prescriptions ran out a few months later. In that time I received a C&P for my lower back injury which was ruled service connected. During this time my weight continued to increase due to inactivity and pain. In my initial C&P examination by PA-C J_______ I was noted to be obese 4/29 /02. In December of 2002 . I sawcivilian _________ Medical center (Dr. _____) to refill current medications for pain and sleep issues, including elavil. In a later examination by PA-C __________, Lincoln VAMC I was noted in January 2003 to weigh 257 lbs when I saw him about pain and medications for pain. I declined to add elavil to my VA medications at that time, hoping that my sleep issues would work themselves out with better pain management.

My psychology treatment records by Dr. R_______ indicate sleep disturbances, and my struggles with weight loss/gain as well, and they are incorporated into my overall rating for depression. Inactivity due to pain is also noted throughout, and prior history is established that I was active prior to military service (theater/music) and obviously during service until my injury. I currently weight (10/15/2011) 312 lbs.

Post service I have struggled with my weight due to inactivity or due to medications taken for pain that have side effects of weight gain. I may lose 5-10 lbs on a severely restricted diet, or an increase in activity, but pain, motivation issues, and depression issues cause me to gain it back. I take one medication, Hydrocodone, in a direct attempt to BECOME more active to try to lose weight but thus far it’s results are unquantifiable because of the myriad other issues contributing to my weight.

In October of 2011 I was diagnosed at the Omaha VA Hospital with Sleep Apnea, and, on the basis of the sleep study, issues a CPAP machine (thank you!) This has helped control my apneic sleep disturbances that I feel are a result of my weight gain from my medications, depression, and lower back injury. It may be that since Elavil was not prescribed until after my injury in 2001 that the beginnings of sleep apnea extend to that point where I started to gain weight before discharge from the Army, and have steadily increased since. PA-C D_______ (Omaha VAMC) opined during counseling that Sleep Apnea is a result of either genetics/physical jaw issues, medications, Psychological issues (PTSD, etc), or obesity, and that it can be caused by, or CAN contribute to obesity and depression, and that my issues with both most likely come at least in part, from this etiology. He also advised to “avoid etoh/sedative/narcotics (do not increase hydrocodone dosage)”. His advisement directly contravenes my attempts to be more active to lose weight, by reducing the options available to me for pain management. However, dying slowly in my sleep is not an attractive option, either, and so I am inclined to follow his reasoning. In doing so, however, I must limit my activity.

My psychology treatment records, military medical records, and treatment records from Lincoln VAMC are in my CFile. My consult from Johnson County Medical Center is in my CFile. My Omaha records from my sleep study are in VISTA. Please find and adjudicate accordingly. Per prior rulings by the DVA, with sufficient evidence, Sleep Apnea post discharge has been granted service connection in cases as secondary to obesity , MH issues, and medication when one or more of those are service connected.

Citation Nr: 0905272

Decision Date: 02/13/09 Archive Date: 02/19/09

DOCKET NO. 04-16 673A ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in St.

Petersburg, Florida

Thank you. Here is what I filed:

Edited March 29, 2012 by brokensoldier244th

[carlie]

Thanks and please keep me posted. I have Sleep apnea due to weight gain, I believe, due to my sedentary life, caused by my PTSD.

pr

pr and others,

Here's another route to SC - SA secondary to PTSD.

If you research BVA decisions - many are won thru this route.

http://www.va.gov/vetapp/wraper_bva.asp?file=/vetapp11/Files3/1121599.txt

http://www.va.gov/vetapp/wraper_bva.asp?file=/vetapp11/Files2/1111350.txt

[Rover]

Great info; this will help with my NOD for OSA denial.

[john999]

Besides getting OSA SC'ed is everyone being successful in treatment? I have not been successful.

Doctor says because of the shape of my nose it is hard to get a good seal? I guess that part must be true since I often wake up with the mask squealing and leaking. Other times my nose and face is very sore so I can't wear the mask. I have been through many masks. My private doctor is a real nerd and it often feels like I am in "Wonderland" when I am talking to him but he supposed to be the best in my area. I deal with doctor, sleep lab, Bpap provider, insurance company and medicare. I can't seem to get them all in line. For the last year I have been dealing with this frustrating situation and feeling very sleepy.

[vet12]

Congrats. I'm waiting for my claim to be processed now.

vet12

[yelloownumber5]

john,

I do get leaks often and curious as well. I can control the leaks for a time period but unaware of how long this might last. I use the nasal pillow mask which I love since it is pretty easy on me.

My problem seems to be the hoses.........I set them in a position not leaking but during the tossing and turning they start to leak. I thought the CPAP used to work very well for a while but now I'm with hands in the air. I am 100% compliant with the CPAP and I have a fit with I have to sleep without it.

Another thing that seems to help very much is getting the new supplies every six months which I have not done lately.

Besides getting OSA SC'ed is everyone being successful in treatment? I have not been successful.

Doctor says because of the shape of my nose it is hard to get a good seal? I guess that part must be true since I often wake up with the mask squealing and leaking. Other times my nose and face is very sore so I can't wear the mask. I have been through many masks. My private doctor is a real nerd and it often feels like I am in "Wonderland" when I am talking to him but he supposed to be the best in my area. I deal with doctor, sleep lab, Bpap provider, insurance company and medicare. I can't seem to get them all in line. For the last year I have been dealing with this frustrating situation and feeling very sleepy.

[Computer Tech]

Number 5,

You really should get a new mask every 6 months, in fact if you're using your CPAP every night and all night you might want to consider getting a new mask every 4 months. I use my machine all night every night and my sleep doctor told me to get a new mask every 4 months. What happens is that after a couple of months the elastic of the head piece looses its elasticity and needs to be constantly adjusted. As to the hoses, if you have a headboard drap them over the headboard that way you won't get tangled up in them, also make sure theat they're pushed on all the way.

Rick