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

[john999]

I wore my mask last night and my nose is so sore I can't wear it tonight. I woke up early with the mask leaking loudly. I am not a happy camper with this thing.

[Doc904]

Service Connected Sleep Apnea...Being a retired military medical person, there are many health problems that link back to Sleep Apnea, Reflux, snoring, high blood pressure, depression, PTSD, type 2 diabetes, heart problems, weight problems, and the list goes on. Weight problems are recorded in your service record as well as your medical record, and all branches of the service have had a weight program for the past 25 years, and if you were ever on this, I'm sure that is one of the causes of your sleep apnea, you don't find out that it caused sleep apnea until you get out and all the other bad medical problems start after discharge. When they do a discharge physical on you , they to the basis physical, they don't want to find any problems that will delay your discharge or retirement or require a medical board. They tell you most of the time, "Just go to the VA when you get out if you have a problem", to avoid your discharge delay. On my retirement physical I had a couple of medical problems I wanted addressed and written down on my physical, the senior medical officer had a fit when he saw them on my physical because it required medical consults and follow ups before my physical was complete, I also refused to sign off on my physical until it was to my satisfaction not his. Also I was in charge of the physical exam clinic at the time, helps to know people lol. Most people who have served in the military know it's all to easy for someone to tell you "NO", then it is for them to say "OK", so you go up the chain of command, everyone's got a boss higher then them, so when you get a "NO" answer, keep trying, if all else fails get you a Lawyer they will win the case for you. Keep on trying until you find that person who will say "Yes you have a disability" they owe that to you for your service to your country. To many Vets are forgotten once you get that discharge paper. I think the military should require a physical of it retired Vets every 5 years just to follow up on service related problems that get you when you leave the service. I think that would be a good preventive medicine and help those out on active duty to avoid things that will knock you down once discharged or retired. Why are we the forgotten ones, after our service?

Doc904

[meghp0405]

Doc904,

The idea of the military requiring retired vets a physical every 5 years has been going on with the VA. the VA use to bring veterans back for a follow up to their sc conditions. That process went out the window when the VA started getting behind on claims. it was a good idea in thought and would of been an excellent pro active approach. however, again, due to the backlog of claims, not enough doctors, vets started slipping through the cracks. it a shame because I think a pro-active program could save a lot on medication and additional appointments as well.

[StreetWalker]

Service Connected Sleep Apnea...Being a retired military medical person, there are many health problems that link back to Sleep Apnea, Reflux, snoring, high blood pressure, depression, PTSD, type 2 diabetes, heart problems, weight problems, and the list goes on.

Doc904

Awesome info right there.

I was recently diagnosed with OSA. I'm service connected for depression, GERD and back problems. I take Oxycodone several times per day. I've gained weight due to inactivity from the back problems and my medications. I guess I'm going to have to my doctor about connecting the dots so I can file for the OSA.

[TommyTX619]

My sleep apnea claim is pending and currently in the pending decision approval status. I am one of those that never was diagnosed in service or tested, although I had the symptoms. My TBI dr actually requested that I be tested after connecting the dots from my migraines and sleepiness. She also stated that many of my other documented problems most likely "hid" the sleep apnea. Needless to say I did test positive and filed a claim.

I am pretty nervous about the decision as I hear cases like mine are rarely approved in the claim realm but often on appeal. After combing through my records I did find something that linked my weight gain to my PTSD meds. At the time I told my shrink I was not going to take my meds anymore after gaining 25lbs and was prescribed Metformin to combat the weight gain. Looking back, that will likely help in my apnea and my ED claim. My ED was denied due to my weight, smoking, drinking, drug use, cholesterol levels, and blood pressure. The only thing that was correct was the weight as I am still 25-30 lbs overweight. The rest was completely false as my cholesterol tests revealed excellent levels and I dont smoke, drink, or do drugs.

I guess I will find out soon enough as those two items have been in pending approval for a little over two weeks now.

Anyways here is the record. do you think that this will help my claim at all?

[JayBrown1]

Thank you for the info, I was denied in 2004 for the same thing but I appeal and my appeal was remanded back to the RO in June 2014 and now I am waiting to see what the RO will do with the Remand. I am hoping they will grant my claim this time.