Is "comorbid" A Good Thing?

[Detonator]

I had a C&P for an increase for insomnia and secondary claim for depression. I'm curious if anyone can tell me if what the doctor wrote about "comorbid" is helpful to my claim or not. I only have a paper copy of the C&P.

Diagnosis #1: Specified Depressive Disorder

Diagnosis #2 Sleep Disorder Insomnia

This is the part that confuses me...

Does the veteran have more than one mental disorder diagnosed? Yes

Is it possible to differentiate what symptoms are attributable to each diagnosis? No

"Conditions are comorbid and causally related to each other. Symptoms overlap and exacerbate each other and are otherwise intertwined and cannot be separated from one another."

He checked X for Occupational and social impairment with reduced reliability and productivity. But again wrote you can't distinguish between each diagnosis as they are comorbid.

Any help with understanding this phraseology and whether it is good or bad for my increase for insomnia and secondary request for depression would be helpful.

[Berta]

If they SC the sleep disorder ( you dont mean Sleep Apnea do you?)

the co morbid factor should warrant the depression as secondary too. This is a good statement:

"Conditions are comorbid and causally related to each other. Symptoms overlap and exacerbate each other and are otherwise intertwined and cannot be separated from one another."

It could be that the depression ,if service connected would warrant the sleep disturbance as secondary as well.

How strong is your evidence for each condition?

Is either the depression or the sleep problems noted in your SMRs?

Have they suggested a sleep study?

It is possible they could award for depression with sleep disturbances, or maybe vice versa.

Co morbidity here means these are un-separable disabilties and it is interesting that the doc referred sort of to a CAVC (COVA ) description of disabilities that are " inextricably interwoven"....mraning with proof of SC for one, the other one should be SC too,.as I understand that.

Edited June 19, 2015 by Berta

[USMC_VET]

Berta,

Not to get off topic. However i have filed before for "sleep disturbances" as they called it, i did not file it as secondary to PTSD/Depression this of course was before i attended hadit university. they denied the claim years ago despite me saying that i have issues with sleeping and feeling tired all day. when i was denied i just let it go, i nthe past 9 months i started asking about it again, docs would just say maybe you have sleep apnea. so they they sent me to sleep apnea doc. i do have apnea episodes but not enough to warrant a full diagnosis, so no apnea at the moment, however still a sleep issue.

i had a sleep study done, etc as i said and i have reported both civlian and va that i feel tired all day, i toss and turn, i dont get good sleep, i dont sleep for long etc. the evidence in doc notes is extensive.

do you think they just rolled that up into the ptsd depression as part of that claim? thats why they denied as secondary, because i know if they use say panic attacks as part of the rating criteria for ptsd you cant claim as secondary. however in the dbq exam notes, there was no mention of feeling tired all day, etc. just the nightmares.

dont meant to hijack anothers thread, however when this comorbid talk came up i wanted to ask

[Berta]

Yes, I think they did roll it all into the PTSD claim.

I think most PTSD vets have sleep disturbances..which really aren't ratable on their own..

[Detonator]

Hi Berta,

Well you made me feel better. Thanks!!!! I was worried that term would be used to deny my depression claim. It does make sense now his statement is similar to a nexus statement for the two issues. I will address your questions:

Yes, I'm SC for Insomnia already as secondary to chronic pain. Just applying for an increase for that and depression as secondary to insomnia & chronic pain.

I feel the evidence is good since I've been seeing sleep doctors for 10 years at the VA, I've had a sleep study, gone through sleep and depression related programs for years, I've seen several therapists and currently see a psychologist routinely. The C&P doesn't mention much about how the issues effect me. He only marked X for depressed mood, chronic sleep and disturbances of motivation and mood. There are a couple more symptoms that should have been marked.

I'm hoping the VSR will look at all my psychologist's past notes and not just the couple of past notes that were pasted into the C&P report. The notes he put in really don't demonstrate how the insomnia or depression impact my life. It does show Axis I: 296.30 Major Depressive Disorder and 780.52 Insomnia on the last page.

I'm thinking positive! Your insight is appreciated.