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The VA says sleep disturbances secondary to PTSD is "Pyramiding".

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kent101

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  • Content Curator/HadIt.com Elder

If you look at the mental health rating criteria, "chronic sleep disturbance" is listed in the 30% criteria. If there is no other reason for sleep issues, then the VA would be correct. The mental health rating criteria is based on symptoms, not necessarily a psychological diagnosis. Having numerous symptoms or diagnosed conditions would still result in a single rating due.

However, there could be other causes of sleep disturbances. For example, if you were an IED victim and suffered TBI, if you suffer from sleep apnea and have daytime hypersomnolence (tiredness all day), etc... For what it's worth, a lot of folks with PTSD have sleep apnea and don't necessarily know it because they never had a sleep study. It would likely take a doctor attributing your sleep disturbances to another cause in order for the VA to concede.

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First, it's "chronic sleep impairment."

Second, psychiatric disorder evaluations are based on levels of functional (occupational & social impairment), with examples of symptoms consistent with said impairment. 

Finally, if your "sleep disturbances" (however they manifest) have been attributed to your PTSD diagnosis by a doctor, then yes, evaluating them without a separate, diagnosed condition that results in sleep disturbance of some kind would most certainly violate pyramiding regulations. 

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On 2/3/2017 at 0:09 AM, rhoe said:

pyramiding regulations. 

Thanks! Good to have someone familiar with the ins and outs of precise rules used in these decisions. You pass those pyramiding  regulations on to us? I'd be very interested in reading those.

It would be very helpful

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Not a problem; in non regulation-speak, the same symptom cannot be used more than once to support a compensation evaluation. So, even if you had both PTSD and an insomnia disorder, since both of these are psychiatric disorders evaluated based on the level of occupational and social impairment, they would be evaluated together under one evaluation. Here's the reg from 38 CFR Part 4:

§4.14   Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.

 

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Brcause the VA has sneaked it by in the federal register. They are denying most OSA claims and lumped them into Lung Disorders so any lung disease no Sleep Apnea awards. 

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