Jayco

Sleep apnea

10 posts in this topic

I filed a claim with the help of my doctor for sleep apnea as secondary connection.  Denied.  Filed a NOD.  Denied.  The NOD was denied over a year ago.  A doctor for the VA said my sleep apnea was due to being over weight and that I "refused" to use my CPAP.  They offered me a hearing, but I never responded.  I have tried off and on for 10 years to use a CPAP and just cannot use them.  Discouraged by the whole process I just gave up. 

Read this concerning weight:

 "Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor that raises the chances of a person developing a disease for type 2 diabetes. Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight."

Read this on CPAP machines and surgery in a forum in Thailand:

"I went to Bummrumgard here in TH and the doctor told me he didn't dispense them to overweight people they didn't work well enough.  He also didn't do the expensive surgery for sleep apnea on older or overweight people."  

Bummrungrad is a well known and highly respected hospital in Bangkok.  I went there for heart disease and diabetes, but not sleep apnea. 

I'm now thinking about trying again.  I have two questions:

Do I start over like it is a new claim?

Can someone recommend an attorney or doctor with experience in filing claims for sleep apnea?

I think I have a case.  It most likely will end up having to go to a hearing, so I need expertise in filing the claim.

Thanks.

 

 

 

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Unless you have some Primo N & M Evidence supporting a Direct or Secondary SC, what makes you think you have a shot at an SA SC?

Before you jump with an attorney or spend a $1+K for an IMO, how about posting your redacted SA C & P DBQ and Denial Letters. There may or may not be a path to an SA SC, more info is necessary to determine the likelihood of an Award.

More problematic at this point is your refusal "Can't Use CPAP" to save your own life. Untreated SA is a Silent (except for your snoring) KILLER.

I took a 2010 50% SA Secondary to CAD and got a 2014 Increase Denial, reversed and Awarded SA 100% 12/15. This was after an extremely negative SA C & P 05/14, where the VA Dr said I was wasting his and my time, requesting an increase. Evidently, the VA Rater agreed with him, got a Denial Letter 07/15 continuing my 50% SA SC.

Unbeknownst to me, a Sr VA Rater initiated a Quality Control Review of the 07/15 SA Increase Denial. This QCR resulted in a 12/15 SA Bump to a 100%, apparently, he agreed with me. I should send a copy of the 100% Award to the VA C & P Dr, help him with his continuing SA Education.

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Went back and reviewed your posts, your SC'd for Heart Disease.

How about posting a timeline regarding your Heart DX and your SA DX? Are you currently under VA Med treatment for both conditions?

You don't "CAN'T" use your Cpap, do you see a Sleep Neurologist (VA or Private) on a regular basis?

If you haven't already done so, go on your E-Ben site and start (Don't hit the Submit Button yet) a New Secondary SA Claim caused by your SC Heart problem (what's the actual DX & code?). The VA will determine if this constitutes a New or Reopening of a former claim, so don't worry about it now. Just get your New File Date established by starting the claim.

Semper Fi

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I referenced in my OP a doctor who would not prescribe a CPAP or surgery for over weight and older people because they did not work well enough.  Not everyone can use them nor do they work well at least according to one doctor for a certain group of people of which I am one. Over the 10 years of trying to use a CPAP, I have overcome some issues and have it down to one issue that prevents me from using a CPAP. Paper dry mouth. I use a machine that has a humidifier, but still not enough. Keeping my mouth closed has always been a problem, but even when I do I still get dry mouth. I wake up in the night struggling to swallow. I recently talked to my cardiologist about pursuing further treatment. I just havn't pulled the trigger. It is not covered by VA, so out of my pocket.

 

I am service connected for CAD and Type 2 diabetes. Filed for SC first time in 2012.  Was for hypertension, but that got cut. In my original filing I ask for SA, but then decided not to pursue.  At the time did know if I could make a case for SA. Then later read where it was being covered for some people.   Problems not service connected are over weight and SA. Recently had a pacemaker installed due to hypersensitive carotid artery which I guess falls under CAD. VA paid.  I was diagnosed with hypertension and diabetes in the 90's. Bypass surgery in 2001. In 2009 determined one bypass is completely blocked. Nothing done. No danger of dying and unblocking could cause more problems. SA was not diagnosed until 2006 kind of as an after thought. One day my GP suggested I might want to do a sleep study. No one had talked about it prior to that. SA is severe. Test results showed I stop breathing on average of 20 seconds out of every minute.

 

On why I think I might qualify for SC on SA, I've read one case where one person had SC approved for SA that at least on the surface did not seem any different than my situation. It came down to basically his diabetes caused him to be overweight as oppose to the other way around. Being over weight then caused the SA thus the SC.

 

VA basically says that my weight caused the SA. It has been determined that “it is more likely than not” that my CAD and diabetes was caused by agent orange. If that is the case, weight gain did not cause CAD and diabetes. AO did. So what caused the weight gain? Is it possible for CAD and/or diabetes to cause weight gain? If yes, thus the SC. If not, then I think no reason to pursue.

 

As I mentioned I read about one legal case which was won based on SC diabetes causing weight gain which then caused SA. I remember many decades ago my father having to go to court for SS disability. I remember a comment he made that almost everyone has to actually go to court to have a chance of getting approval. They try to make you give up.

 

3 hours ago, Gastone said:

Unless you have some Primo N & M Evidence supporting a Direct or Secondary SC, what makes you think you have a shot at an SA SC?

I have no evidence other than what I have already stated.  Can you give me an example of evidence you are talking about?  This is one reason why I need someone who has the expertise to handle the filing.  I just do not have it. 

Thanks.

 

 

Edited by Jayco

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1st off, you're 70% SC, so all CAD DB II and SA treatment and equipment is covered by the VA.

I see a strong relationship between your CAD DX and your eventual SA DX. Forget about being a Porker and having a 17+ neck. My BMI was 35+ and I had a 19 in neck when I got my MSA SC'd secondary to my 01/06 CAD DX with subsequent Quad BP surgery.

I've referred 4 other Local Vets to my non-VA Sleep Neurologist, all had 1 visit and received a copy of Clinician Treatment Notes indicating that their respective SC "More Likely than Not," contributed directly to the development of their SA.  Total cost was (1) office call, less than $200.00. His Medical Opinion resulted in theirs and my SA SC Award.

You need to find a local Non-VA Sleep Neurologist (preferably a Vet), have him/her review your medical records and opine regarding the possibility of your CAD being the "More Likely Than Not" cause of your SA.

Start your New Claim on E-Ben yesterday, then start searching for the Sleep Specialist. This is doable!

Semper Fi

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I agree with Gastone, when the VA Doc's won't help a veteran in a situation like this  its time to check out a private DR for his opinion  and get him to write  its as more likely as not your OSA is secondary  or related to your  S.C.  C.A.D.

your VA PCP should recommend you to the VA Sleep Clinic  for a sleep study,if he knows your having problems not breathing while sleeping?  either way S.C. or Not  get you a C-PAP    ASAP.

You can use my'' secure messages'' on MyheatheVet & Ask your PCP for the  Request.

The only thing about this is most of us veterans can't afford  these expensive specialist, because they generally will require a over night sleep study, This is why I suggested a VA PCP  Request a Sleep study from the VA Sleep Clinic..and get diagnose for OSA, Then find the private specialist to give his opinion by reading your medical records that is pertinent to this issue.

your going to need to file a secondary claim for OSA/ S.A. Related to your S.C. Disability's.

 

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