ptsd Please review my C&P Sleep Apnea DBQ

[Leon2015]

Hello guys, please let  me know what you think about my Sleep Apnea DBQ, hopefully this is enough to get my service connected? 30% or 50%?

Sleep Apnea
Disability Benefits Questionnaire

Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination

Request?
[X] Yes [ ] No

ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this

document:
[X] In-person examination

Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA) [X] CPRS

1. Diagnosis
------------
Does the Veteran have or has he/she ever had sleep apnea? [X] Yes [ ] No

[X] Obstructive
ICD code: G47.33 Date of diagnosis: 03/24/2014

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's sleep disorder condition (brief summary): The veteran is claiming a service connection for obstructive sleep apnea (OSA). The veteran was first diagnosed with mild OSA in March, 2014 after completing a home sleep study while he was residing in CA. He reports using CPAP since being diagnosed and was seen 02/02/2017 by a physician from the Pulmonary & Sleep Specialists 

Please note, the veteran brought a copy of this Office Consultation Note to this C&P appointment/examination; I requested that he submit this to the RO. As per the 02/02/2017 Office Consultation Note, and by the veteran's own self report he continues to experience the following symptoms: morning headaches, excessive daytime sleepiness, weight gain that he attributes to the medications he is prescribed and taking for PTSD and depression. Other symptoms that the veteran endorses and that are not listed on the 02/02/2017 Office Consultation Note include: "choking and gasping during sleep, waking up with a dry mouth or sore throat, hoarseness in voice/throat, restless/fitful sleep, insomnia and waking up during the night, going to the bathroom frequently during the night, waking up feeling out of breath". As per this 02/02/2017 physician's note, "His weight gain appears to be worsening his sleep
apnea. He has gained over 20 pounds...IMPRESSION: 1. Obstructive sleep apnea by history, worsening with increasing weight gain, may be related to some of his medications that he is taking for his chest pain. 2. PTSD. 3. Depression. 4. Increased weight."

Of note, the veteran's weight recorded in CPRS 03/17/2014 was 198.6 lbs.

On 03/13/2017, the veteran's weight is recorded as 201.0 lbs.

b. Is continuous medication required for control of a sleep disorder condition?
[X] Yes [ ] No

If yes, list only those medications required for the Veteran's sleep

disorder condition:
Mirtazipine 30 mg qhs for sleep.

c. Does the Veteran require the use of a breathing assistance device? [ ] Yes [X] No

d. Does the Veteran require the use of a continuous positive airway pressure (CPAP) machine?
[X] Yes [ ] No

3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms attributable to sleep apnea?
[X] Yes [ ] No

If yes, check all that apply:
[X] Persistent daytime hypersomnolence

[X] Other, describe: SEE MEDICAL HISTORY

4. Other pertinent physical findings, complications, conditions, signs, symptoms and scars

-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above?
[ ] Yes [X] No

b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above?
[ ] Yes [X] No

c. Comments, if any:
No response provided.

5. Diagnostic testing
---------------------
a. Has a sleep study been performed?

[X] Yes [ ] No

If yes, does the Veteran have documented sleep disorder breathing? [X] Yes [ ] No

Date of sleep study: 03/18/2014

Facility where sleep study performed, if known: San Diego

Results:
Home sleep recording performed using the Carefusion T3 System.

IMPRESSION: Mild obstructive sleep apnea.

b. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No

6. Functional impact
--------------------
Does the Veteran's sleep apnea impact his or her ability to work? [ ] Yes [X] No

 

 

[Gastone]

Not really, no discussion of in service symptoms, only "Lightly" mentions "Possibly" associated with PTSD.

What's the Date and SC% of your PTSD, when exactly was it DX'd, before 03/18/2014?

The Dr indicated that your SA doesn't interfere with "your" employment. How can that be?

An SC for SA requiring CPAP or BiPap is 50%.

What are your P02 % from your Sleep Study, do they drop below 90%, if so how often? Talk to your Dr about the possible need for supplemental 02 while on Cpap. The Dr would have picked it up but you never know.

Semper Fi

[Leon2015]

Gastone, please keep in mind that is this claim is for secondary/and or aggravation to GERD and MDD.  My SA claim is been ongoing since 2007, it went all the way to CAVC and now back to AMC for this current C&P. Since this appeal started I have been approved 60% for GERD and 70% for MDD with diagnosis a for PTSD  all through out my VA records.

The examiner wasn't a doctor it was Nurse Practitioner who was there just for paperwork. He just ask me a few questions at the C&P. I know in order to win I will need a IMO. I have that in the works too and will be submitting this week.

I'm not sure if this DBQ from the NP helps me at all?

Edited March 27, 2017 by Leon2015

[Gastone]

Leon, I just got on this bus, missed all your back story. If you have time, how about posting an Awards, Denials, and appeals timeline?

This recent SA C & P was the result of a Remand from the CAVC? How about a Docket Number?

CAVC Remands are supposed to be conducted by Sr Medical Personal with extensive Specialist training in the condition in question. An NP doesn't seem to meet the criteria of being an Expert in Sleep Medicine.

What is your current Combined SC Rating?

Semper Fi

[Leon2015]

Wow I didn't know I was suppose to have a experienced person working on my remand. Ok. Current combined rating of 90% SC.

Here is the Docket# 

Case Number:15-885 I'll update some more the timeline tomorrow but most of the info is in the docket case file.

Edited March 28, 2017 by Leon2015

[Gastone]

You mention "PTSD has been documented throughout your Med File," have you ever filed a claim for it?

I see no mention of an actual PTSD SC and date Awarded. Do you have a VA or Private Psychiatrist definitive DX of PTSD?  how about a copy of your PTSD DBQ?

If you review the DSM V, of interest, is the discussion regarding SA and Depression. Strictly my Lay interpretation but the Psychiatrist's seem to acknowledge that Moderate/Severe SA is a Nexus to, not from depression.

Semper Fi

[Leon2015]

I have letter from my VA Psychiatrist diagnosing PTSD and it mention all throughout my VA records since 2014. No claim for it because I'm 70%MDD.