diabetes Denied Sleep Apnea / Need Advice For Nod

[Rover]

On 2 Nov 2012, I've received Sleep apnea Denial Reason: The evidence does not show a current diagnosed disability. Explanation: Your service treatment records do not contain complaints, treatment, or diagnosis for this.

I've submitted supporting documents from three buddies, wife, and medical statement from sleep doctor ( MD, Ph.D) saying: Given the findings of the sleep studies and history of weight changes (more in the past), diabetes and reported symptoms, it is more than likely than not, that the patient developed sleep apnea while in service. My sleep problems started 12-15 years ago.

Also i included documents from a current sleeping study conducted by the American Sleep Clinic, were my sleeping problem was diagnosed as Obstructive Sleep Apnea.

Note:

1) I am not able to point to any specific problems in my medical records. All three buddies attest to my sleep problems while serving in the Army. 2) The sleep study was conducted in 2011; my initial claim was filed Dec 2010 and denial letter was received on 2 Nov 2012.

3) The sleep study doctor written a detailed medical statement about the current findings, sleep apnea onset, insomnia, sleep study reports, discussed follow up visit and overall assessment.

Prior to submitting my NOD; maybe i should do a sleep lab follow up and ask for another IMO statement.

[deanbrt]

I have some fear Dr. Bash is becoming a red flag for the VA. I certainly grant that his IMOs are detailed and supportive. I have a friend who is the risk manager for all of the junior colleges in my state. He told me the doctors that write repeated worker comp opinions favorable to the claimant are discounted by the commission.

Here is a post from the gulf war veterans site.

"May I recommend just a slight bit of caution as I have heard rating specialist comment on the "long distance doctor" referring to Dr. Bash. I'm not saying that he isn't good but the VA views him as too biased to the side of the veteran so if they don't put as much weight on his opinion, that is why. "

Edited December 13, 2012 by deanbrt

[Rover]

It's time to start writing OSA NOD. Thank you all for posting past & future helpful tips.

I'm still wondering if i should contact sleep doctor for follow up? In order to receive another IMO letter. In two months, it will be two years since i conducted my first sleep study.

[71M10]

I would ask for a post decision hearing. State that you need the hearing to discuss/better understand the VA decision and how the evidence was evaluated. If they will meet with you and go on the record as to why the first opinion from your sleep doctor was not acceptable. It will help you to not repeat the same mistake.

You have a year from the decision date to NOD.

[AmicusBrief]

I have a little experience in sleep disorders medicine. However, my information should only be considered as anecdotal, not medical or legal advice.

You may be able to support your claim that you suffered from sleep apnea while in service with documentation from observers. If your buddies can document that they observed you snoring and experiencing apneas or hypopneas while asleep it may add creditability to your claim. Just as a person that had a seizure wouldn't necessarily remember the event, people with sleep disorders don't often know that they are affected. They only know they are always tired and have daytime sleepiness. Patients are usually the worst historians when it to comes to sleep disorders. Spouses and other familiy members often provide a better overview of the patient's sleep habits. Also, keep in mind that memory loss of arousals associated with apnea is typical. Many patients have hundreds of arousals yet remember nothing. Snoring is the cardinal sign of sleep apnea and is a prime indicator of partial airway obstruction. Other indicators are hypertension and elevated hemoglobin or hematocrit due to chronic hypoxemia. Use of alcohol and/or sedating drugs can exacerbate sleep apnea by depressing the hypoglossal nerve that controls airway patency. You might look for these other things in your records. Adding the current clinical diagnosis to the in service observations paints a larger picture of the preexistence of the malady before confirmation by the polysomnogram.

Edited December 19, 2012 by AmicusBrief

[Rover]

I have a little experience in sleep disorders medicine. However, my information should only be considered as anecdotal, not medical or legal advice.

You may be able to support your claim that you suffered from sleep apnea while in service with documentation from observers. If your buddies can document that they observed you snoring and experiencing apneas or hypopneas while asleep it may add creditability to your claim. Just as a person that had a seizure wouldn't necessarily remember the event, people with sleep disorders don't often know that they are affected. They only know they are always tired and have daytime sleepiness. Patients are usually the worst historians when it to comes to sleep disorders. Spouses and other familiy members often provide a better overview of the patient's sleep habits. Also, keep in mind that memory loss of arousals associated with apnea is typical. Many patients have hundreds of arousals yet remember nothing. Snoring is the cardinal sign of sleep apnea and is a prime indicator of partial airway obstruction. Other indicators are hypertension and elevated hemoglobin or hematocrit due to chronic hypoxemia. Use of alcohol and/or sedating drugs can exacerbate sleep apnea by depressing the hypoglossal nerve that controls airway patency. You might look for these other things in your records. Adding the current clinical diagnosis to the in service observations paints a larger picture of the preexistence of the malady before confirmation by the polysomnogram.

With my claim, I did submit three buddy statements to include statements from wife and sleep doctor.

[Jim MAC]

I due have just one question for you. Are you currently useing a CPAP machine? If you are make sure you let the VA know that. If you do get SC for Sleep Apena use of a CPAP machine is a rateing of 50 percent.

Good Luck

Jim