Corwin

About 2 years ago, I filed a sleep apnea claim as secondary to my CAD (60%) and my tinitus(10%). I submitted my private Doctors report from 2010 with the diagnosis. My VA primary had advised me in 2010 to have a test and go to therapy for possible PTSD. I did go to counseling but didn't file a claim then as I was still employed and leery about the reaction if known.The sleep apnea DX results were provided to the VA at that time and I then received a CPAP machine, etc. The DX results included my Doctor's opinion that my PTSD, heart conditions, possible excessive drinking (more than one a night) could have caused my sleep issues. Subsequently, in 2022 I filed a claim and included an opinion letter from ".Dr. Anaise" which opined that my sleep apnea was more likely than not caused by CAD and tinitus. I was quickly denied and appealed. The Judge denied my appeal due to his reviewer suggesting that it could also be caused by excessive drinking as referenced in the DX. No mention of Dr. Anaise's opinion letter. I now understand he as well as several "opinion writers" are on the VA's shit list. This past summer I finally submitted to a C & P for a PTSD claim. 60 days later they rated me at 50%. I have now filed for sleep apnea again providing documentation both from the VA and the original diagnosing Doctor suggesting that PTSD is a causative factor of my sleep apnea. My question is if I am denied again, while I will appeal, I am also wondering if excessive drinking is a possible secondary condition to PTSD and worth filing a claim for SMC. If it were and granted to me, then the VA will have run out of reasons to deny a sleep apnea claim. Probably wishful thinking but any comments, information? Thanks, Nick

I recently (March 2) put in a claim for OSA secondary to CAD and tinnitus. I included an independent medical opinion (IMO). I received a minimally worded denial on April 11. It contained no opinion or even reference to the contents of the IMO. A C&P was never asked for nor did the reviewer even mention the tinnitus part of the claim. The reviewer also stated that they reviewed the most recent 18 months of medical records and stated as a fact that my OSA was DX'd ..." Your VA examination conducted on March 8, 2022 confirmed an active sleep active diagnosis". "Active sleep active"??? No surprise I am sure to most, but I was never at the VA on that date which was after I actually submitted the claim. My OSA dx was given to the VA in June/july 2012 and I have had several subsequent appointments with their sleep physicians since then . Those original DX records were included with my claim. My feeling is, when they saw the IMO, they punted. Their claim response certainly seems counter intuitive to their supposed 'responsibility" to assist. Has anyone else had this experience? I am considering addressing this issue with the VA directly through the Inspector General office with copies to Congressman. After several error filled claims experiences, I am, at this point, a little tired of dancing. Best, Nick

Dustoff, As fate has it, in early march I actually used that self same Dr to review my case and I included his multi page analysis and nexus conclusions as to sleep apnea being secondary to both (and/or) my service connected DX of CAD and tinnitus. The VA reviewer blew me off in a 30 days response with a denial. The denial was bare bones, no detail in explanation (i.e. ...the evidence of record does not show that your current condition is related to any other service connected conditions.Therefore, secondary service connection cannot be established (38 CFR 3.307, 38 CFR 3.310.)), etc. The fast track system only allows claimant to show one disability in their format but I attached a statement saying I was also claiming sleep apnea as secondary to my tinnitus DX. This was never addressed at all! There was not a C&P exam request and the reviewer only showed as asking for/apparently reviewing my discharge physical as well as only the past 18 months of VA appointments even though my CAD and tinnitus dx were from 2010. BTY, my first actual CAD incident as (minor heart attack and stent) used to document my original claim occurred in 2004. MY sleep apnea DX as reported to the VA occurred in 2012 ( i enclosed copies) and I had VA physician appointments about sleep apnea in 2013 and 2014, both of which it took me about 15 minutes to find using my ebenefits account. The Dr's nexus letter which addressed both the CAD DX as well as the tinnitus DX was never addressed at all. No rebuttal, no counter theory or fact, they just ignored it! Even worse, the reviewers "favorable findings" section only identified my CAD DX and then stated .."you have been diagnosed with a disability. Your VA examination conducted on March 8, 2022 confirmed an active sleep diagnosis." You will note that my latest VA appointment was on Jan 25th-haven't been there since. I guess I naively expected that the reviewer would be sensitive to his responsibility to "assist" in substantiating a claim. And I am still waiting for a surgical referral based on my Jan 25 visit. Irony? In your opinion or any of the more experienced folks out there, do I bother with a higher level review and point out all the errors, disservice in view of VCAA, etc. or just go to a BVA review? Thanks in advance, NIck C-tired old Marine

my point was that the proposed change turns the rating system around. In the past you received 50% only because a physician prescribed the wearing of a CPAP. Nobody measured and rated its effectiveness as a treatment of an issue/ or issues. Now the proposed criteria will read as follows: Specifically, VA proposes to assign a 0 percent evaluation when sleep apnea syndrome is asymptomatic, with or without treatment. VA would assign a 10 percent evaluation when treatment yields “incomplete relief.” VA would assign ratings above 10 percent ( e.g., 50 and 100 percent) only when treatment is either ineffective or the veteran is unable to use the prescribed treatment due to comorbid conditions. In other words, if they want, the VA, in theory, could retest you and claim a 10% rating because in their view (subjective view BTW) there is partial relief-i.e. with a CPAP device your respiratory disturbance index (RDI) has been reduced to 15.2 an hour from 41.9-my numbers with a CPAP by the way. No metrics for measuring "ineffective" like using a METS assessment or a hearing test for example. I may be over reacting but...

My notice about the changes included: Veterans who currently receive compensation for a service-connected condition can apply for increased compensation, but no reductions shall be made unless an improvement in the Veteran’s disability is shown to have occurred. This sentence, if actually part of new language, could potentially affect a lot of people. I think about 1.3 million are currently rated for OSA. I don't like it! Nick

HI, I AM VIETNAM VET RATED 60% CAD AND 10% TINITUS. ALSO HAVE BEEN TO APPROXIMATELY 12 MONTHS COUNSELING FOR PTSD BUT NEVER APPLIED. ABOUT 10 MONTHS AFTER CAD RATING ( AND 7 YEARS AFTER MILD HEART ATTACK AND STENT AT 54) I WENT TO LOCAL SLEEP CENTER STUDY GROUP DUE TO INCREASING SLEEP DISTURBANCE ISSUES, MULTIPLE AWAKENINGS, INCLUDING HYPER VIGILANCE, SNORING, ETC. NEVER HAD ANY ISSUES EARLIER IN LIFE. RECEIVED SLEEP APNEA DX (WHICH WAS SENT TO MY VA DOC) AND IMMEDIATELY WENT ON CPAP MACHINE-IT HELPED A LOT. NEVER THOUGHT MUCH ABOUT SECONDARY OR ADDITIONAL CLAIMS UNTIL A FRIEND POINTED THEM OUT TO ME. HAS ANYONE HAD POSITIVE RESULTS PROVING SLEEP APENEA SECONDARY TO CAD? D O YOU HAVE A REFERENCE TO A GROUP OR SLEEP CONSULTANT WITH EXPERTISE TO WRITE A NEXUS OPINION. IS THE "VA CALIMS INSIDER" A GOOD WAY TO GO AS I DON'T WANT TO SPEND THE REST OF MY LIFE GOING THROUGH APPEALS, ETC. THANKS IN ADVANCE FOR ANY HELP AND/OR ADVICE. NICK USMC 66-70

Carlie, After discharge in 1970, the VA tested me for hearing loss and tinnitus . While they did say I had suffered hearing loss in my left ear it wasn't sufficient for compensation. On the tinnitus, they said the same. They did acknowledge in the record that both the hearing loss and tinnitus were service connected. In talking to my VA case manager for an Agent Orange related presumptive disease claim last month, my case manager mentioned my old hearing and tinnitus claims. She asked how they were. When I told her that my hearing has progressively gotten worse and the tinnitus never went away, she set me up for a C&P hearing test in late January. My question is: Have the VA's standards for awarding disability for tinnitus changed since 1970? I am a little confused reading some of the posts in regard to current claims and awards. And, if the standards have changed, is there a way to appeal the original 0% rating? Thanks for any advice you can offer and thanks for your time helping others. Corwin