militarynurse

http://www.cnas.org/sites/default/files/21st_Cent_VA_11885.pdf

The Veteran is SC'd for TBI. A VA sleep study indicated central sleep apnea. Assuming a nexus has been medically determined between the TBI and the central sleep apnea: Questions: 1) Is central sleep apnea (CSA) a separate ratable neurologic brain disorder apart from TBI or is it rolled into the TBI rating? and, 2) While obstructive sleep apnea (OSA) is considered and rated as a respiratory condition, why is that the same for CSA, which has it's etiology associated with an organic brain dysfunction?, Should CSA be considered a "chronic sleep impairment" to be rated analogous to a sleep impairment a mental health condition like PTSD, depression or an anxiety disorder etc. might cause? ( 6847) Sleep Apnea Syndromes (Obstructive, Central, Mixed)

http://www.eurekalert.org/pub_releases/2015-10/smp-wpd101415.php

Check out what the neurologist said in this NY Times story about concussion injuries from boxing at West Point Military Academy at link: http://www.nytimes.com/2015/09/30/us/despite-concussions-boxing-is-still-required-for-military-cadets.html?_r=0

Is it even possible to be separately rated for both obstructive sleep apnea, (OSA), and another lung condition, ( like COPD ),? I heard both were respiratory disorders and hence only the highest rating for one is what the VA allows.

He believes his Insomnia and hypertension can be linked as secondary conditions or aggravated by his VA diagnosis of "adjustment disorder with mixed anxiety and depressed mood". BTW, is "adjustment disorder" the same as "chronic adjustment disorder"?

Bluevet, Thank you for the reply. The article that quote came can be found at the following link: http://archive.armytimes.com/article/20100812/NEWS/8120325/ A fellow I know just had his C&P exam with the as likely as not diagnosis of "adjustment disorder with anxiety and depressed mood." Not "chronic adjustment disorder", however, it appears nowadays it doesn't make any difference. He was not assigned a GAF score. While PTSD is linked to a number of secondary conditions ( which he is aiming for ), I'm not sure that an "adjustment disorder"....chronic or otherwise...is. Anyone know?

I had read in Mil.Times that: "According to the psychiatric manual used to diagnose mental health issues, the DSM-IV, adjustment disorder occurs when someone has difficulty dealing with a life event, such as a new job or a divorce, or after someone has been exposed to a traumatic event. The symptoms can be the same as for post-traumatic stress disorder: flashbacks, nightmares, sleeplessness, irritability, anger and avoidance. According to military and Veterans Affairs Department policy, if those symptoms last longer than six months, the diagnosis should be changed to PTSD." Has anyone seen where a SC'd "chronic adjustment disorder" diagnosis for longer than 6 months or more in duration was changed to a diagnosis of PTSD? Thank you.

GP, Thanks for the reply. I didn't find chronic cough as a separate ratable condition in the Schedule Of Ratings for Respiratory Disorders, however, I did find another BVA case that indicated it could be one. So it remains a puzzle.

Found one: http://www.va.gov/vetapp13/Files1/1303246.txt so apparently chronic cough can be rated as a separate condition.

Thanks for the reply. That's what I was thinking as well...but you never know if there wasn't some sort of precedence claim for chronic cough that was granted.

What might be the rating for a non-productive chronic cough secondary to an already service-connected throat condition rated at 0%? Is a chronic cough even ratable as a separate condition? Could use some help on this one please.

I just read a decision yesterday of a navy veteran I know. He was treated once for a rash in the service during 1988. Only self treated it since. C&P doctor opined it was the same rash he had since 2008 called tinea versicolor over 20%-40% of his body and that it is difficult to eliminate. Dr. wrote is was as least as likely as not the same rash he was treated for in the military. He was awarded a 30% rating, about $400 per month without dependents. However, his tinnitus and hearing claims were inexplicably denied despite his service spotting planes on a carrier. His hearing test was sub normal, however non-compensable for VA purposes. didn't even get a "0" percent rating. Moral of the story: C&P exams are like a box of chocolates...you never know what your going to get.

According to John Hopkins school of Medicine, "sinusitis" is also known as "rhinosinusitus": http://www.hopkinsmedicine.org/otolaryngology/specialty_areas/sinus_center/conditions/sinusitis.html

Medics, nurses and other medical personnel, especially those working in critical care, trauma and ER settings...be it combat or non-combat, have an increased risk of developing PTSD and other serious mental health conditions due to repeated exposure to extreme stressors while performing their jobs. Being around all manner of damage to the human body, dying and death can understandably take its toll. There are numerous studies that support this finding.

New 2015 Research: http://www.sciencedaily.com/releases/2015/01/150114140600.htm

The frustrating thing about VA mental health is it's so darn inconsistent. Two Veterans with exactly the same symptoms could see two different VA "shrinks" and get two different diagnosis. "Chronic adjustment disorder" due to a service connected medical problem may be worth something comp-wise, however, it's more like a runner-up placeholder for the PTSD diagnosis.

Ah, the old "adjustment disorder" bamboozle. Dealing with the VA's "shrinks" is always a crapshoot. Also, any chance that the kidney disorder arose from agent orange exposure in Vietnam or from trauma while in military service?

Have an MRI done on a 3T machine.

Look at it this way: If you don't file, you get zilch.

38 USC 1702 (b) does not indicate it is for treatment purposes only: 38 USC 1702 (b): (b) Mental Illness.—For purposes of this chapter, any veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have incurred such DISABILITY in the active military, naval, or air service if such veteran develops such DISABILITY— (1) within two years after discharge or release from the active military, naval, or air service; and (2) before the end of the two-year period beginning on the last day of the Persian Gulf War. It might be argued that "1702 (b)" could be used to establish service connection for compensation purposes, (and not just for treatment purposes), in an otherwise eligible Gulf War veteran. "1702 (b)" is a presumption that an active mental illness disability was incurred in service if it developed within 2 years of discharge. "1702 (b) does not even require a reason for the mental illness need be given. It also doesn't even mention the word "treatment" at all.

Jumpmaster, Thanks for the reply. I don't have the initial denial...I'll see if I can get it. As I understand it, the initial denial did not reflect parts of the veteran's service....particularly the part when the stressor occurred...not that that should have even mattered because this Gulf War era veteran was eligible anyway under the presumption provided for by 38 USC 1702 (b). The veteran has not exhausted the appeals process yet. In fact he still has time to file a NOD.

--How is it possible that the law 38 USC 1702 (b) morphed into the administrative regulation 38 CFR 17.109(b) below which only relates to the providing of medical treatment by the VA? How did that limitation to providing only medical treatment happen? 38 CFR 17.109(b): 2. Mental Illness (other than Psychosis). Eligibility for benefits under 38 CFR 17.109(b) is established for TREATMENT of an active mental illness (other than psychosis), and such condition is exempted from copayments under 38 CFR 17.108, 17.110, and 17.111 for any Veteran of the Persian Gulf War who developed such mental illness: a. Within 2 years after discharge or release from the active duty military, naval, or air service; and b. Before the end of the 2-year period beginning on the last day of the Persian Gulf War (end date not yet determined). -versus- 38 USC 1702 (b): (b) Mental Illness.—For purposes of this chapter, any veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have incurred such DISABILITY in the active military, naval, or air service if such veteran develops such disability— (1) within two years after discharge or release from the active military, naval, or air service; and (2) before the end of the two-year period beginning on the last day of the Persian Gulf War. --Can it be argued that "1702" (b) could be used to establish service connection for compensation purposes, (and not just for medical treatment), in an otherwise qualifying Gulf War veteran? ----------------------------------------------------------------------------------------------------------------------------------------------------- --Now compare the law 38 USC 1702(b) to the regulation 38 CFR 17.109(b) that implements the USC law above. See the difference? They are not the same. 38 CFR 17.109(b) has the medical treatment limitation implied in 38 USC 1702 (b). --Since 38 CFR 17.109(b) is derived from 38 USC 1702(b), is it logical to provide a qualifying Gulf War veteran with service connection eligibility only for medical treatment but not find him/her eligible for service connection for disability compensation purposes rated at 0% or more? 38 USC 1702(b) provides for a presumption of service connection: "shall be deemed to have incurred such DISABILITY",( that disability being a mental illness ), from active military service if certain conditions are met. A qualifying mental illness disability must therefore be service connected in all respects. It cannot be otherwise. This law is unconditional. It specifically does NOT state "shall be deemed to have incurred such DISABILITY, in the active military, naval, or air service",...for the purposes of receiving treatment only. The USC law is fine. "1702(b's" presumption of disability seems unique among all the presumptions in that it is the only one were the implementation of it through 38 CFR 17.109(b) establishes service connection only for medical treatment, not for disability compensation. This is not right. Can you imagine the uproar if the presumption(s) for Agent Orange exposure were similarly handled? http://fas.org/sgp/crs/misc/R41405.pdf Opinions wanted please? *Please note: 38 USC 1702" doesn't refer to "treatment only" because, since it is in Chapter 17 of Title 38 that is already implied and so it probably doesn't need to. Chapter 17 refers to hospital & medical care etc. only, not compensation. See more at link: http://www.gpo.gov/fdsys/pkg/CPRT-112HPRT65875/pdf/CPRT-112HPRT65875.pdf The VA's position: "These presumptions are granted by law and are to be used SOLELY for the purposes of receiving VA MEDICAL benefits for those conditions. These Veterans do not have to file a claim for service-connection with the Veterans Benefits" http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2893 http://www.gpo.gov/fdsys/pkg/FR-2013-05-14/html/2013-11410.htm

Thanks for the reply and I agree that it's a way for the VA to treat. However, please see (b) under 38 USC 1702 which deals with mental illness, ( other than psychosis ), specifically for Gulf War veterans. Where does this presumption of law indicate service connection is limited to being established for medical treatment only? Why not for compensation purposes as well?

Friends, There was the initial denial decision which the veteran asked for a review of at the regional office level. What you see on my original is the results of the review by the RO decision, which largely echoed the denial determinations of the original decision except for #1. This is not a 0% rating. #1 in my original post is stated verbatim. This Persian Gulf War era veteran was discharged in 2011. Initial comp claim was filed in 2012. Claimed PTSD Stressor occurred CONUS and involved no physical trauma. That's all I'm at liberty to say about it. Claimant has 20 year retirement letter. Again, no C&P exams were even offered to this veteran...ever. New info: Indication for #1 in my original post are based on 38 USC 1702 however, does that limit SC only to treatment? It doesn't seem to read that way. Also just found the VA's interpretation: Psychosis--38 U.S.C. 1702. Whenever a claim for service connection for a psychosis based on wartime service is denied, determine entitlement to service connection for treatment purposes under 38 U.S.C. 1702. Code the decision "48. Active Psychosis--SC. for treatment purposes only," Your thoughts?