Jump to content
VA Disability Community via Hadit.com

VA Disability Claims Articles

Ask Your VA Claims Question | Current Forum Posts Search | Rules | View All Forums
VA Disability Articles | Chats and Other Events | Donate | Blogs | New Users

camidonHP

Seaman
  • Posts

    17
  • Joined

  • Last visited

About camidonHP

Profile Information

  • Interests
    toxicology, clinical psychology, neurology

Previous Fields

  • Branch of Service
    Coast Guard

Recent Profile Visitors

717 profile views

camidonHP's Achievements

  1. IF you already have a service-connected mental disorder, you might be able to get OSA connected: Here's the research I have on the relationship(s) between Obstructive Sleep Apnea and mental disorders: Correlation/Comorbidity between OSA and PTSD Sharafkhaneh et al (2005) Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort SLEEP, Vol. 28, No. 11 "Our data show that the prevalence for comorbid psychiatric conditions is significantly higher in individuals with diagnosed sleep apnea than in individuals not diagnosed with sleep apnea. This pattern was most pronounced for mood disorders (depression and bipolar disorder), PTSD, and other anxiety disorders." “Our data strongly support an association between sleep apnea and PTSD.” 11.85% of the PTSD group has OSA, compared with 4.74% of the non-PTSD group. Odds ratio=2.70 (Note: Also supports depression/anxiety as secondary to sleep apnea.) Krakow et al (2001) Complex Insomnia: Insomnia and Sleep-Disordered Breathing in a Consecutive Series of Crime Victims with Nightmares and PTSD BIOLOGICAL PSYCHIATRY 949 49:948–953 Study of crime victims with PTSD. “Sleep-disordered breathing was diagnosed in 40 of 44 patients; 22 patients met OSA criteria.” Sharafkhaneh et al (2005) Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort SLEEP, Vol. 28, No. 11, Compared the prevalence of sleep-apnea diagnoses in subjects with and without specific psychiatric diagnoses. 11.85% of the PTSD group has PTSD, compared with 4.74% of the non-PTSD group. Odds ratio=2.70 PTSD Causes sleep disturbances Orr (2011) Sleep Disturbances and Posttraumatic Stress Disorder Medscape Pulmonary Medicine This isn’t peer-reviewed, just a web article, but is a good review of research that shows sleep disturbances are related to PTSD. The only time it mentions apnea is when it references Krakow (2011) Krakow et al (2002) To Breathe, Perchance to Sleep: SleepDisordered Breathing and Chronic Insomnia Among Trauma Survivors Sleep and Breathing/volume 6, number 4 Good review of research that shows higher rate of sleep disordered breathing and fragmentation. Sleep Deprivation Causing or Worsening Apnea Series F, Roy N, Marc I.(1994) Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med 150:481–5 Sleep fragmentation (such as is prevalent in PTSD [see: van Liempt, 2011]) increases the propensity for upper airway collapse in patients with sleep apnea. Krakow, 2001 Complex Insomnia: Insomnia and Sleep-Disordered Breathing in a Consecutive Series of Crime Victims with Nightmares and PTSD Guilleminault C, Rosekind M. (1981) The arousal threshold: sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bull Eur Physiopathol Respir. 1981;17(3):341-9. Shows that sleep deprived patients have increased frequency and length of apneic events, similar to the effects of alcohol. (Also useful for nexus, as it talks about how prolonged shift work (such as military watches) can cause the sleep deprivation that worsens apnea. ) Leiter JC, Knuth SL, Bartlett D Jr (1985) “The effect of sleep deprivation on activity of the genioglossus muscle)” The American Review of Respiratory Disease [132(6):1242-1245] Sleep deprivation appears to increase the severity of obstructive sleep apnea, due to decreases in genigoglossus activity. Eckert et al (2011) Sleep Deprivation Impairs Genioglossus Muscle Responsiveness Am J Respir Crit Care Med 183;2011:A6163 These data indicate that acute sleep deprivation leads to potentially important reductions in genioglossus muscle activity. In particular, muscle responsiveness to chemical (hypercapnia), and mechanical (resistive loads) stimuli is impaired by approximately 60% following acute sleep deprivation. These data suggest that sleep deprivation may initiate or worsen OSA, at least in part, via impaired upper airway dilator muscle function. Persson, Svanborg (1996) Sleep Deprivation Worsens Obstructive Sleep Apnea Chest. 1996;109(3):645-650 Showed an increase apneic events and longer apneic events after sleep loss. PTSD decreases Slow Wave Sleep, which worsens apnea McSharry et al (2012) A Mechanism for Upper Airway Stability during Slow Wave Sleep SLEEP, Vol. 36, No. 4, 2013 This shows that the severity of apnea is diminished during slow wave sleep. The next study shows that slow wave sleep is greatly diminished in PTSD. Fuller, K. H., Waters, W. F., & Scott, O. (1994). An investigation of slow-wave sleep processes in chronic PTSD patients. Journal of anxiety disorders, 8(3), 227-236. “Overall, PTSD subjects had a decreased percentage of slow-wave sleep relative to controls, which may explain their increased arousals during the first half of the night.” Stress from PTSD symptoms worsen OSA Nakata et al (2007) Perceived job stress and sleep-related breathing disturbance in Japanese male workers Social Science & Medicine 64 (2007) 2520–2532 Shows that sleep-disordered breathing increases with proportion to occupational stress, as well as anxiety and depressive symptoms. (Kind of a weak paper, scientifically, though.) Sleep Deprivation/Fragmentation occurs with PTSD van Liempt et al (2011) Decreased nocturnal growth hormone secretion and sleep fragmentation in combat-related posttraumatic stress disorder; potential predictors of impaired memory consolidation Psychoneuroendocrinology (2011) 36, 1361—1369 Sleep was more fragmented in patients with PTSD, with more awakenings in the first half of the night. (Also shows that these awakenings lead to lower GH production, which may explain the memory problems in PTSD patients) Psychiatric Times Sleep Disturbances Associated With Posttraumatic Stress Disorder Insomnia and other sleep disturbances occur frequently in patients with PTSD and they can be severe. Sleep problems worsen PTSD Belleville, Guay, Marchand (2009) “Impact of Sleep Disturbances on PTSD Symptoms and Perceived Health” The Journal of Nervous and Mental Disease Volume 197, Number 2, February 2009 The present study highlights the important role sleep plays in PTSD. Sleep appears to have a unique contribution in accounting for the severity of PTSD symptoms. Sleep also impacts how individuals with PTSD perceive their own mental health. Most individuals with PTSD present significant sleep difficulties regardless of their clinical presentation. Spoormaker (2008) Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008 Jun;12(3):169-84. This article is about how PTSD may be worsened or aggravated by sleeping issues, and suggests sleep disturbances may be risk factors for PTSD. Benzos/Meds worsen apnea Dolly FR, Block AJ. Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects. Am J Med. 1982;73:239–43. Hanly P, Powles P. Hypnotics should never be used in patients with sleep apnea. J Psychosom Res. 1993;37:59–65 Berry RB, Kouchi K, Bower J, Prosise G, Light RW. Triazolam in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1995;151:450–4. Hope this helps!
  2. This should be enough to show that it's at least as likely as not that PCBs were in the smoke from the fire, as long as you have documentation for the fire. "It has been reported that of about 1.4 billion pounds of PCBs produced in the U.S. between 1929 and 1977, about 750 million pounds are still in use in some form. Approximately 25% of this is estimated to be associated with the electrical utility industry where PCBs are used primarily in two types of equipment: transformers; containing mixtures (askarels) of PCBs and PCBZs, and capacitors; containing only PCBs . .. As discussed, various researchers have shown that PCDFs are formed when PCBs are heated and that PCDFs and PCDDs are fonned when PCBZs are heated. It is therefore possible that large-scale formation of PCDFs (and PCDDs) from PCBs and askarels could occur. Fires involving electrical equipment or inefficient PCB incineration may give rise to conditions ideal for the formation of PCDFs and PCDDs. Formation of Polychiorinated Dibenzofurans and Dioxins during Combustion, Electrical Equipment Fires and PCB Incineration (oops, I saw someone already linked to that one. Although mine's the full pdf.) "At Paducah, various types of cable insulation were analyzed and many samples tested had positive results ranging from 41 parts per million (ppm) to 3446 ppm PCBs. Then in 1996, PCBs were found in electrical cable from an old test reactor at the Savannah River site. At Savannah River, the PCBs may be linked to facilities with specifications for fire protection, heat or thermal cycling, water proofing, and/or chemical resistance. This is consistent with findings of the U.S. Navy, where many vessels utilize transformers, wiring, and other components that contain PCBs." in Hazardous Materials Management: PCBs in Insulated Electrical Cable, Lessons Learned from Electrical Upgrades at the Holifield Radioactive Ion Beam Facility at the Oak Ridge National Laboratory "EPA believes it is often practicable to remove non-liquid PCBs. including: air handling system gaskets; robber; plastic; dried applied paint that is flaked-off; electrical cable insulation;" " EPA Letter to the navy regarding sinking Navy boats. "In 1990, the US Navy contends that, in many instances, the jackets insulating wire cables on Navy vessels contained PCBs in concentrations greater than 50ppm." (See: statement of facts #11) PCBs aboard the USS Lexington
  3. I honestly don't know enough about TCP to be able to state for sure, but I plan on doing some research on it now that you've brought it to my attention. As far as a common thread between AO and Burn pits, there is definitely evidence that there was/is TCDD (the dioxin contaminant found in AO) in burn pit smoke as well. I think the VA tends to pick and choose which data they use to make decisions, or else maybe use a magic 8 ball of some sort. They don't acknowledge salivary gland cancers as being caused by AO, but yet there are studies showing that vets exposed to agent orange had seven times higher risk of salivary cancers than would normally be expected. I'm really sorry you're going through such hardship. I can't believe how difficult they make this process on vets.
  4. Also look at smoke from Oil Well fires. Burn pits and oil well smoke, especially in combination, are like the perfect storm of chemical exposures. I mean, there's just so many chemicals that are plainly harmful to so many systems, from TCDD (the Agent Orange contaminant) to vinyl chloride. I mean, there's just so many. Not exactly sure on what you're trying to get service connected, but as far as hypothyroidism: -Sometimes, the closest cohort to study with regards to burn pit exposure are firefighters, as burning household good are supposedly what's burning in burn pits (I'm sure in reality, there's way more toxic stuff in burn pits.) This study found a nearly two-fold increase in the incidence in thyroid cancers in firefighters. Same researcher, this time studying cause of death of the firefighters found a nearly five-fold increase in deaths from thyroid cancer than what we'd expect. Benzenes are shown to be toxic to the thyroid. You could also try and connect your thyroid problems with PTSD. There have been studies that show a high correlation between PTSD and thyroid dysfunction.
  5. Talon, thanks. That's really interesting info about how the command put the kibosh on testing the fluid. I agree the MSDS isn't a very good source, and there are often contaminants. I sometimes use them as jumping off points. This paper has a ton of great info, including known contaminants. While I certainly agree that different manufacturer's oils, and even different batches from the same manufacturer can have different constituent components and contaminants, I would think providing evidence in the article I linked to that says the contaminants or components are common SHOULD be sufficient to show "at least as likely as not." Is it a scientifically sound proof that you were exposed or that health problems are a direct result of exposure? No. I'm not a lawyer, but it would seem to me that you just need to provide enough evidence to show that it's at least as likely as not. Of course, it's the VA, so who knows. Your list of conditions sounds terrible. If I were making an argument to connect a lot of them to your time in service, I would likely focus on jet fuels rather than the oils, and there are just an insane amount of constituent components in JP fuel that can cause so many problems.
  6. According to Mobil's MSDS, these are the components of 7808 Fluid: 1-NAPHTHYLAMINE, N-PHENYL- 90-30-2 1% ALKYLATED DIPHENYL AMINES 68411-46-1 1 - < 5% TRICRESYL PHOSPHATE 1330-78-5 1 - < 3% Tricresyl Phosphate (TCP) is definitely known to have dermatological and neurological effects. See the WHO's report here. I haven't found too much on the long-term effects of chronic exposure, or a definitive link to dermatitis. It seems to be excreted fairly quickly. I'm not sure what your neurological symptoms/diagnoses are, but it's clear that exposure to constituents in JP-jet fuels can cause many neurological problems: The n-hexane found in JP-4 has been shown to cause peripheral neuropathy, and distal nerve fiber degeneration throughout the nervous system. In some cases, the peripheral neurodegeneration caused by chronic exposure to n-hexane and its metabolites can lead to atrophy of the skeletal muscles. The toulene and xylene (along with trichloroethylene (TCE,) which is a solvent many in the military use on a regular basis, including many who are regularly exposed to JP-jet fuels, such as aircraft mechanics and electronics technicians) have both been shown repeatedly to cause symptoms of brain atrophy, reduction in nerve conduction, loss of both grey and white matter, and a general “clinical syndrome of premature aging of cortical function.” Chronic exposure to toulene has been shown to affect the function of the N-methyl-D-aspartate (NMDA) receptors in the hippocampus. This leads to an average of 7% decrease in cognitive function, including visual memory, verbal memory, visual pattern perception, and even manual dexterity. It's fairly easy to link JP jet fuels to parkinsons, dementia, and alzheimer's as well, and possibly even ALS and Huntington's. Jet fuels are no joke. I'm not a doctor, but I have read that chronic seborrhoeic dermatitis CAN be a sign of parkinson's. If you're also having other neurological symptoms, you may want to double check with a specialist to be sure.
  7. No problem. I honestly don't think it will be difficult to get OSA connected as a secondary condition. As far as your health issues, I would need more specifics, but I can most likely help find supporting research connecting them to your time in service. I've done a TON of research involving kerosene based jet fuels, and likely have research linking it to your conditions in one way or another.
  8. Of course not. Carcinomas are not sarcomas. Just to clarify, there are three main types of cancer based on the type of cell they originate in: Carcinomas are cancers that originate in epithelial cells, and are the most common types of cancers (80-90%) Lymphomas are cancers that originate in the blood and lymphatic system (7%), and Sarcomas begin in connective tissue (1%). The VA admits SOME carcinomas are related to the TCDD in AO. (i.e. Lung Cancer, Cancers of the lung, larynx, trachea, and bronchus.) Now, the VA is basing this on epidemiological evidence, NOT pathogenesis, not the underlying mechanism of the cancer. So the more common cancers, (i.e. lung cancers, prostate cancer) which show up more often on epidemiological studies, get more attention. What I'm saying is that any carcinoma-ANY cancerous epithelial cells at any site in the body- SHOULD be covered under VA law. It's just a scientifically incorrect decision on the part of the VA, based on faulty logic. It's like observing that most burns on the human body happen on the feet and hands, therefore the buttocks are fireproof! VA logic!
  9. If cancer in a non-presumptive site is thought by the VA to spread to a presumptive site, I've seen them reject it. It's ridiculous. I'm assuming that the original site (base of tongue) was squamous cell carcinoma? This is how I would argue it from a science standpoint: 1. TCDD isn’t actually damaging that original cell-it was likely a carcinogen in cigarette smoke- but TCDD prevents apoptosis (“cell-suicide”) from happening. The research shows that this happens even when researchers give mice a chemical that is specifically designed to trigger “cell-suicide.” The research is pretty clear on this. It even happens in that study when they introduce a chemical that specifically causes "cell-suicide." 2. Another “hallmark of cancer” is when damaged cells keep replicating themselves. The signal to replicate comes from other cells. TCDD is believed to be disruptive to genes that regulate the switch that tells the cell to make copies of itself, known as the epidermal growth factor receptor (EGFR.) Research shows us that in colon cancer cells, TCDD flips this switch, and causes cancer cells to start reproducing like crazy. This is obviously NOT a good thing. Now, the research above use lung epithelial cells and colon epithelial cells. But, really, what the VA is not getting is that the SITE DOES NOT MATTER. Any carcinoma involves epithelial cells, no matter where it is, and the vast majority of cancers are carcinomas.
  10. If they can't find something physical, and you're already service connected for PTSD and/or Depression, then your only real option is to say the weight loss is either secondary to the psych disorders, or a side effect of the meds. A second opinion is probably a good idea, though I doubt they will find anything. Maybe see an endocrinologist if your bloodwork didn't include a hormone panel. Do not go see a "homeopathic physician."
  11. Well, I'm assuming you're service connected for your back injury? And you say you're in constant pain. It must make sleep difficult. I posted a list of good references in Maybe you could make the argument that sleep deprivation is causing the apnea, and so your OSA is secondary to your back pain?
  12. Here's the research I have on the relationship(s) between Obstructive Sleep Apnea and PTSD: Correlation/Comorbidity between OSA and PTSD Sharafkhaneh et al (2005) Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort SLEEP, Vol. 28, No. 11 "Our data show that the prevalence for comorbid psychiatric conditions is significantly higher in individuals with diagnosed sleep apnea than in individuals not diagnosed with sleep apnea. This pattern was most pronounced for mood disorders (depression and bipolar disorder), PTSD, and other anxiety disorders." “Our data strongly support an association between sleep apnea and PTSD.” 11.85% of the PTSD group has PTSD, compared with 4.74% of the non-PTSD group. Odds ratio=2.70 (Note: Also supports depression/anxiety as secondary to sleep apnea.) Krakow et al (2001) Complex Insomnia: Insomnia and Sleep-Disordered Breathing in a Consecutive Series of Crime Victims with Nightmares and PTSD BIOLOGICAL PSYCHIATRY 949 49:948–953 Study of crime victims with PTSD. “Sleep-disordered breathing was diagnosed in 40 of 44 patients; 22 patients met OSA criteria.” Sharafkhaneh et al (2005) Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort SLEEP, Vol. 28, No. 11, Compared the prevalence of sleep-apnea diagnoses in subjects with and without specific psychiatric diagnoses. 11.85% of the PTSD group has PTSD, compared with 4.74% of the non-PTSD group. Odds ratio=2.70 PTSD Causes sleep disturbances Orr (2011) Sleep Disturbances and Posttraumatic Stress Disorder Medscape Pulmonary Medicine This isn’t peer-reviewed, just a web article, but is a good review of research that shows sleep disturbances are related to PTSD. The only time it mentions apnea is when it references Krakow (2011) Krakow et al (2002) To Breathe, Perchance to Sleep: SleepDisordered Breathing and Chronic Insomnia Among Trauma Survivors Sleep and Breathing/volume 6, number 4 Good review of research that shows higher rate of sleep disordered breathing and fragmentation. Sleep Deprivation Causing or Worsening Apnea Series F, Roy N, Marc I.(1994) Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med 150:481–5 Sleep fragmentation (such as is prevalent in PTSD [see: van Liempt, 2011]) increases the propensity for upper airway collapse in patients with sleep apnea. Krakow, 2001 Complex Insomnia: Insomnia and Sleep-Disordered Breathing in a Consecutive Series of Crime Victims with Nightmares and PTSD Guilleminault C, Rosekind M. (1981) The arousal threshold: sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bull Eur Physiopathol Respir. 1981;17(3):341-9. Shows that sleep deprived patients have increased frequency and length of apneic events, similar to the effects of alcohol. (Also useful for nexus, as it talks about how prolonged shift work (such as military watches) can cause the sleep deprivation that worsens apnea. ) Leiter JC, Knuth SL, Bartlett D Jr (1985) “The effect of sleep deprivation on activity of the genioglossus muscle)” The American Review of Respiratory Disease [132(6):1242-1245] Sleep deprivation appears to increase the severity of obstructive sleep apnea, due to decreases in genigoglossus activity. Eckert et al (2011) Sleep Deprivation Impairs Genioglossus Muscle Responsiveness Am J Respir Crit Care Med 183;2011:A6163 These data indicate that acute sleep deprivation leads to potentially important reductions in genioglossus muscle activity. In particular, muscle responsiveness to chemical (hypercapnia), and mechanical (resistive loads) stimuli is impaired by approximately 60% following acute sleep deprivation. These data suggest that sleep deprivation may initiate or worsen OSA, at least in part, via impaired upper airway dilator muscle function. Persson, Svanborg (1996) Sleep Deprivation Worsens Obstructive Sleep Apnea Chest. 1996;109(3):645-650 Showed an increase apneic events and longer apneic events after sleep loss. PTSD decreases Slow Wave Sleep, which worsens apnea McSharry et al (2012) A Mechanism for Upper Airway Stability during Slow Wave Sleep SLEEP, Vol. 36, No. 4, 2013 This shows that the severity of apnea is diminished during slow wave sleep. The next study shows that slow wave sleep is greatly diminished in PTSD. Fuller, K. H., Waters, W. F., & Scott, O. (1994). An investigation of slow-wave sleep processes in chronic PTSD patients. Journal of anxiety disorders, 8(3), 227-236. “Overall, PTSD subjects had a decreased percentage of slow-wave sleep relative to controls, which may explain their increased arousals during the first half of the night.” Stress from PTSD symptoms worsen OSA Nakata et al (2007) Perceived job stress and sleep-related breathing disturbance in Japanese male workers Social Science & Medicine 64 (2007) 2520–2532 Shows that sleep-disordered breathing increases with proportion to occupational stress, as well as anxiety and depressive symptoms. (Kind of a weak paper, scientifically, though.) Sleep Deprivation/Fragmentation occurs with PTSD van Liempt et al (2011) Decreased nocturnal growth hormone secretion and sleep fragmentation in combat-related posttraumatic stress disorder; potential predictors of impaired memory consolidation Psychoneuroendocrinology (2011) 36, 1361—1369 Sleep was more fragmented in patients with PTSD, with more awakenings in the first half of the night. (Also shows that these awakenings lead to lower GH production, which may explain the memory problems in PTSD patients) Psychiatric Times Sleep Disturbances Associated With Posttraumatic Stress Disorder Insomnia and other sleep disturbances occur frequently in patients with PTSD and they can be severe. Sleep problems worsen PTSD Belleville, Guay, Marchand (2009) “Impact of Sleep Disturbances on PTSD Symptoms and Perceived Health” The Journal of Nervous and Mental Disease Volume 197, Number 2, February 2009 The present study highlights the important role sleep plays in PTSD. Sleep appears to have a unique contribution in accounting for the severity of PTSD symptoms. Sleep also impacts how individuals with PTSD perceive their own mental health. Most individuals with PTSD present significant sleep difficulties regardless of their clinical presentation. Spoormaker (2008) Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008 Jun;12(3):169-84. This article is about how PTSD may be worsened or aggravated by sleeping issues, and suggests sleep disturbances may be risk factors for PTSD. Benzos/Meds worsen apnea Dolly FR, Block AJ. Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects. Am J Med. 1982;73:239–43. Hanly P, Powles P. Hypnotics should never be used in patients with sleep apnea. J Psychosom Res. 1993;37:59–65 Berry RB, Kouchi K, Bower J, Prosise G, Light RW. Triazolam in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1995;151:450–4. Hope this helps!
  13. Gredge, Were you exposed to burn pits or jet fuel, or exposed to degreasers like trichloroethylene? Not sure what branch or what sort of duties you performed, but there is some research linking PCB exposure (PCB's are found in plastics that were burned in the pits), kerosene-based (JP) jet fuel exposure, and TCE exposure to lower serum testosterone.
  14. Do you have service-connected PTSD? You may be able to claim your sleep apnea as secondary to your PTSD. There's a fairly large body of evidence that the sleep deprivation many PTSD sufferers experience can cause problems with sleep apnea. Not to mention anti-anxiety meds.
  15. Well, I find it's better to start with what your disability is, and work your way back. If you're Iraq/Gulf War, there's Burn Pits, Oil Well Smoke. If you were around jets and helos, there's JP jet fuel exposure, if you were electronics or mechanic you may have trichloroethylene exposure, diesel fumes, I mean there are so many exposures it's really much easier to figure out what exposure more likely than not can cause or aggravate your disability.
×
×
  • Create New...

Important Information

Guidelines and Terms of Use