camidonHP

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!

Excellent sources

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.

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.

I would not be so quick to file a CUE claim here because I believe that you might have a better option in getting that effective date. A revision under clear and unmistakable error (CUE) is extremely difficult because you are bound by the law and the evidence in the C file at the time of the decision. It is a claim of last resort. Not to mention, if you have a claim open on that issue then you are expressly not allowed to file a CUE claim on that issue.

What I cannot tell from your facts is if VA did not get all your service medical records for the first decision. The BVA decision referred to the new evidence in this decision as current VA and private treating records but the subsequent rating decision granting benefits referenced service records showing headaches. Did VA have those service medical records when it decided your case?

If VA did not and, instead, added those service records here then you have a claim for an earlier effective date under 38 C.F.R. 3.156©. Under this regulation, VA must review and reopen any previous claim on an issue if the new claim added service records to your C file. Where I see this happen most often is in PTSD cases involving combat or military sexual trauma. With combat cases-- especially in Vietnam-- VA would fail to get unit records to verify a stressor. In sexual assault cases, VA would get the veteran's service medical records but not the service records, which could show changes in performance. Once these records were added in a subsequent claim then that triggered the original claim to be reopened.

The benefit of this regulation is that it treats the original claim as part of the current one and allows you to submit new evidence, as opposed to the CUE claim where you cannot add evidence.

If the service medical records were considered in the original claim then it looks like CUE is your only route.