Corpsman8404

Andyman, Saw quite a bit of research indicating that Bruxism is common to OSA from a "medical" standpoint.... BUT...from what I have read here, bruxism in non-compensable, and not alot of VA cases tying the two. Bruxism is a symptom. Seems it is more common to secondary to PTSD...BUT...it is difficult. (isn't everything when it comes to all this?) Which leads to actually trying to apply for TMJ, and seeing what comes of that. Somebody here will know much more than I do, on this. This bruxism thing is a confusing one! http://community.hadit.com/search/?type=all&q=%22bruxism+secondary+to%22

Yes Navy4life Update 1)Took the letter back to the private Dr. and had him change the wording. GREAT staff, as well!!! From: "Based on my examination and records reviewed, in my opinion it is highly probably that his sleep apnea is related to his other service related condition PTSD" To: "Based on my examination and records reviewed, in my opinion it is more than likely than not that his sleep apnea is related to and aggravated by his other service related condition PTSD" -----So, we shall see. God forbid the raters now get stupid with, "more than likely than not" instead of "AS not"! Deeeerp! 2) The private Dr also did a DBQ for me! 3) On a side note, met with my PCP while at the VA today, and she stated that she would put the "cannot work" info in my progress notes, and for me to bring something of a draft since I explained the EXACT types of words needed "gainful, cannot sustain, any work, et cetera". She said she understood what I needed and would also put in her own info from her time with me, and such. Also spoke with my PTSD counselor (LCSW) who stated she couldn't write that kind of wording but would make a strong case from my treatment/classes time with her for not any work. So not the same as the PCP, but more ammo...

Took it to that sleep private dr this am and having it changed to more likely than not. At the VA now and my PCP after a good conversation, agreed to make a statement in notes about IU and I explained the wording needed for that.

Thank you, asknod. I will be asking him to change the wording tomorrow. He seems very willing to help me out. Entire staff there does. I meant to keep this in my own thread here:

Roger that, Talon! Thanks! (Dr is board certified, MD, sleep specialist btw) Anyone ---> Okay...editing, for PERFECT clarification here: When he fills out the DBQ, should he state, "it is more likely than not that his sleep apnea is related to his other service related condition PTSD" "it is more likely than not that his sleep apnea is aggravated by his service connected PTSD". Please read the above carefully and advise. There are soooo many different things that could make a difference there in those two. I mean it's crazy, there is "related/aggravated/service related/service connected...." Perfect sentence? Anyone? Thanks in advance!

Thanks, Gastone, Ok, so I went the other day to a Private Sleep Dr, who like described above, did a IMO letter. Picked it up today. 1) He said he was going to write "more than likely as not" but wrote this in one of the sentences. "Based on my examination and records reviewed, in my opinion it is highly probably that his sleep apnea is related to his other service related condition PTSD. This relationship has also been noted in the medical literature". (My highlights) So, does this look ok? This "sounds" better, but we all know the VA.... 2) Also, he is going to fill out the DBQ for me (sleep apnea). --Do I really need it from him since I have the CPAP now and been diagnosed with sleep apnea from the VA? Can't hurt, right?

Ok, so I went the other day to a Private Sleep Dr, who like described above, did a IMO letter. Picked it up today. 1) He said he was going to write "more than likely as not" but wrote this in one of the sentences. "Based on my examination and records reviewed, in my opinion it is highly probably that his sleep apnea is related to his other service related condition PTSD. This relationship has also been noted in the medical literature". (My highlights) So, does this look ok? This "sounds" better, but we all know the VA.... 2) Also, he is going to fill out the DBQ for me (sleep apnea). --Do I really need it from him since I have the CPAP now and been diagnosed with sleep apnea from the VA?

Fantastic journey and WIN, Buck! Congrats!

Good deal!

Noooice! Congrats "Devil Doc" !

So, after getting those results above from VA official Sleep Study, I spoke with the VA Sleep doctor on Feb 2nd: See below: I didn't even get the chance to give it to the Sleep Dr. He was SET on explaining how his theory of sleep apnea is based on sympathetic parasympathetic issues and quoted an Albuquerque study from 2001, and a rat study that showed even if you do stuff to them they can have sleep issues, and when we are asleep we may hear a noise like a siren and think it's an emergency and wake up...et cetera. This was loong before I even began discussing the correlation between PTSD and sleep apnea that I wanted to begin with him. I don't disagree with all that, but he was adamant to the extreme about his theory and that he "would some day be vindicated" by science. Very smart Dr, and I learned alot about other issues with the brain and sleep. When I began my conversation on research I had, he stated he wouldn't look at it. He was unaware of the US National Library of Medicine/National Institutes of Health/Journal of sleep medicine information and other info that I had researched. Likewise, as the conversation went on, very respectfully between the two of us, he stated he was told the other day not to spend time with vets on this issue (deeply), and that he understood my thoughts and such, but it was a "waste of time" and this discussion was keeping him from helping other vets. Uh...That's where I nicely stated that this is the VA, and aren't you helping vets like me? He then began to give me the "look, I DO care about vets and I find that insulting" speech, to which I stated "yes Sir, I saw you here past 8pm on the night I had my sleep study, I certainly do believe you are passionate and caring about vets and your research into your beliefs on sleep apnea, you are very well versed and I have learned alot from you on this conversation". I then made my case and he listened and was impressed. I mentioned the cases won, the research that DOES show a relation, and that I was not asking for a "caused by" but a discussion on the "aggravation". I then stated that if the VA believes there is no relation between PTSD and sleep apnea as secondary to it, then why is there an option when you make a claim in the VA system to select it. This stunned him...He actually didn't know this, and stated he would certainly look at it. Now, I know we all know that they are separate entities, and I am preaching to the choir when I say it's preposterous that they don't know this and that soooo many claims could be DONE, and time, money, appeals, and backpay saving the VA/Govt money if this could be approved the first time. He also stated he doesn't make the decisions. I told him "I understand that, but I would argue that actually, in a way, you do make a decision when you put your notes about my visit in your system for the RATERS to see. (I am being totally professional all this time and so is he). "The raters will go by that, and deny." He paused and "hmmmmed". He got it, for a brief second..... I politely thanked him for his time, and he said I could send him my research info to his email. Sure, he's probably going to keep his ideas and his research that is VERY convincing as HIS proof of what causes SA, which is fine. But I'm amazed that the BIBLE (sleep) that his profession is based on states the correlation/connection, and he is unaware. I get the feeling (and I understand) that they all are extremely busy and that they do not focus on that aspect for vets. I get it. But again, preaching to the choir, you wouldn't continue being so busy in the long run if the damn system was correctly DONE RIGHT. In the end, we laughed and we both agreed how passionate we both were on our research. I had spent hours typing up a draft nexus for him to look at, but there was certainly no use in offering it to him. I left there very professionally, but I was drained from being nice and attentive and not wanting to choke slam this SOB. Fast forward to TODAY. The battle continues! Did research, typed up a draft letter, and took my records to this PRIVATE board certified sleep doctor (pulmonologist) . I was mentioning how I had been told at the VA that there was no correlation et cetera, and he began saying "oh there is", and mentioning medical research and literature showing the ties. He stated he just did this for a vet a few weeks ago. I began describing how the Raters require specific verbage such as "at least as likely" and the Doctor was typing up my letter and stated he was putting in "more than likely", as he did for the other vet. He was genuinely concerned and stated he couldn't believe the hoops we had to jump through and pretty much was describing all the things needed in the "nexus" letter as he was typing it up and speaking to me. I mentioned that I could send him the research I had from the American Academy of Sleep Medicine, and he stated he had already known about those studies and tons of other data on the subject of PTSD/Sleep Apnea and that he was going to mention that in his write up for me.Is this a guarantee of a connection/50% compensation? NOPE. But I certainly am thankful that he is going to put pretty much everything in a nexus letter needed, and even better than "as least as likely as not" he is putting "more than likely as not". Picking up the letter early next week, and I will post it here and ask for any "changes" that you guys recommend. I actually got emotional in the office with him, as he was extremely helpful and then his nurse came in his office afterwards and stated, "we are going to help you, and anything you need you do not hesitate to call me." So again, the day couldn't have been better. Like I said, this isn't a guarantee for getting the raters/examiners to agree, but it surely does feel good.This hill, taken...on the next objective.

Others on this board will chime in with more concise info compared to my "opinion", but I don't see the correlation. I searched the BVA decisions and found one which was denied. http://www.va.gov/vetapp93/files1/9307424.txt Doing a google search did find "some" correlation, such as: post-traumatic stress disorder, which itself may be accompanied by tinnitus and may exacerbate it. https://www.psychologytoday.com/blog/what-i-hear/201310/tinnitus-can-literally-drive-you-crazy Carlie (rest her soul), Berta, Gastone, and georgiapapa gave some good advice here on the issue: Maybe a better route would be to apply for tinnitus as a stand alone? What was your MOS?

Thanks Buck! I have a question for anyone on this statement from your past thread link of: Nvlsp Common Va Errors For Increase http://www.purpleheart.org/ServiceProgram/Training2011/T-4%20%20VA%20Errors%20in%20Claims%20for%20Increase%203.2011.pdf Diagnostic code for most psychiatric disorders follow a pattern: – For certain rating, vet must suffer from occupational and social impairment at level A, due to such symptoms as B, C, D and E VA denies higher rating on absence of B, C, D, and E. BUT symptoms listed in the diagnostic code are simply meant as guidance, not as an exhaustive list – consider all of the evidence of record – “It is not the symptoms, but their effects, that determine the level of impairment.” Argue 38 C.F.R. § 4.7 if your client’s level of disability more closely resembles a higher evaluation, even if she or he does not suffer from all of the enumerated symptoms So, I guess my question is this. Since I feel I have some of the 100% attributes (PTSD), would it be "inappropriate" to reference that bold part above in my documentation for the raters/examiners in a document,or even my "request for IU" written statement when applying for it? Wondering if the raters would be like...."oh, a smarta$$ here"? * I am not doing a NOD, but asking for a increase on PTSD and also applying for IU.

Congrats!

Congrats!

Glad to hear your exam went well Buck! On the issue of the CPAP, I also received mine last week and it has really helped. Went from 59 AHI to 4-6 AHI. Huge difference in sleep quality. I access my "graphs" from "sleepyhead" software. I take my card out of my Resmed Autosense 10 machine, and import the data into the software on my computer. Fairly simple process, and shows much more info than one can get from ResMed/Air website. If anyone wants extra data, it is a pretty simple process. http://www.sleepfiles.com/SH2/ You can click on individual graphs to really see minute by minute, also. ---> ALWAYS write protect CPAP data cards before inserting them into your computer. Certain operating systems write index/cache files to the card without asking, and this could lead to data corruption, making your card unreadable by your CPAP machine. (In other words, click that button on the side of your card to a "lock" pic, when you stick it into your computer, then "unlock" it when putting back into your CPAP machine) Just sayin'....

OEF 21B, I feel your pain on your Psych Dr saying there is no connection between PTSD and SA. I nicely told her in one of our meetings that I have seen some instances of it connected. Either way, I may bring it up again Monday when I go see her and suggest the "aggravated" instead of "caused" route. (Insert Jim Carey grin and stating, "Sooo you're saaaaying there's a chaaaaance") Side note--I got my Sleep Apnea machine the other day (Resmed Airsense 10) and used it for the 1st time last night. WOW!!!! During my sleep lab study in Dec, I had an AHI of 59, and I checked the AHI average on my sleep using it last night, and the AHI was 3.8. I requested a meeting with the VA Sleep Dr and could only get Feb 2nd at the earliest. I am going to try in so many words to approach him with perhaps filling out a DBQ, and making a nexus letter for me. If that doesn't work, I'm going Private route. Did you use a "sample" Nexus Letter from here, or have it available from somewhere else?

Buzz, Did a search for Citation Nr :0102100 Returned case info of this: http://www.va.gov/vetapp01/files01/0102100.txt

Great news! I am happy to hear over and over that it indeed IS POSSIBLE. About to add my sleep apnea secondary to PTSD, as well.

Nice! Happy New Year!

Good info, thanks Buck!

Thanks, goaltender. The above is the overnight sleep clinic study with all the probes. I'll see if I can get the graph data, too.

Had test results come back, here they are: Reason for study: Sleep apnea Age: 47 Weight(Ibs):185 BMI: 29.1 Epworth: 19 SLEEP SUMMARY: This technically satisfactory study runs for: 436 min Total sleep time: 210 min Sleep efficiency: 48.2% Latency to sleep: 110 min Latency to REM: 177.5 min N1/TST: 14.% REM/TST: 6.4% Arousals/hr of sleep: 22.3 PLM/hr: 5.1 Pre-treatment respiratory events per hour of sleep (AHI): 58.5 SpO2 fluctuation: lowest SpO2 of 86 Snoring: yes Suspected RLS TREATMENT TRIAL: Optimum PAP: CPAP at 10 cm H2O. Most satisfactory PAP headgear fitted: ResMed Mirage FX nasal Residual AHI: <5 SpO2: maintained RECOMMENDATIONS: Treat with PAP per treatment trial with heated humidification

Congrats! Merry Christmas!

Thanks, Gastone. I'll be doing my sleep apnea test Monday, and have a few appointments next week as well, and I will try to get some time setup with a VA Vocational Rehabilitation Counselor and my VSO. Speaking with my PCP the other day, she stated it was good that I am working with a Pharm Psychiatrist, but she wants to start me speaking to a Psychiatrist. Since I'm not working now (STD), I am going to look more into this (IU). Indeed, my issues have become much worse, and I don't see me going back to work. I've spent many months debating whether I should cease working, and I just can't do it anymore. Thanks for the info, Devil Dog.