EODCMC

September 7, 2016

Perhaps the reason I could authenticated online is because I am retired military? All I know is that I have never been to the VA.

seminoles · September 6, 2016

My exam was on August 30 and I woke up to the results on Friday, Sep 2.

seminoles · September 6, 2016

3 days.

seminoles · September 6, 2016

I became a premium account when I set up on E-benefits. I never left the house. I see my C&P exam esults in the notes section of the blue button.

September 5, 2016

Gastone, I googled the Dr. And came up with he is a Geriatric Dr. Affiliated with the VA Hospital San Diego.

September 5, 2016

Gastone, the only information that I have on the Dr. Is what I posted. During our chat I got the impression that he was a GP. Well, then I can't imagine getting more than 10% for Allergic Rhinitis. If I'm correct that should mean 55% if the SA and AR are combined, right?

Buck, that is will major cause of concern. Is SA a static condition. I haven't read anyplace where SA has been cured.

I use the CPAP every night. I can't imagine not using it...It really works! It can be ill fitting when you don't change out the mask and readjust the straps regularly. I purchased the SoClean. This machine makes 02 cleaning the machine a snap. No more soap, water and drying.

Again, thanks for your' help and advice!

September 5, 2016

Gastone and Buck, thank you very much for taking the time to review my information. I understand all and fully agree. I was immediately concerned about the P02 levels. I was a Navy diver for 25 of my 28 years. I know how important the oxygen partial pressures are.

I'm dismay to hear that the VA is looking to make negative changes to SA. I havnt read this anywhere. I suppose I could ask my doctor support it should the VA make some negative decision, but not before. I mea, they should feel that their DX already states the need, right? Is the 50% rating going away and do you think it will be retroactive?

I have questions about the Sinusitus. It seems to me that the VA Doctor essentially stated that all my previous DXs by numerous doctors were misdiagnosed. And, because I did not show the appropriate symptoms on the day of the C&P, that I don't have chronic Sinusitis. Just from looking up my nose in a half hour interview? Do I have grounds to appeal?

Also, because he diagnosed me with chronic Allergic Rhinitis, does that mean I can receive compensation for this or do I need to submit another new claim? There are numerous DXs of this in my SMR also.

Again, thank you. I really appreciate your help.

September 4, 2016

OK, the following is my C&P Exam results for Sinusitis and OSA...please comment and offer suggestions:

--------------- MY HEALTHEVET PERSONAL INFORMATION REPORT ---------------
*************CONFIDENTIAL*************
Produced by the VA Blue Button (v12.10)
03 Sep 2016

Name:

------------------------ DOWNLOAD REQUEST SUMMARY -----------------------

=========================================================================
Date/Time:
Note Title: C&P EXAMINATION
Location: VA San Diego Healthcare System
Signed By: Same Name
Co-signed By: Same Name
Date/Time Signed:
-------------------------------------------------------------------------

LOCAL TITLE: C&P EXAMINATION
STANDARD TITLE: C & P EXAMINATION NOTE
DATE OF NOTE: ENTRY DATE:
AUTHOR: GASS,ARNOLD P EXP COSIGNER: No Entry
URGENCY: STATUS: COMPLETED

Sinusitis, Rhinitis and Other Conditions of the Nose, Throat,
Larynx and Pharynx
Disability Benefits Questionnaire

Name of patient/Veteran:

Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination
Request?
[X] Yes[ ] No

ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this
document:

[X] In-person examination

Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS

SECTION I: Diagnosis:
---------------------
Does the Veteran now have or has he/she ever been diagnosed with a sinus,
nose, throat, larynx, or pharynx condition? (This is the condition the
Veteran is claiming or for which an exam has been requested)
[X] Yes [ ] No

[X] Allergic rhinitis ICD code: J30.1 Date of diagnosis: 1994

SECTION II: Medical history
---------------------------

Mr. XXXX is being evaluated with an opinion for direct service connection
for sinusitis. During his first three years in the Navy, he worked in a
paint locker, being exposed to fumes. He sought medical care. He then left
active duty but on reenlistment he worked with explosives and was a diver.
Shortly after reenlistment while in Hawaii he developed upper airway
symptoms problems diagnosed as "sinusitis...acute R" (STR 7May1974) treated
w/ Actifed but not antibiotics. During this inital episode he was "out of
it
for 2 months." On 7May1975 he was diagnosed with "stuffy sinuses" and on
13Jun1975 with a "sinus headache" when he had L retroorbital pain;
antibiotics were not prescribed. He listed "hay fever" but commented "no
known allergies" on a reenlistment SF 93 on 11Jul1980.
Environmental allergies were recorded has having had an onset ~1994 (SF 93
9Dec2000.)
A history of "rhinitis for 7 years" with a diagnosis of "allergic
rhinitis" was noted (10May1999.) Naldecon
(Caffeine/chlorpheniramine/paracetamol/pseudoephecrine) was prescribed.
He was worked up for allergies by skin testing in 1999 and was diagnosed
again with "Allergic Rhinitis" in IM Allergy Clinic on 30Apr2001. Treatment
which had been with Vancenase (beclomethasone) and Allegra-D
(fenoxfenadine/pseudoephedrine) were discontinued; Nasonex (mometasone) and
Drixoral (brompheniramine/psuedoephedrine)were begun.
Symptoms alternate from nostril to nostril. Of the multiple oral and
inhaled nasal decongestants which have been prescribed, the most effective
was Naldecon. However, when that was discontinued per Navy formulary
policy, his symptoms became more annoying.
Following separation from the Navy he continued to have "clogggeed sinuses
on a daily basis." What he means, is that his nose feels stuffy. His
rhinorrhea is thin and watery, not purulent. Although he feels he has
seasonal symptoms, he cannot pinpoint a specific season. He has received
care from TriCare: his primary medications are psuedoephedrine 60 mg. and
fluticasone OTC prn. He continues to have symptoms, sometimes "laying him
up or a few days as if I have a bad cold." During this time he has had
intermittent courses of antibiotics but none as long as 6 weeks; the longest
he remembers is 2 weeks. His last course of antibiotics was prior to exit
from the Navy.
He does not have asthma (PFTs were normal in 1999 and 2001) but has eczema.
A brother has "allergy problems."


SECTION III: Nose, throat, larynx or pharynx conditions
-------------------------------------------------------
Does the Veteran have any of the following nose, throat, larynx or pharynx
conditions?
[X] Yes [ ] No

[X] Rhinitis

2. Rhinitis
-----------
a. Is there greater than 50% obstruction of the nasal passage on both sides
due to rhinitis?
[X] Yes [ ] No

b. Is there complete obstruction on the left side due to rhinitis?
[ ] Yes [X] No

c. Is there complete obstruction on the right side due to rhinitis?
[ ] Yes [X] No

d. Is there permanent hypertrophy of the nasal turbinates?
[X] Yes [ ] No

e. Are there nasal polyps?
[ ] Yes [X] No

f. Does the Veteran have any of the following granulomatous conditions?
[ ] Yes [X] No

If yes, check all that apply:
[ ] Granulomatous rhinitis [ ] Rhinoscleroma
[ ] Wegener's granulomatosis [ ] Lethal midline granuloma
[ ] Other granulomatous infection, describe:

6. Other pertinent physical findings, complications, conditions, signs,
symptoms and scars
-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to the conditions
listed in the Diagnosis Section above?
[X] Yes[ ] No

b. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
Section above?
[ ] Yes[X] No

c. Comments, if any:
No answer provided

d. Does the Veteran have loss of part of the nose or other scars of the nose
exposing both nasal passages?: No answer provided

e. Does the Veteran have loss of part of the nose or other scars causing
loss
of part of one ala?: No answer provided

f. Does the Veteran have loss of part of the nose or other scars causing
other obvious disfigurement?: No answer provided

SECTION IV: Diagnostic testing
------------------------------
a. Have imaging studies of the sinuses or other areas been performed?
[X] Yes[ ] No

[ ] Magnetic resonance imaging (MRI) Date:
Results:

[ ] Computed tomography (CT) Date:
Results:

[X] X-rays:
Sinus series.

Date: 3Jan2001

Results:
FINDINGS: The paranasal sinuses show normal aeration.
There is no evidence
of mucoperiosteal thickening or bone destruction.

IMPRESSION:

1. NORMAL PARANASAL SINUS SERIES.

[ ] Other:

Date:

Results:

b. Has endoscopy been performed?: No

c. Has the Veteran had a biopsy of the larynx or pharynx?

No answer provided

d. Has the Veteran had pulmonary function testing to assess for upper airway
obstruction due to laryngeal stenosis?

No answer provided

e. Are there any other significant diagnostic test findings and/or results?:
Yes

If yes, provide type of test or procedure, date and results (brief
summary):
PFTs 30Apr2001: Normal w/ FEV1 106% and FVC 103%.

SECTION V: Functional imp
act and remarks
----------------------------------------
1. Functional impact
--------------------
Does the Veteran's sinus, nose, throat, larynx or pharynx condition impact
his or her ability to work?
[ ] Yes [X] No

2. Remarks, if any:
-------------------
Mr. XXXXX's history since 1974 is most consistent with chronic rhinitis,
both
perenennial and allergic. Despite the diagnoses of "sinusitis" in the cited
STRs, there is no evidence that he ever has had sinusitis. He does not meet
criteria for chronic sinusitis (UpToDate.)

MEDICAL OPINION REQUEST

TYPE OF MEDICAL OPINION REQUESTED: Direct service connection

OPINION: Direct service connection

Q: Does the Veteran have a diagnosis of (a) sinusitis that is at least as
likely as not (50 percent or greater probability) incurred in or caused by
(the) complaints of and treatment for sinus congestion during service?
A: No.

Evidence reviewed: Tab A (STRs in VBMS): Service treatment records noted
with
sinusitis dated 09/06/1983 and 04/07/2001.
Tab B (STRs in VBMS): Physical exams noted with sinusitis dated
12/01/2000.
Other STRs cited in Medical History above.

Rationale: Mr. XXXX's history is most consistent with chronic rhinitis
w/out
evidence of sinusitis by imaging (2001.) He has never been treated with a
prolonged course of antibiotics; in fact, most of the time even a short
course of antibiotics has not been prescribed. Treatment has been with
antihistamines, inhaled corticosteroids, and decongestants. The two most
complete evaluations (1999 and 2001) explicitly diagnose "allergic
rhinitis,"
not sinusitis.
Since he has nasal obstruction by my exam as well as a prior sense of
fullness, the fullness is mainly a stuffy nose, not a sense of sinus
pressure
or fullness. Thus although his symptoms are suggestive of chronic
rhinosinusitis (CRS,) he has not had confirmatory imaging or endoscoptic
examination, two studies which are required to confirm the diagnosis of CRS.
The only study he had, a sinus series done in 2001, although not the most
sensitive test for CRS, was not even suggestive of a sinus condition.

Therefore, it is my opinion that Mr. XXXXX has chronic rhinitis, both
perennial and seasonal (allergic,) but not sinusitis. The rhinitis is at
least as likely as not (>/= 50% probability) incurred during service.

****************************************************************************

Sleep Apnea
Disability Benefits Questionnaire

Name of patient/Veteran: James Edward Conti

Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination
Request?
[X] Yes [ ] No

ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this
document:

[X] In-person examination

Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS

1. Diagnosis
------------
Does the Veteran have or has he/she ever had sleep apnea?
[X] Yes [ ] No

[X] Obstructive
ICD code: G47.33 Date of diagnosis: 2002

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's sleep
disorder condition (brief summary):
Mr. XXXXX is being examined with an opinion for direct service
connection for sleep apnea (OSA.) During his second enlistment he
snored
quite loudly - "It hurt my operability because, when I went on field
ops, the enemy could hear me!" Subsequently his wife complained of his
snoring; she also noticed apneic spells. They slept in separate rooms.
Therefore, a sleep study was done (4Jun2002.) This showed mild sleep
apnea (AHI - 11.7.) A palatal procedure was suggested (23Aug2002) in
Otolaryngology Clinic but, when he heard of the side effects, he
declined the operation. CPAP was prescribed but he declined usinc it
since he could not take the machine on a mission.
At separation he weighed 204 pounds but chose not to apply for
benefits at that time. Regarding treatment, "I forgot about the CPAP
part. I did not want to use a machine. My snoring did not bother my
wife as much." His new PCP, concerned about headaches on awakening,
easy irritability, daytime hypersomnelence, cognitive problems and
non-retorative sleep, ordered a sleep study (3May2016) which showed
severe OAS (AHI 38.0.) CPAP was precribed immediately. He can tolerate
the mask. He is using it. "I feel like a wet blanket was taken off me
but I still have problems remembering names."

b. Is continuous medication required for control of a sleep disorder
condition?
[ ] Yes [X] No

c. Does the Veteran require the use of a breathing assistance device?
[ ] Yes [X] No

d. Does the Veteran require the use of a continuous positive airway pressure
(CPAP) machine?
[X] Yes [ ] No

3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms attributable
to sleep apnea?
[ ] Yes [X] No

4. Other pertinent physical findings, complications, conditions, signs,
symptoms and scars
-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to any conditions
listed in the Diagnosis Section above?
[X] Yes [ ] No

If yes, describe (brief summary):
Ht: 5'11"; Wt: 270#. BMI: Neck circ: 19-1/2"; 49.5 cm.
Oropharynx: large obstructing tongue, small oropharyngeal
diameter.
Palate not redundant or particularly dependent.

b. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
Section above?
[ ] Yes [X] No

c. Comments, if any:
No response provided.

5. Diagnostic testing
---------------------
a. Has a sleep study been performed?
[X] Yes [ ] No

If yes, does the Veteran have documented sleep disorder breathing?
[X] Yes [ ] No

Date of sleep study: 2002; 2016

Facility where sleep study performed, if known: 2002: Naval Medical
Center SD (Balboa.) 2016 Sleep Data, SD.

Results:
2002 AHI - 11.7 (mild OSA.) 2016 AHI 38.0 (severe OSA.)

b. Are there any other significant diagnostic test findings and/or results?
[ ] Yes [X] No

6. Functional impact
--------------------
Does the Veteran's sleep apnea impact his or her ability to work?
[ ] Yes [X] No


7. Remarks, if any:
-------------------
Mr. XXXXX has OSA, first diagnosed definitively in 2002 (mild) and
reconfirmed in 2016 (severe.)

MEDICAL OPINION REQUEST

TYPE OF MEDICAL OPINION REQUESTED: Direct service connection

OPINION: Direct service connection

Q: Does the Veteran have a diagnosis of (a) sleep apnea that is at least as

likely as not (50 percent or greater probability) incurred in or caused by
(the) complaints of and treatment for breathing difficulty and sleep apnea
during service?
A: Yes.

Evidence reviewed: Tab A (STRs in VBMS): Service treatment records noted
with
sleep study
diagnosed with mild sleep apnea dated 06/04/2002 and 03/20/2003.

Rationale: Mr. XXXXX had symptoms consistent with sleep apnea during active
service. A sleep study (4Jun2002) confirmed OSA and this diagnosis was
entered on a progress note "Separation from Active Duty" (20Mar2003.)
Therefore, the Veteran's sleep apnea was at least as likely as not (>/=50 %
probability) incurred during service.
Risks for sleep apnea include age, gender, and weight. Mr. XXXXX was 17
years old and weighed ~142# at entry into the Navy; at discharge in 2003 he
was 50 years old and weighed 204#. Never-the-less the fact remains that a
sleep study in 2002 was +ive and consistent with his symptoms.
At the time of his current sleep study (3May2016) he was 62 years old and
reports weighing ~250. Clearly age, weight gain, a neck circumference >18",
and a small oropharynx with a large tongue all contribute to his
sleep-disordered breathing and have contributed to his progressing from mild
OSA (AHI 11.7) in 2002 to severe OSA (AHI 38.0) in 2016. He has benefitted
from CPAP but would do even better should he be able to lose weight as he
plans to do.

Conclusion: Mr. XXXXX has a diagnosis of obstructive sleep apnea (OSA) that
is at least as likely as not (>/= 50% probability) incurred during service;
confirmed by sleep study 4Jun2002.

/es/ XXXXX, MD
ACOS/ECS
Signed:
-------------------------------------------------------------------------

September 3, 2016

Yea, I had sleep study an DX of mild OSA on active duty in 2002. I elected to not use the CPAP for operational reason. I had a recent study with DX of very severe OSA and I have been using the CPAP since late May. I actually thought I had Alzheimers. It has helped a lot but not completely. I hadn't talked with the experts yet, I wanted to give CPAP a chance. My previous post in this thread shows both studies and DXs.

September 3, 2016

Thanks...does the 02 help with the symptoms?

September 3, 2016

Gastone, my sleep report indicates that I spent more the 20% of my 8 hour study with P02 below 90%... As low as 81%. Does this indicate that I should be considered for 02? That would really be a good nights sleep.

September 2, 2016

Amazingly, my results were posted on myhealthvet this morning. Severe OSA was a slam dunk. The Dr. used those words. The Sinusitis, not so much. I'm trying to decide if I will appeal. I will post redacted copies in an hour or so. I could use some sage advice.

September 2, 2016

My C&P exam was Tuesday, Aug 30. The results were up on Healthvet, notes this morning. OSA was a slam dunk. Sinusitus, not so much. I will post redacted copies on my stream later today. It was not done at the VA.

September 2, 2016

Good news Buck. Congratulations!

August 31, 2016

Thanks Buck...yes, will do.

August 31, 2016

So, I had my C&P exam. Buck, you were right. I think he was QTC. He actually told me the OSA was a "slam dunk". The Sinusitus, not so much. He did say; however, what I have is allergic rhinitis and it's very well documented in my service record and I should apply for that. I'm not sure how I can see the results of my C&P. Ideas anyone?

August 29, 2016

Thanks Broncovet, my question was not a complaint. It was born out of curiosity. I just wondered if there was a time lag between posting and viewing (others).

August 29, 2016

Tbird, thanks for your response. No problem at all. My question was just to satisfy my curiosity. Thanks again.

August 28, 2016

Yes, she specifically referenced the 2002 Navy Medical Center Sleep Study and went on to say that " it showed OSA in the mild degree. Therefore, a continuing worsening symptoms of his sleep apnea that was already noted since 2002. This is in support of claim of his medical condition that has exacerbated thru time". Yes, It could have been worded differently and even better, yet I think it's as good as the canned statement that it's more likely than not a result of SC blah blah blah. It shows that it was DX'd on active duty and has worsened. But, you have seen more of these than I.

August 28, 2016

Understood. Thanks!

August 28, 2016

Thanks Buck, I have my first VA C&P exam on Tuesday for both claims. Other than asking me to correct my bank routing number and dependants statement, they have asked for nothing from me.

August 28, 2016

Thanks Buck, I thought I was getting it.

August 28, 2016

Best wishes Buck.

August 28, 2016

Ha...John, don't candy coat it, say what you feel. This administration has shown they react to whistleblowers, regardless of motive.

August 28, 2016

Can I claim Hadit Nerd secondary to tinnitus? I wanted to ensure my 100th posting was worthwhile.

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