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§4.114 Schedule of ratings—digestive system. Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. Unfortunately, this statute would rebut your CUE, to seperate the combined IBS and GERD; but there's some good news. My understanding of the bolded part, is that if a single rating is going to be assigned; the highest rating must be given from either 7319 and 7346 depending on the severity of the symptoms. What does this mean? The highest rating of the two diagnostic codes would fall under 7346 Hiatal Hernia [GERD is assigned this code]at 60%. (That is the highest that is allowable.) 7346 Hernia hiatal: (hiatal hernia) Here is a case where the veteran was granted 60% for combined GERD and IBS. Please read carefully. This case outlines exactly how the board used the medical evidence and the LAW to get it granted. You may have a CUE for getting assigned the highest rating. https://www.va.gov/vetapp09/files2/0919318.txt I apologize if this isn't what would be ideal to hear, but I believe I found a way for attaining a higher evaluation, under your circumstances.

I had to read it over and I could see how it would be confusing. No worries.

If your C&P was administered at a VA facility you would have access to it within 3 to 10 days in myhealthevet in your VA electronic record (Blue Button) If it was done with QTC,VES, or LHI...then you wouldn't have access to that C&P exam immediately.

I concur.

That's how I meant it to be read. But, it's always good to be fact checked. Which is always appreciated. Secondary connection still requires this criteria to be met: #1. Current Diagnosis #2. Service-Connected Disability #3. Nexus of Opinion linking #1 to #2 and a rationale present.

Buck, I'm sure you're correct, but allow me to explain. I'm talking about SECONDARY CONNECTION....not DIRECT SERVICE CONNECTION which would need all that I mentioned to be present IN-SERVICE. A veteran still requires a diagnosis, sleep study of OSA, and issuance of of a medically required CPAP after service plus a Service Connected disability that could link OSA, on a secondary basis. But, if you require that I reference the CFR. I'll go back and do my homework. I'll follow up after I'm done. I appreciate the fact checking.

You don't require a diagnosis, sleep study of OSA or issuance of a medically required CPAP in-service if you are secondary connecting it to a service connected disability such as certain mental health disorders, respiratory conditions, heart conditions, diabetes, etc. You do require a diagnosis, sleep study, and a medically required CPAP issued in-service to direct service connect. Although, the reasonable doubt doctrine has been occasionally used to grant direct service connection for OSA based off of buddy letters or family letters.

Makes sense.

What was your MOS? If you were a groundpounder, you might have a small chance to use that. It's a stretch, considering you DID NOT seek treatment in-service, but it's worth a shot. If you were a POG/Admin, then there's zero chance. Which I don't think you were, since you mentioned you would PT 5 days a week. I agree with getting a buddy letter. In addition, it would help if you had your C-file or service medical record. Once you tell me your MOS i can begin to research some medical literature for you and give you my findings.

At the very least you should have been granted hypersomnia at that time. Depending on the severity it can be rated under 8911 petit mal seizure. No, hypersomnia is not a seizure, but if you suddenly lose consciousness or fall asleep this is not good. As it can put you and others in danger. See my point? You probably should re-open if it's over one year or claim hypersomnia. BEWARE: if you claim hypersomnia you MIGHT lose your earliest effective date. But, if it was diagnosed during that exam and you were afforded a favorable nexus I don't see why you would lose that earliest effective date. If you're still feeling tired, despite using your CPAP, there may have been a possible progression of worsening from OSA to Central Sleep Apnea.

There's some good news. Sleep Apnea can be Secondary connected to Mental disorders; in your case, your anxiety disorder. It's tough, but doable. Below is a medical research that links Sleep Apnea to Psychiatric disorders. Be advised, going the secondary connection route will re-start the effective date; meaning you'll lose the original effective date because it will be considered a new claim. Sorry to be a debbie downer. Weigh the risks. Vasovagal syncope can worsen Sleep Apnea, according to some studies,but you are not service-connected for it. If you're not service connected, you can't use it to secondary connect. SecondarySleepApneaArticle.pdf

Since you did not have a diagnosis for sleep apnea in-service. Secondary connection is the path of least resistance to take. You can try to re-open the previous denial in the Supplemental Claim lane with "new and relevant" evidence. A nexus of opinion would re-open the denied Sleep apnea claim. If you have a service connected disability like a mental health disorder, respiratory/nasal/sinus disorder, or heart condition; you may secondary connect Sleep Apnea to either of those. What are you service-connected with and I'll look up medical literature if there's a link.

Did you deploy anywhere?

Well, let's see what those folks at the VBA do with the evidence you provided. They seem to do what they want.

Please post the letter for review. Redact or darken out any personal identifying information.