doc25

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.

Unfortunately, even when we do everything right. The VBA still gets it wrong. Sorry to hear that happened to you.

I stand corrected. The diagnosis doesn't need to state it, but it needs to be in the documentation. If you still believe that the phrase "medically necessary" doesn't need to be present? Let's consider the advisement of this veteran's law firm. The bad news is that this extra scrutiny by VA will be a trap for the unwary. If a veteran doesn’t have a statement from the doctor saying the CPAP is medically necessary, it is an invitation for VA to deny the claim now. https://veterans.perkinslawtalk.com/post/bad-secret-change-to-va-sleep-apnea/

Screwed? Not so fast. Let's take into consideration: #1. There is a link that was made. #2. A specialist made the link. A pulmonologist opinion carries more weight than a General Practice Dr., Physician Assistant, or a Nurse Practitioner as a C&P examiner It doesn't hurt to ask your dr. to write it in the format that was mentioned. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- You seem to have met the Caluza elements for secondary connection, anyway. #1. You met the criteria for current diagnosis of Sleep Apnea. #2. You met the criteria for a service-connected disability. #3. A nexus of opinion was provided. Albeit, it does not contain the legal terminology. It does raise a significant amount of reasonable doubt in your favor. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- What we need to also look at is that: #1. You had a sleep study done. #2. The sleep study confirms you have sleep apnea. #3. A diagnosis for sleep apnea was made. The diagnosis also has to state you need a "medically necessary" CPAP Machine #4. You were issued a CPAP machine.

[I'm guessing you are already service connected for Asthma? Is this correct? If yes, proceed and read below. If no, you will need to get Asthma service connected first.] Unfortunately, there is legal terminology that is required in a nexus of opinion. Your Dr. has to state one of these phrases for a favorable nexus. 1. "Due to" (100% probability) Ex. The veteran's claimed condition is due to the veteran's service-connected Asthma and the veteran's burn pit exposures in military service.. 2. "More likely than not" (Greater than 50% probability) Ex. The veteran's claimed condition is more likely than not, due to the veteran's service-connected Asthma and the veteran's burn pit exposures in military service. 3. "At least as likely as not" (Equal to or greater than 50% probability) Ex. The veteran's claimed condition is at least as likely as not, due to the veteran's service-connected Asthma and the veteran's burn pit exposures in military service. Here is a study below I attached that you can show your doctor and see if he'll use it to make the link in his rationale. Asthma_and_obstructive_sleep_apnea_More_than_an_as.pdf

In order to get retropay for the earliest effective date/original date of your claim, you would need to find a Clear and Unmistakable Error or CUE. Your effective date, if granted this time around; will be the date you reopened the claim.

There is some good news, but please start your own topic so we can point you in the right direction. I'll initiate some of that good news on here. #1. Don't beat yourself up over something that you did or didn't do. #2. All the other issues you are having can be secondary connected to Psoriatic Arthritis, once you get it service-connected. #3. Since the pain is severe enough that it is causing you to not get sleep that is called Insomnia; you can claim that secondary as well. Is this condition also causing you to have Depression? This can also be claimed, as secondary. The Insomnia and Depression will be combined because both are mental health disorders. I'll explain further once you create your own topic.

Glad you are seeking help for PTSD. Are you currently diagnosed with PTSD? If not, at least you're getting the paper trail or medical evidence by seeking help. If you are diagnosed with PTSD this is how it is granted. #1. Current Diagnosis #2. In-service event/stressor #3. Nexus of opinion stating https://www.hillandponton.com/3-steps-to-presenting-a-strong-va-ptsd-claim/ Let's say you do get PTSD granted. It will be combined with the service-connected to Sleep Disorder/Anxiety. The PTSD being combined has to be considered for a possible increase in rating. If there is no change in your rating once combined, there are still secondary conditions to your mh disorders that get rated seperately; providing you an increase. For example: Obstructive Sleep Apnea secondary to Mental Health disorders is prevalent among the veteran community. It's been well-known for awhile, but the VA denies, denies, denies.

The sleep disorder that is combined with anxiety should have said Insomnia/Anxiety. The VA rates Insomnia as a mental health disorder. Therefore, the sleep disorder is combined with Anxiety. https://www.hillandponton.com/va-disability-benefits-insomnia/