doc25

I appreciate all the info you and other forum members have provided.

If I stand or walk longer than 20 minutes my feet feel like a knife is being stabbed into them. I have severe pronation, as well. If you go back to my previous post with the C&P exam; the examiner does note "with symptomology and orthotics." I believe it was rateable for 10% at that time. Now my feet are rateable at 30%. But, that's just my opinion.

Ok. I will start over. 1. A Navy podiatrist made the initial diagnosis 12/5/2007 of bilateral flat feet (nothing of congenital was noted on the Dr.note.) 2. June 2007 a PA conducted the exit c&p exam. Only rationale he gave was that I was given orthotics then made the "congenital bilateral flat feet with symptomology". 3. In 2016, a VA podiatrist made the diagnosis of bilateral flat feet. His note did not mention anything about congenital flat feet. I am still being treated by the VA podiatrist. 4. Yes. Xrays were done in-service and through the VA. The bone clearly has an arch that was developed on the xray but when I stand my arches (muscles,tendons)collapse and my feet pronate. This is called Aquired flat feet. If I had congenital flat feet in my entrance exam (I was 18 upon enlistment) I would have had xrays done to show the bone was not fully developed into an arch or there had been a previous injury; and if osteoarthritis was present, that's all an xray would show. Besides, the Flat foot DBQ states on top of page 9 for diagnostic testing; plain or weight bearing foot xrays are not required to make the diagnosis of flatfoot. It is quite clear to me that there has been a deliberate effort by the VBA to continously deny my claim.

There is a bit of a debate from what I was researching between the correlation between CSA and CAD. It seems that the studies done; tip the scale toward CSA causing CAD rather than CAD causing CSA. (I'll research some more.) Your SC hypertension could be causing your CSA. Review this veteran's case with the BVA word for word. It was granted. https://www.va.gov/vetapp15/Files4/1534763.txt Your SC anxiety disorder could also be a culprit to causing your CSA. Review this one also. It too was granted. https://www.va.gov/vetapp15/Files4/1537135.txt III. Sleep Apnea Initially, the evidence shows that the Veteran has a current diagnosis of sleep apnea. See, e.g., February 2015 VA Sleep Apnea DBQ. After review of the evidence of record, the Board concludes that the Veteran's sleep apnea was caused by his service-connected anxiety disorder. Of record are multiple letters from Dr. J.Z. A letter dated May 2013 noted that the Veteran was a patient of Dr. J.Z. This letter stated in part: [The Veteran] asked me to write him a letter to determine if in fact the depression/anxiety which he had first might have more likely than not contributed to his developing the other major medical conditions and I believe that this is indeed the case. With his depression/anxiety, he became somewhat despondent and took worse care of himself, causing him to gain a fair amount of weight as he did not participate in exercise and turned to food as his redeemer. He developed...obstructive sleep apnea because of this...Again, if he had not been depressed and used food to help satisfy his needs where nothing else would and stopped exercising, he would not have developed any of the other medical conditions...All of these conditions can be traced directly back to [the Veteran's] depression and anxiety - maybe not as a direct cause but a definite contributing factor and more than likely partially to blame. In another letter from Dr. J.Z. dated June 2013, it was stated that "[a]gain, due to the anxiety issues, [the Veteran] gained a fair amount of weight in comfort eating and not exercising which led to his...[obstructive sleep apnea]." A February 2015 VA opinion provided a negative opinion with respect to whether the Veteran's diabetes mellitus was secondary to his service-connected anxiety disorder. The rationale provided was that "[a]nxiety or depression does not cause obstructive sleep apnea (OSA). OSA is caused by mechanical compromise of the upper airways during sleep, usually associated with obesity...The [V]eteran has comorbidities of morbid obesity." The opinion additionally stated that the Veteran's diagnosis of sleep apnea "coincides with the time period he has become morbidly obese." Based on the evidence of record, the Board finds that the Veteran's sleep apnea was caused by his service-connected anxiety disorder. The letters from Dr. J.Z. contained medical opinions indicating that the Veteran's service-connected anxiety disorder resulted in the Veteran's obesity, which resulted in the Veteran's sleep apnea. The physician's opinion is supported by a cogent rationale and is entitled to probative weight. The February 2015 VA opinion, while providing a negative opinion as to whether the Veteran's sleep apnea was secondary to his service-connected anxiety disorder, also suggested that the Veteran's sleep apnea was caused by his obesity. The February 2015 VA opinion, however, did not address the causation of the Veteran's obesity, which the letters from Dr. J.Z. attributed to the Veteran's service-connected anxiety disorder. As such, the Board concludes that the criteria for entitlement to service connection for sleep apnea as secondary to a service-connected anxiety disorder have been met and the Veteran's claim is therefore granted. 38 U.S.C.A. § 1110 (West 2014); 38 C.F.R. § 3.310 (2015). Here is how it is rated: Sleep Apnea Code 6847: Any sleep apnea syndrome is rated under this code. Sleep apnea is a disorder that occurs while asleep. There is either a pause when breathing that can last up to a few minutes or there is very shallow, low breathing. Central sleep apnea is caused by a decrease in the “action” of breathing—the body doesn’t try as hard to breathe properly. Obstructive sleep apnea is caused by a block in the airways, like a narrowing of the airway passages or an excess of mucus. This causes severe snoring. Mixed sleep apnea is a combination of both central and obstructive. Sleep apnea can cause a significant impairment of the heart and respiratory system by limiting the amount of air that is taken in during the hours of sleep. If the condition continues over a long period of time and causes respiratory failure with right heart ventricle failure or with too much carbon dioxide in the blood stream, or if it requires a tracheotomy, it is rated 100%. If it requires the use of breathing machines like a continuous positive airway pressure (CPAP) machine during sleep, it is rated 50%. If it causes serious sleepiness during the daytime or not feeling rested after sleeping, it is rated 30%. If it is diagnosed by a sleep test, but it doesn’t cause any significant symptoms, it is rated 0%.

Does the nexus of opinion state any of these? “is due to” (100% sure) “more likely than not” (greater than 50%) “at least as likely as not” (equal to or greater than 50%) “not at least as likely as not” (less than 50%) “is not due to” (0%) " The top three provide a favorable nexus of opinion. The other two are unfavorable. In addition, a rationale for or against the claim must be present for all of the five.

It's Clear and Unmistakable I did not have flat feet noted in my entrance exam. Normal Archs is circled. EntranceExam98.pdf

Will do. I have everything ready in chronological order from my entrance exam to my last podiatry visit at my local VA. Also, I should be receiving my C-File on disc around Wednesday or Thursday. So, I'll have all weekend to go through it. My C&P was rescheduled for Monday 2/18 at 8am. Employer denied my leave request for this wednesday. just my luck.

Yea.Dr.Bash mentioned the CUE when he looked at the evidence. A PA did the initial exam. Then a GP dr. (QTC)did the 2nd exam, which he only concurred with the PA's rationale. Dr.Bash did my exam for the DBQ. Now, a NP will conduct the c&p exam. Just my luck. I do anticipate a denial but this time I'm not going to let it go and appeal even if takes another 10-20 yrs. Oh yea I got a call about my c-file today and apparently there were two requests I made and they just wanted some clarification. The lady that called said it should arrive 2-3 business days. I then rescheduled my LHI appt. I was surprised they let me reschedule.

In-service diagnosis for flat feet in 2007. Then I was diagnosed again by a Va podiatrist in 2016. Apparently, I had "congenital" flat feet according to that flippin' PA. Which was BS. The nexus was inadequate because it did not state "less likely than not" or "not due to" only that bogus rationale about congenital flat feet was provided. I had normal archs when I was accepted into service. I'll post the exam. C&Pfeetexampg1.pdf C&Pflatfeetpg2.pdf In-service Dx.pdf

Anthrax could be a possible cause.

Wouldn't the stressor be corroborated with the JSSRC?

Every exam is different depending on the medical evidence the examiner has available. So, it's hard to say exactly what they'll ask. If anything, the examiner has to ask about the symptoms that pertain specifically to you. Look at the page that has all the symptoms listed. Go over it and check the one's you know you have had and continue to have.

So, I was able to obtain a filled out DBQ for Pes Planus (flat feet) and submitted a claim to re-open my previously denied claim. I've been scheduled for a c&p exam with LHI and a Nurse Practitioner is doing the exam. The anxiety shot through the roof when I got the letter (it never gets old). I've read through my initial c/p exam from 2007. That one was done by a PA and the examiner somehow concluded that my in-service diagnosis was congenital (pre-existing) without looking at my entrance exam that says I had normal archs. That claim was denied. I was denied again in 2016 when I reclaimed it. This will be my third time claiming it. Hopefully, 3rd time is the charm. Can I take all my evidence? Or no?

Man they're really trying to make it harder aren't they?

Oh yea...that's clear and unmistakable.

Voiding dysfunction: Rate particular condition as urine leakage, frequency, or obstructed voiding Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence: Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day 60 Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day 40 Requiring the wearing of absorbent materials which must be changed less than 2 times per day 20

No issues ever that you know of. Do you have access to your service medical record? So, if Type 1 Diabetes came out of nowhere, yet you have been deployed in the past. 1.What was your NEC? 2. Where were you deployed? 3. Were you around burn pits in Iraq and Afghanistan for an extended period of time while deployed? https://www.publichealth.va.gov/exposures/burnpits/index.asp 4. If you were deployed to one of the sandboxes. This also may need to be considered. https://www.publichealth.va.gov/exposures/sand-dust-particulates/index.asp

Indeed it is Wanderer. In 2014, I was pretty much at the end of my rope. All I had been getting was 20% that didn't start until 2012. I was married with a baby and unemployed(eventually did find work.) I wasn't aware that I could get an increase to the 10% PTSD with MDD I had and I wasn't aware about secondary Sleep Apnea until 2015(initial claim for increase) and 2017(granted sleep apnea), respectively. In 2016, I was awarded 70% PTSD with Depression, 10% Tinnitus, 0% Hearing loss, and 10% L Knee Patellofemoral Syndrome. My VSO asked me after my award if I had Sleep Apnea by any chance. I said,"Yes. Why?" She said that I could secondary connect Sleep Apnea to PTSD. So, I submitted the secondary claim, which was DENIED twice. I had the first two parts for secondary connection of OSA: #1. Must have a SC condition. #2. Must have a current diagnosis for secondary condition claimed, plus a CPAP and it said "medically necessery" . #3. NO NEXUS OF OPINION I was able to re-open my OSA claim with a filled out DBQ from a pulmonologist. Got sent to a C&P exam at another VA and that's where I received the favorable nexus of opinion for secondary OSA.

“is due to” (100% sure) “more likely than not” (greater than 50%) “at least as likely as not” (equal to or greater than 50%) “not at least as likely as not” (less than 50%) “is not due to” (0%) " Wonderful! As long as you have one of the top 3 you have a favorable nexus of opinion. #3. Is the minimum threshold for a favorable nexus.

1. Technically, yes you are 80% under scheduler ratings...BUT you have a combined rating greater than 60% so that's why you were awarded P&T in 2005. 2. Your VSO is full of it getting on telling you don't qualify. You won't know unless you apply. So Apply anyway. 3. If you qualify, you want to file for SMC back pay to 2005; is that correct? I'll be honest, that's out of my knowledge base, but I'll find something out or someone else can answer this one for you. Look over this webpage for A/A benefits. You might also want to look over the Housebound benefits. Best wishes. http://www.militarydisabilitymadeeasy.com/specialmonthlycompensation.html#r

You have two positive medical opinions that's the good news. The not so good news is that the nexus of opinions are absent of a rationale (A medical study, article, etc). Therefore, the rater "might" use that technicality to deny your claim. I have taken the liberty to provide you with the necessary rationale that links Fibromyalgia to PTSD/MST below. I do hope this helps your claim/appeal. The Gerber Study was done by VA Dr. Megan Gerber and some other researchers. GerberMRFibromyalgiaWVJGIM2018.pdf PTSD and Fibromyalgia Syndrome.pdf

The IMO (nexus of opinion) must state the minimum threshold of "at least as likely as not" (equal to or greater than 50% probability) the veteran's Sleep Apnea is due to or the direct result of the veteran's service-connected Depression. It is "medically necessary" for the veteran to use a CPAP or equivalent breathing assistance device. [Then the physician's rationale such as a referenced medical study, journal, article, linking OSA to Depression.] If you need an article. I've taken the liberty of providing one below. Print it out if you need to give it to your private physician. As far as, a primary physician doing your C&P exam, I had one do mine too. So, it's not unsual, but if you are provided an unfavorable exam, yet you have a favorable nexus of opinion from your private physician...then it's a tie of medical evidence...and guess what?? A tie has to go to the veteran. Immeadiately, file your notice of disagreement (NOD) and appeal IF it happens to get denied. Best wishes. SecondarySleepApneaArticle.pdf

Here are two articles I found for you to research. SecondarySleepApneaArticle.pdf Association with Sleep Apnea and Asthma.pdf

Read this article by Chris Attig, a veteran's lawyer. You'll understand why I made the suggestion after you read it. https://www.veteranslawblog.org/lay-evidence-in-a-va-claim/

Here you go. ****Do not fill it out. Examiner fills one out on the computer.**** SLEEP APNEA DBQ.pdf