Wifey

thank you for that link. I actually did read that but like so many thought it just didn't apply to us because his apnea is "severe", of course he has to use a CPAP. I'm definitely going to call the VA hospital tomorrow and see if they will put it in writing. This is just crazy. I just finished filing the claim and uploaded everything I have. I'm only missing the nexus letter which should arrive tomorrow and the note from the doctor that says the CPAP is required. I'll run my butt off to get that ASAP. I know they won't decide anything that fast so I can still upload those things tomorrow. Problem, I hit the submit claim button, it showed that everything was complete, but then when I went to look at my open claims it wasn't there. Does it take a few hours to show up? sure hope so.

I have searched and searched on line for what are the medical requirements for when a CPAP is REQUIRED vs. recommended and I can't find one article telling this. I found hundreds that say severe apnea is treated with a CPAP among other options like surgery etc. But not one saying it is REQUIRED. I found articles defining mild, moderate and severe (anything over 30 per hour is severe and he has 64 per hour). I know that this letter has to come from a Dr. but I just wanted to at least find the guidelines so I could make it easier. We have had ZERO luck getting any VA doc to ever write anything.

Thanks for the article. The nexus letter does contain the magic words and has a medical journal attached but I'm not sure if it is this one. I'll include both. I do think we need to get a statement saying "required ". It says Severe apnea and recommend initiation of Aito PAP therapy. I'll put a request in ASAP to his DR.

Thanks, going to submit what we have tomorrow. I think we have it covered.

We're getting ready to file a claim for sleep apnea, secondary to Fibromyalgia. I have a nexus letter but I know that sleep apnea claims are one of the toughest to get approved. For those who have gone through this, do you think we should get our own DBQ and submit it with the claim? Would they just order another one anyway because they do everything they can to prove a claim isn't good enough. If they have our lay statements, a nexus letter and a completed DBQ both signed by physicians it would be 4 pieces of positive evidence with no negatives. I'm planning to submit this as a decision ready claim. I also have his sleep study from the VA confirming his diagnosis in 2014 (severe apnea, CPAP required) What do you think?

Yes, that is basically my question...when a secondary condition is service connected based on a primary condition "aggravating " it, it falls under the Allen Aggravation rules. That says that the secondary condition can only be compensated for the difference between the baseline (degree of illness prior to aggravation) and the post aggravation. So in my husband's case he used a CPAP prior to the Fibro and after. 50%-50%=0%. What the Fibromyalgia has done is make his sleep worse due to the pain. He wakes up in pain. I'm glad she didn't say "aggravated by" . She is reworking the wording to make it clearer.

Yes, fibro is presumptive and I'm expecting 40% for that. I believe we have that claim tightly locked up but you never know. I'm concerned about the OSA rating that we are trying to tie secondary to the Fibro.

Update, we got the nexus letter and it DOES NOT state the OSA was aggravated by the Fibro. It says "It is at least as likely as not that the veteran's Obstructive Sleep Apnea is secondary to the veteran's fibromyalgia. The Dr. states in her rationale a medical reference linking the two conditions and how his particular REM sleep mimicked that in the study showing that his type of OSA was just like that and therefore secondary to his condition. I'm still worried about the dates of the two diagnosis. I asked them to add more to the nexus letter stating why Fibro diagnosed in 2019 could be the cause of OSA diagnosed in 2019. They said it is due to the dates the Fibro started (1996 documented in medical records) and that the symptoms of the Fibro were there for many years prior to the diagnosis. That made sense to me so I asked them to put that detail in the nexus letter.

We are just about to file a claim, like no later than Sunday, and I'm about to pull the plug on part it. I'm afraid we will not be getting what we expect. We filed an intent to file last June 3rd, 2018 We will be filing a claim now for Fibromyalgia and OSA secondary to the Fibro. My husband is a Gulf War vet (1979-1999 with 2 trips to the Persian gulf) so we are filing the Fibro as a presumptive to that. We have the current diagnosis, lay statements, proof he was there and all the medical records from his time there to present where he was treated for the symptoms of Fibro prior to the actual diagnosis. We hired a company, Valor4Vet to review his C-file and all medical records and if they could, write a nexus letter for OSA. They reviewed everything and said they could provide a nexus for OSA secondary to the Fibro. This is coming from a Dr. At first I thought great but now I am afraid it will just get rated with 0 compensation. Here is why and please tell me I am wrong. He was diagnosed with OSA in 2014 and has used a CPAP machine since then. He was just now diagnosed with Fibro although the symptoms date back to his time in service. The nexus letter, which should come in an email any minute now, is going to state that the Fibro aggravated the OSA. Not that it caused it but that it aggravated it. This is true, even though he sleeps with the CPAP, he wakes up in pain nearly every single night from the pain of the Fibro. So I have read that you have to establish a baseline for the secondary condition prior to the primary condition aggravating it. Since he has been sleeping with a CPAP since 2014 and just now got his Fibro diagnosis, I'm afraid his baseline and his current OSA would both be at the 50% level, therefore no compensation would be awarded. I think it would be quite a stretch to say that his Fibro caused his OSA or that his OSA was "proximately due to" his Fibro. Am I wrong in how it would be rated? I don't want to apply for it only to get SC and then get 0%. I would rather fight the tough battle to get a direct service connection.