Lavish

I am 100% SC for MDD and Anxiety and have a 50% rating for SA as a secondary condition. It was a long hard fight after several denials, and it took getting a C&P examiner that cares and knows the VA game. The studies the C&P examiner referenced are: Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008 - PubMed (nih.gov) and Depression as a Manifestation of Obstructive Sleep Apnea - PMC (nih.gov) Hope this helps someone else.

Jamescripps2, Why did you file for an increase for diabetes when you have three 100% P&T ratings?

ArNG11, This is my concern as well. I'm rated 100% for MH and I work a full-time job; however, if it weren't for the meds, I would be a complete basket case.

deedub75, Yes, I filed as secondary, but the examiner said OSA was likely cause by obesity and sedatives (she apparently didn't fully review my records because if she had, I'm SURE she wouldn't have said that). I agree that the examiner may have already made the nexus with the statement about the sedatives, since I take them as part of my treatment for the depression and anxiety. I also feel, as you stated, that the VA will would probably not honor it.

Dustoff, I think most have to actually go to BVA to get awarded OSA, even when there is sufficient documentation in the file. I just don't think I'm willing to do that because the long wait for the decision would be too nerve racking for me. I know one should file it and forget it, but I wouldn't be able to do that... my mind already runs a 1000 times a minute worrying about things.

broncovet, I've been diagnosed with major depressive disorder and anxiety for over 20 years. The VA only awarded it as of 2015, after over 20 years of filing claims, it taking VA years to make a decision - only to deny, and then me letting the claims die w/o appealing. But, yes the "sedatives" are prescribed as treatment of the insomnia related to the depression and side affects of the depression medications.

broncovet, thank you for your response. That was my concern (I don't have a nexus) - just my theory of the cause of the weight gain due to the meds which likely caused the sleep apnea along with some documentation of the weight gain. I wouldn't mind paying someone to give an IMO to provide a nexus, but I read so many post about people who were still denied even after a nexus. The reason for pursuing it is for the back pay. I may not pursue it; however, I'm wondering if the VA denial letter stating that the examiner said "sleep apnea is more likely due to being obese and taking sedatives" is a nexus in itself, since I take the sedatives to part of the treatment for the mental health condition. Your thought?

I am trying to decide if I should file a supplemental claim for Sleep Apnea to get back pay from a claim I've kept alive since 2015. My last Sleep Apnea claim was a HLR that was denied April 2021. As of 2020, I'm rated 100% P&T for depression and anxiety, after filing for an increase. In 2015, I was rated 50% for depression. In 2021, I received back pay for a 40% Fibromyalgia rating, with an effective date of 2015, since I'd also kept that claim alive. I was denied Headaches and CFS, but later awarded 0% for CFS in a HLR with an effective date of 2015. The CFS C&P Exam was conducted as part of a Gulf War General Medical Exam. During the Gulf War General Medical Exam, several different DBQs were done as part of presumptive conditions related to the Gulf War - two of them were Headaches and Sleep Apnea. However, none of these DBQs were addressed in the HLR, CFS, decision letter - apparently since the exam was specifically requested for CFS. I'm going to submit the supplemental for Headaches and I think I will be awarded 30%, due to the examiner stating they are "a diagnoseable but medically unexplained chronic multi-symptom illness of unknown etiology". My question is, based on the below information from the DBQ for Sleep Apnea and the fact that I want to claim as secondary to medications that cause weight gain - which IS the reason I've gained the weight (I've taken every med in the book for depression) and perhaps also claim as secondary to Fibro, do you think I have a chance or am I just wasting my time? I've gone back through as many records that I could find to document my weight history, but have only been able to locate 1991 - 1998 (VA records) and 2005-present (PCP records). I stopped going to the VA in 1998 and my PCP said all of my records, prior to 2005, have been destroyed. Unfortunately, I started taking the depression meds in 2001 and that is part of the missing years. I am able to document a 62 pound weight gain from 1998 to 2005, but I don't know if VA would consider that to be normal progression or not, but the weight didn't start piling on until I started taking the meds. Note: VA previously denied sleep apnea due to the examiner stating that sleep apnea is more likely due to me being obese and taking sedatives. My headaches were denied because examiner stated my headaches are more likely due to the sleep apnea and use of sedatives. I am prescribed the sedatives (sleeping pills) due to my depression and insomnia. I've been having the headaches since the Gulf War. SECTION I - DIAGNOSIS Does the Veteran have or has he/she ever had sleep apnea? [X] Yes [ ] No [X] Obstructive ICD code: G 47.33 Date of diagnosis: 2/1/2010 SECTION II - MEDICAL HISTORY Date of onset: 1990s Details of onset: Veteran started having trouble falling asleep and staying asleep Course of condition since onset: [X] Stayed the same Any treatment, medications, or surgery? Zolpidem extended release 2B. Is continuous medication required for control of a sleep disorder condition? {X] Yes (if "Yes" list only those medications required for the veteran's sleep disorder condition): Zolpidem extended release 2C. Does the Veteran require the use of a breathing assistance device such as continuous positive airway (CPAP) machine? [ X] Yes [] No SECTION III - FINDINGS, SIGNS AND SYMPTOMS Does the Veteran currently have any findings, signs or symptoms attributable to sleep apnea? [X] Yes [ ] No If yes, check all that apply: [X] Persistent daytime hypersomnolence SECTION IV - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS SIGNS AND/OR SYMPTOMS [] Yes [X] No SECTION V - DIAGNOSTIC TESTING 5A. 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: 02/01/2010 Results: Obstructive Sleep Apnea. 5B. Are there any significant other significant diagnostic test findings and/or results? [] Yes [X] No SECTION VI - FUNCTIONAL IMPACT 6. Does the veteran's sleep apnea impact his or her ability to work? [X] Yes [ ] No (If "Yes" describe impact of the veteran's sleep apnea, providing one or more examples): Can't do physically demanding work; can't do work requiring accuracy

Dustoff 11, I am rated 100 P&T scheduler for major depression and anxiety and I work full time. I think they allow the working because medication helps. If I were not on the medication, I would DEFINITELY be unable to work!

Oh my! That's what I figured.

GBArmy, that is what would concern me. Dustoff11, how long did the BVA decision take?

Dustoff11, so you are basically saying that although you submitted an IMO from Dr. David Anaise to the VARO for OSA secondary to PTSD, it was denied and you had to file an appeal with the BVA in order for it to be granted?

Buck52, Those symptoms are SO ME! ArNG11, I would be fighting you (with the little energy I have) to get in front of you! I feel like the last 30 years of my life has been a total waste!

I might send in a supplemental claim for the headaches and sleep apnea and use the DBQs from the Gulf War Exam as the "new evidence". However, I did just go to my PCP about 2.5 weeks ago and requested something for headaches - because my last VBA denial for headaches was due to no "chronicity" of care. In the past, I would just deal with the daily headaches, take Tylenol when they got bad, and of course lay down when they got really bad and turned into migraines. Dr. put me on Amitriptyline for the headaches, I'm suppose to take 1/2 pill up to two 10 mg pills a day. I started 1 pill and it did help a little, but they come back. I move to 1.5 and now I'm at 2 a day as of a couple days ago and they are still coming back toward the end of the day. I've been dealing with them for 30 years now, so to just have a few hours where I don't have to deal with them is a relief.

I'm not even really concerned about the CFS rating - although, I do have both CFS and Fibro, which I know will be hard to rate with the MDD. However, my main issue is with the headaches that I've had also for over 30 years and have been denied several times. I feel that the headaches should have been rated since a DBQ was done for them AGAIN under the Gulf War Exam. But BVA didn't even address the headaches, joint paint, sleep issues, or any of the other DBQs that were done. I feel they should have at least given a reason for WHY they rated 0% for CFS, other than just saying I'm diagnosed with it without any compensable symptoms - they need to go say HOW they determined no compensable symptoms. If it's because the other symptoms have been rated under my other disabilities they should say that. But, they didn't and can't say that because many of the other conditions haven't been rated under my other disabilities.

I got my decision for the CFS with the 0% rating, which states the below: REASONS FOR DECISION Service connection for chronic fatigue syndrome. Service connection for chronic fatigue syndrome has been established as directly related to military service. (38 CFR 3.303, 38 CFR 3.304) A noncompensable evaluation is assigned from April 26, 2015, the date VA received your claim. Since you continuously pursued and appealed your claim for benefits the effective date is the date the claim was received. (38 CFR 3.2500 and 38 CFR 3.2501, 38 CFR 3.400) We have assigned a 0 percent evaluation for your chronic fatigue syndrome based on: • A diagnosed disability with no compensable symptoms Note: In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. {38 CFR §4.31} A higher evaluation of 10 percent is not warranted for chronic fatigue syndrome (CFS) unless the evidence shows: • Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms controlled by continuous medication; or • Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year. (38 CFR 4.88a, 38 CFR 4.88b) I'm sure the 0% rating is due to cognitive impairments (such as inability to concentrate, forgetfulness, confusion) is because these are already rated in my MDD disability. HOWEVER, a Gulf War Medical Exam was also requested with the CFS C&P exam and the Dr. did 20 different DBQs as part of the Gulf War exam, but it doesn't appear that ANY of those were reviewed - even though "General Medical Gulf War" exam is listed in the evidence section. My concern is that headaches, fatigue, joint pain, sleep disturbances (which DBQs were done on as part of the Gulf War Exam) were not considered - and they aren't listed as part of my MDD disability rating and shouldn't be listed separately from my Fibro rating. What do ya'll think?

You mean Fibromyalgia, not Fibrosis, right?

Wow, I didn't realize a 100% vet could get reimbursed for any treatment out of the county!

The difference is, from what I understand, is that IBS can be rated at 0%, but CFS starts at 10%. Maybe they meant to put in 100%...I doubt it. I should be rated at least 40% though -easily. The claim isn't showing closed out yet, so maybe they are going to rate some of the other systems separately.

From e-benefits and speaking with an American Legion rep, it looks like the VBA has rated me 0% SC for CFS effective 2015. I thought the ratings for CFS had to be 10, 20, 40, 60, or 100. As of 2015, I am rated 50% for MDD w/ anxiety, and 40% for Fibro. As of 2020, I am 100% for MDD w/ anxiety. They are trying to screw me out of back pay and SMC. I did a C&P exam in August for CFS and Gulf War Illness. I was hoping they would rate me for all of the many other issues that I have since the examiner did DBQs on them, but definitely the headaches, which I was denied for back in May. I have so many issues that have been documented by the VA. How can they rate me at 0% for CFS and nothing for GWI? I know they are trying to lump the fatigue in with the Fibro and MDD, but there are a WHOLE lot of other issues related to CFS that isn't included in the MDD and Fibro award. I didn't think I would need to file a supplemental again for the headaches and other issues, since the examiner did DQBs for 20 different things - I "thought" VA would list them as secondary to the CFS or something, but I guess that was wishful thinking.

Ms. Bertha, Thank you for all the information. I did claim OSA as secondary to both MDD and Fibro, both were denied in that letter I attached. I'm currently waiting on a decision to my supplemental claim for CF...QTC did a Gulf War exam in August and about 20 different DBQs were done (sleep apnea wasn't one of them though) - the exam was mainly for CFS, but VA sent a "rework" request back to QTC because the dr. didn't provide a medical opinion for the fatigue in regards to my MDD and Fibro. I'll have to decide if I want to keep fighting after this decision - hopefully I won't have to. If I do, I will certainly use all the advice you gave!

Ms. Bertha, the sedatives are referring to the sleeping pills that I have to take each night, due to the MDD & and anxiety meds I take. I can't sleep a wink if I don't take them. I am aware that other veterans have gotten OSA awarded as secondary to mental health conditions...I guess it's just the luck of the draw..or maybe they had a better medical opinion given than myself. Also, from what I understand, board cases can't be used as "evidence" in a claim. Is this incorrect?

Ms. Bertha, I attached the denial for OSA.

Ms. Bertha, Thanks for the information. I will have to review it. I am SC for MDD and anxiety, but was denied for sleep apnea due to weight...even though I didn't gain the weight until I started taking the meds for MDD and anxiety.

Donny Dollaz, Is the 20% for the knee arthritis your only SC disability? If so, (IMHO) I don't believe you have any chance of sleep apnea being awarded as secondary to the knee. If you have some other issue (like depression), I would file that as secondary to the knee. There are probably several others that can more easily be rated as secondary to the knee than sleep apnea. Just do a google search for secondary issues related to knee arthritis and see if you have any of those conditions. If you do, file them.