rexlan

OK ... I have already spent hours on this and this was last resort. I always do my own research first. Can't even get an answer from the VSO and VA sites are not stellar -- I will move on.

Thanks much

I looked at claims and I see 3 methods and only one allows new evidence. I an not sure how to proceed and or if I need to complete the NOD of just ask for a supplemental decision review and then submit my new documents.

Great discussion. I am badly overweight but only because I love to cook and eat - I make a LOT of sausage and nothing better than that with some fine pasta - so, that won't fly and the fats on me - literally ... lol.. Also, I do not take meds for PTSD and tossed them in the trash when they were initially given to me. I filed the sleep apnea claim as secondary to the PTSD but only submitted a simple statement about Viet Nam and a completed DBQ signed by my doctor. I also submitted the sleep study and it says severe sleep apnea with an AHI of 58.9 and oxygen desaturation as low as 63% - killer stuff. I was prescribe a CPAP machine as medically necessary and bought one. I use it every night and do well with it. I had another post about the battery backup after I lost it 2 nights because of a storm and I could not sleep at all. The VA, after a lot of fighting, finally gave me a CPAP and I use it and put mine away for a rainy day. The VA had a nurse practitioner called me and she did an interview, confirmed all my stuff and she concluded that my sleep apnea was LESS likely than not caused by my PTSD. Not sure how she could conclude that but she did and the VA denied the claim. These are the notes she made with her examination 73 MARINE CORPS VETERAN WHO IS CLAIMING OBSTRUCTIVE SLEEP APNEA SECONDARY TO PTSD. EXAM CONDUCTED VIA TELEPHONE INTERVIEW. REPORTS WHILE IN VIET NAM HE WAS TOLD HE SNORED SO LOUD THE ENEMY WOULD FIND THEM. REPORTS HE ALSO HAD FATIGUE AND SLEEP ISSUES OVER THE YEARS. REPORTS SYMPTOMS WORSENED OVER THE YEARS WITH FALLING ASLEEP DURING DAYTIME. REPORTS HIS WIFE INSISTED HE BE TESTED. REPORTS HE ALSO HAS COPD. PER DR. HOVEY, MD PULMONOLOGIST NOTES IN VBMS VET WITH STAGE 3 COPD ON CONTINUOUS OXYGEN, DX. ON 1/229/2019 RESPIRATORY FAILURE WITH HYPOXIA - 86% O2 SATURATION ON ROOM AIR. STARTED ON CPAP 1 YEAR, REPORTS 100% IMPROVEMENT IN AHI. REPORTS HE STILL FEELS FATIGUED, SNORING HAS STOPPED AND STILL FEELS SLEEPY IN THE DAYTIME. REPORTS HE IS DIAGNOSED WITH NARCOLEPSY. She concluded this: b. The OBSTRUCTIVE SLEEP APNEA claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service connected POST TRAUMATIC STRESS DISORDER. RATIONALE: VETERAN DIAGNOSED WITH SEVERE OBSTRUCTIVE SLEEP APNEA 2/11/2019 BY POLYSOMNOGRAPHY. WHILE OBSTRUCTIVE SLEEP APNEA AND PTSD ARE RECOGNIZED AS HAVING AN ASSOCIATION WITH OVERLAPPING SYMPTOMS, THE CURRENT MEDICAL EVIDENCE ESTABLISHES NO CAUSAL RELATIONSHIP BETWEEN OSA AND PTSD (NIH; MAYO CLINIC). THUS BASED ON THE MEDICAL EVIDENCE: The OBSTRUCTIVE SLEEP APNEA claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service connected POST TRAUMATIC STRESS DISORDER. Claim Denied.

I filed for sleep apnea and it was denied as service connected. I have all the documents and use a CPAP daily so the issue is secondary to PTSD and service connected. I am inclined to just let this go; however, I started my sleep issues in Viet Nam but back in the mid 60's most folks did not look for help because Viet Nam was pretty unpopular with the folks back home. I have had sleep issues all my life after military. But in fairness I was just 18 when I went in (4 active USMC). My question is if it is worth an appeal or a supplemental claim? I can get my doctor to give me an opinion letter and state how the sleep issues relate to PTSD. But the big question is if I already screwed up by letting the VA nurse have here say first. My regular doctor filled out the original DBQ but we did not offer an opinion at that time. I am 70% for PTSD and don't need more money but I would like to get 100% so I can get the full benefit of what we were originally promised. Advice or personal experience with the supplemental claim process - thanks very much.

Buck52 It sounds like your sleep clinic is as bad as mine. There is NO POSSIBLE WAY for you to screw up the machine. Change settings = yes, but easy to adjust. As I said in my other thread, 99% of the titration sleep studies are WRONG. Strange bed, environment and you will never have a normal sleep. It is quite marginal with an at home study too. Almost always the machine pressures are set too high and this causes mask leaks and awakenings. They set mine at 5 to 15 and I could not sleep at all. Started tweaking it and found my sweet spot to be 5 to 7.5. My AHI now averages about 1.8 and has been great for almost a year. Unless you have a really severe blockage more pressure is not necessarily the answer. You can tweak it and only change it 1 Cm at a time, test 2 nights, until you find what works for you on pressures. The flex setting that reduces pressure during exhale is also important and mine is set a 2. (1-3 is available) Also you need to look at the Sleepyhead software and download your sim card. Then you can see EXACTLY what is going on, when you have an apnea and if it is a central, obstructive or hypopnea. You will also be able to see the machine automatic pressure adjustments while you sleep, arousal when you wake up, etc. Fort me, the arousal right before I wake is associated with a high pressure then a mask leak as a result ... lower pressure for me get back a shallow and calm breathing pattern and I sleep great.

Thanks for this reply. I know the advocate I've dealt with has not been helpful and my primary Dr. is worthless and I have consequently pissed her off probably. The CPAP clinic has been terrible. But I will reach out to the advocate again on this issue and see/report what happens.

As usual great information and replies -- thanks very much!! My stuff is Viet Nam PTSD (1965) .. I let it go close to 50 years and only applied last August. Funny thing is I didn't want the $$ just the health care we were promised back in the day -- totally rethinking that now.

I have run into this new issue and feel that my VA system in Alabama is using a different set of procedures compared to others. I am 70% rated,on oxygen and CPAP so all medical is covered. After 3 months of struggle I finally got a CPAP machine from the VA - but it was a struggle. We lost power here after some severe storms and it was off for 2.5 days (2 nights). I ran out of oxygen battery from my portable in 7 hours but OK. However, I could not use the CPAP and I had a really rough 2 nights. My friend is in NY and on CPAP as well. He asked about camping and his VA sent him a battery unit for his Philips Dream Station like mine and a 12 car adapter ... very nice stuff. He is rated 10% but not for sleep apnea so I's not sure how all that works. I asked my sleep clinic in Montgomery if the had the battery unit OR (important OR) a 12v car adapter and I could make my own OR if they had a bad power unit so I could just get the plug on the end and make my own. I got what I thought was a pretty arrogant reply - "The VA does no supply any battery backup for CPAP but you can purchase your own on the Internet" - well no shit! I thought that was a horribly attitude and no mention or the OR possibilities. So my question is if the VA has uniform policy or did my friend just get very lucky? It seems that all of the VA clinics should offer the same supplies uniformly. Does anyone have experience with this? Thanks very much for the input.

Update: I guess I complained long enough that the VA decided to mail me a machine after all. They just called and said I should have it by the end of the week. Thanks to all for the great advice - I learned a lot here and will be back!

Dream station ... hold the dial button and the ramp button on top for 5 seconds ... it will bring up the therapy menu ... make the adjustments then exit. What are your current pressures, flex setting, ramp setting, heated tube, humidity? I am not into all of the we are going to die drama. Very few die from sleep apnea, more so because of the underlying conditions like me with COPD and blood pressure. I am very conservative and 100% of the sleep titration studies I have seen get it wrong. You are in a strange environment and nothing is "normal" about it. The tech monitors occasionally, changes the pressure and watches the AHI and looks for centrals. Boom, you're good to go and you're all set he says - well not so fast cowboy, let's get it right for me instead.

@pete992 I am very familiar with sleep apnea and as I said I am 100% compliant. I download my data every week and use Sleephead SW to review it. I also lay my oxygen on top of the data so I have a real timeline. I get along very well with it so I am fortunate. @broncovet ..... I can help you with the settings if you like ... what machine do you have? It took me a long time to get mine right and I now use 5 min and 7.5 max. I found that the labs really crank them up and this causes allot of issues, especially mask leaks that used to wake me up. Now my AHI is less than 2 always.

GBArmy: This started because the tech at the sleep clinic suggested (no me) that he could come to my area and I could pick up locally ... then he waffled and then my primary said she would not authorize the travel and here we sit. You are very observant - I haven't been open minded because from my point of view my primary is not qualified to treat a dog and she has not been helpful at all so I got a bad taste right off the bat. However, I am not unreasonable and did not get this far in life being a jerk. I offered every accommodation I could think of including the video conference, sending to a local DME and to my PCP and they said "we don't do that". Perhaps I am being unreasonable. I am not broke and I can just go buy a new machine. I resisted filing a claim for 50 years and was finally persuaded to do it in August. It has been an unpleasant experience even though I was treated very fairly and given 70% rating. I had much higher expectations for VA Health Care and I cannot use this PCP. She simply is less than half speed. Thanks for the input.

Thanks for the replies. Well, I have been using the same machine Philips Dreamstation, for a year and know as much about it as they do - they also know this. I have 100% compliance now with mine and my AHI is down to 1.8. It was 58.8 when I did the sleep study. So, it seems to me that it is a policy issue or a hard nose in the clinic and it is going to be his way or no way - that is my impression anyway unless I can find a bypass. I am Viet Nam, USMC, era and travel is not easy, COPD, oxygen, etc. .. my wife does most of the driving so transportation isn't an issue. If I catch this virus I am DEAD so there is no possibility I will travel to a major area full of sick folks to pick up a CPAP machine in-person ... nope. Where I am in lower Alabama we only have one case ... at Montgomery where the clinic is there are a thousand. Good information on the advocate - she has been totally worthless to date. I am 70% rated so I should have 100% VA health care coverage. They have not rated the actual sleep apnea yet but if they do I will be 100% rated. I am already in group 1. I just don't know where to go next and have successfully PO'd some folks after messing with them for 6 weeks. Thanks again for the replies!

I am new to VA since January 2020 and have a 70% rating. I have been using a CPAP for a year and it has worked well. My machine is about shot (bought it used). I was approved to get a new unit from the VA but they said I had to drive up to Montgomery, Alabama (2++ hr. each way) to pick it up in person. I told them at my age and with the complications of COPD and oxygen I did not feel safe traveling that far. They have refused to mail me a machine which is exactly like the one I am using now and have used for a year. I asked to have it mailed to me and they said no. I asked to have it sent to a local DME and then do telehealth with the clinic - they said no. So we have gone around on this for 2+ months now and it seems unreasonable, especially now with this virus stuff. I went to the advocate who lucky for me is in another state!!! She has done nothing to help and just tells me it has been refereed to management ... I aske my primary 3 times about this and she passes the buck back to the clinic. So I can't get past the advocate who is worthless and the CPAP clinic says TS. Is my only option to just roll over and beg or play dead? If this is VA health care it really sucks and I can't imaging what folks who are totally dependent on it must put up with. Any advice how to get this VA in Alabama to help? Thank you