Vync

Hmm... That's interesting. I thought they either approved or denied. Did not know they could just skip stuff.

Dano, Have they done an actual sleep study yet? I am looking into getting SC for sleep apnea, secondary to my SC sinus problems. I discussed my sleeping problems with my VA primary care doc. I explained that I felt my sinus problems are preventing me from getting a decent night of sleep. He gave me a referral for a sleep study. I got a questionnaire in the mail and also a date to attend a sleep education something-type class. Instead of mailing the packet, I am just going to take it in with me when I go. I got the ball rolling with my stuff, but am waiting to see how it turns out. That is just my experiences so far. Some of the other nice folks here might be able to provide their experiences and recommendations for you.

Just the thought of being on a ship with mines blowing up nearby is some scary stuff. Some of the elders here probably have better advice than me, but I think evidence is evidence. Don't send the original tape. Send them a copy and make sure you keep a copy in a safe place. Also, is there a chance that you can get a buddy letter to go along with it? If you have not already, request a copy of your military service records. There might some good information in there too.

Congratulations!

Sounds interesting. It would be cool to order a burger and not have to steamroller it before eating.

John, My teeth have not fallen out yet. Personally, I do not even look forward to having my teeth cleaned. Just can't hold my mouth open very far and suffer from really bad headaches afterwards. The bone grafts sound interesting, but I don't know if I want to know where they get the bone...

I lived in the Lenlock area, right across the street from the entrance to Ft.McClellan in 1989-1990, which is where I joined the Army. I was a military dependent until I joined. When I joined the Army, the only issues on my entrance physical were eyeglasses, acne, and minor allergies. Otherwise, I was in great shape. Since then, my health has gotten worse. I have a range of health issues, including heart problems, but have yet to be diagnosed with any autoimmune disorders. I know about Project SHAD/Project 112, in which soldiers and the public were exposed to various agents. Ft.McClellan is on one of the lists. There is a topic here regarding these projects (http://www.hadit.com/forums/index.php?showforum=87). Of course, the tests we know about are only the ones which were declassified. Also, don't forget that chemical plant in Anniston. I think it was called Monsanto. It was always in the news about leaks and contamination. I remember people nearby were given gas masks.

I don't know if they do these on a set schedule, but last week I requested mine and received a questionnaire in the mail on Saturday. They send you to a sleep apnea educational meeting prior to the actual study. Mine is scheduled for next week. I really have no idea what to expect, but will be leaving my pillow at home. Others here might be able to offer their opinions. I am hoping to have my condition diagnosed as secondary to allergic rhinitis/TMJ. It sounds wierd, but I can't really breathe through my nose very well, even with all the meds the VA gives me. Also, the VA made me a giant bulletproof night guard to help keep me from grinding my teeth at night. Even though I can breathe through my mouth, that thing gets in the way too. I am not sure which way to have yours diagnosed as secondary, but check this out. If they got it approved, then hopefully you can too. It looked like the Veteran who had PTSD also was overweight and they granted the claim on benefit of the doubt. Also note that this case is a bit old. http://www4.va.gov/vetapp01/files01/0102100.txt Citation Nr: 0102100 Decision Date: 01/25/01 Archive Date: 01/31/01 DOCKET NO. 99-22 315 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for sleep apnea as secondary to service-connected post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Richard A. Cohn, Associate Counsel INTRODUCTION The veteran served on active duty from April 1970 to December 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 1999 rating decision of the Department of Veterans Affairs (VA) Regional Office in St. Louis, Missouri (RO) which denied service connection for sleep apnea as secondary to service-connected PTSD. FINDINGS OF FACT 1. The record includes all evidence necessary for the equitable disposition of this appeal. 2. There is competent medical evidence linking current sleep apnea to the veteran's service-connected PTSD. CONCLUSION OF LAW The veteran's sleep apnea was aggravated by his service- connected PTSD. Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000); 38 U.S.C.A. § 5107, 38 C.F.R. § 3.310(a) (2000). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran attributes sleep apnea to his service-connected PTSD. The veteran does not contend that he incurred or aggravated sleep apnea during service and there is no evidence of sleep apnea or other sleep disorder in the veteran's service medical records SMRs. Procedurally, this appeal is developed fully and ready for Board adjudication. The RO has verified the veteran's period of service; there is no issue as to the substantial completeness of the veteran's application for VA benefits; the veteran has undergone VA examination pursuant to the application; the RO has requested and associated with the claims file all available service and postservice medical records pertinent to this appeal; VA is unaware of other unrequested records pertinent to this appeal, and; the evidence is sufficient to permit the Board to proceed with appellate review. See Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096, (2000). A veteran may be entitled to service connection for a disability under either a direct or secondary analysis. Direct service connection is warranted for disability resulting from disease or injury incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (2000). Secondary service connection is warranted both for a disability caused by a service-connected disorder and for a disability aggravated by a service-connected disorder. 38 C.F.R. § 3.310(a) (2000). In the latter case, compensation is limited to the extent to which the service- connected disorder increased the severity of the secondary disorder. Allen v. Brown, 7 Vet. App. 439, 448 (1995); Jones (Wayne) v. Brown, 7 Vet. App. 134, 136-37 (1994). A service- connected secondary disorder becomes part of the original disorder. 38 C.F.R. § 3.310(a). The veteran is a decorated former Army combat soldier whose PTSD has been service-connected since July 1995. SMRs include no evidence of a sleep disorder in service and the veteran claims none. VA medical records confirm that the veteran underwent sleep studies in February and October 1998 from which he was diagnosed with sleep apnea. A VA psychiatric progress note from February 1999 briefly reviewed the studies' findings and applicable research and concluded that PTSD and its treatment "in all probability has aggravated the obstructive sleep apnea." The note further states that "it is certainly as likely as not that this veteran's sleep apnea is directly related to his PTSD." The VA physician who examined the veteran in July 1999 identified two likely causes of his sleep apnea: enlarged tonsillar tissue and obesity. The physician found no etiological connection between PTSD and enlarged tonsillar tissue. However, he acknowledged that "an argument could be made" linking the veteran's obesity with PTSD although the veteran's medical records did not include another medical opinion to that effect. In the Board's judgment the record presents adequate evidence upon which to base a finding that the veteran's PTSD aggravated his sleep apnea. The opinion expressed in the February 1999 progress note is neither ambiguous nor equivocal on that point. The July 1999 examination report is more tentative -- finding only a medical possibility of attenuated causality under a different rationale. Nevertheless, the July 1999 opinion does not refute the February 1999 opinion, and it is well established that VA itself may not refute expert medical conclusions in the record with its own unsubstantiated medical conclusions. Colvin v. Derwinski, 1 Vet. App. 171, 175. (1991). Therefore, absent medical evidence actually denying a causal linkage between PTSD and sleep apnea in this case, the Board reads the two opinions together as providing, at minimum, evidentiary equipoise which must be resolved in the veteran's favor. See 38 U.S.C.A. § 5107(;). Accordingly, the Board is constrained to find that service connection for sleep apnea is warranted here under a secondary analysis. See 38 C.F.R. § 3.310. ORDER Service connection for sleep apnea is granted secondary to service-connected PTSD. WARREN W. RICE, JR. Member, Board of Veterans' Appeals

Berta gave some good advice there. Comb through your medical records and see what you can find. Buddy statements will likely come in very handy. Don't let the apnea go untreated. Go to the VA primary care doc and tell him what's going on. He will probably give you the usual quick checkup and then refer you for a sleep study, which will occur at a later date. I am researching too and found that sleep apnea is linked to some cardiac problems, but most of the time is linked to irregular heart rhythms and not necessarily HTN. You might need a pretty decent nexus letter/IMO if you want to have apnea SC.

Yep, I found out about the C-file the hard way and that's what they told me. I talked to a couple of folks and they said that I should get a copy instead of reviewing it first, as there are stories of the RO folks getting cranky about slow readers. Due to the way my claim is progressing, I need a copy of my C-File in order to continue my research. If I knew, I would have done it from the start. So, I am now playing the waiting game.

Go back and request an ENT doc who is qualified to use a scope. That tool is the heart of their occupation.

It sounds like the Nebraska office knows how to do things. Can we request our cases be transferred to a different RO? i.e. the competent ones?

Do you know if that also goes for deductibles or any other out of pocket fee, like the percentage that insurance did not cover?

I called the 800 number and some dude told me I could review my C-file by just driving to the RO and walking in. Turns out I was given bad info. They said that it is stored in a warehouse or is being worked on somewhere. They told me it would take three months because other people are in line ahead of me. 700 people, they say. Larry's comment sounds right, but I don't know the workings in the RO. I want my C-file going in one direction. Forward...

My best/only friend, other than my girlfriend, retired from the Air Force. They also told him that he made too much for care.

Wow, I wish you the best of luck in your surgery. Take care of yourself over there. Remember, we're here if you need someone to talk to.

John999, Yes, they gave me one because my first duty assignment was highly classified. I think the DOD also visited half my family members and even interviewed their neighbors too. After about a year, I started having trouble with nightmares and they quickly referred me to MH for re-eval. They just told me I was overworked.

No implants here yet. I am SC for TMJ and grind the hell out of my rear teeth. They did not give me implants, because of the amount of bone loss beneath the second molars when the Army hosed up my third molar extraction and the fact that I grind like crazy. Instead, they installed several gold crowns and made me a bulletproof night guard to wear when I sleep. Also, they won't give me porcelain fillings in the rear teeth. They said I would shatter them within a couple of weeks. Instead, I get the silver fillings back there. They did say that they would install implants if I started losing my front teeth. I'm category 1 with the dental team. I think they are choosing to be realistic in my case.

Also, remember the golden rule. The VA does not recognize common sense. You can have a mile long list of problems in your service treatment records, but the VA often will come back and tell you that the very same problem is not service connected. This happens even if it is painfully obvious.

Did your orthopedic doctor write you an IMO/nexus letter? Was this submitted as part of your claim? Sometimes the VA will disregard a nexus letter unless it has specific airtight wording.

Fletch, Glad to help! Check this out: C-File I requested my C-file by submitting form 21-4138 via mail and have a tracking number. I called the 1-800-827-1000 number and they said it should take about a month to get them. I read where a number of other people say it can take months to get them. When I went to the RO, they said it takes several months. I did get a letter last week telling me that my request had been received and they are working on it. I did an IRIS request and got pretty much the same response. VA Treatment Records On Nov 2, I physically went to the Birmingham VA medical center and sign a paper to get them to send my medical records. The lady said it will take 20 business days (a month) to get a copy, because my records go back through 1995 are in storage. I found out "in storage" meant they were in St.Louis in a storage facility. This data is supposed to include any medical records from when I was treated in the Birmingham outreach clinic in Gadsden, AL, which is cool. I checked yesterday and they said that everything has been received, but it is waiting on supervisor approval before it goes out or can be picked up. Military service records: http://www.archives.gov/veterans/military-...ce-records.html I hope this helps!

Congratulations! That's awesome!

Fletch, Here's a link to the spine claim repository, which has the rating codes and range of motion associates with each diagnosis. Here are the ratings which are higher than 30% (from the topic mentioned above) and the reference describing unfavorable ankylosis: Unfavorable ankylosis of the entire spine 100 Unfavorable ankylosis of the entire thoracolumbar spine 50 Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40 Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

It would be worth a shot to ask. Also, how long did it take for you to receive your C-file?

I'm not an elder here, but it sounds like you might have a decent shot for a rating increase, but the VA might ignore some evidence. Let's hope that does not happen. If you really cannot move your back, you might get rated with unfavorable ankylosis or just ankylosis of the upper or lower back. There is no telling how long it will be until they send you a letter, so go ahead and see about getting a copy of the C&P letter. Compare the C&P notes with the spine ratings. Based on the range of motion (or lack thereof), you could get a pretty good idea of what to expect.