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Seems the VA can on occasion consider obesity merely as a "symptom"* and perhaps even the type of symptom that the VA alleges is caused by the Veteran's own willful misconduct of overeating or being inactive so it can deny the claim. However, since the American Medical Association ( AMA ) recently in June of 2013 has officially declared that "obesity is a disease", might that allow disabled veterans whose service connected condition(s) led to excessive weight gain to now find more success claiming obesity as a ratable secondary medical condition or a disease aggravated by the Veteran's service connected condition(s)? *"Obesity Service connection is not warranted for obesity. Claiming service connection for obesity amounts to claiming service connection for a symptom, rather than for an underlying disease or injury which may have caused the symptom. In this respect, obesity, in and of itself, is not a disability for which service connection may be granted. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has defined "injury" as "damage inflicted on the body by an external force." See Terry v. Principi, 340 F.3d 1378, 1384 (Fed. Cir. 2003), citing Dorland's Illustrated Medical Dictionary 901 (29th Ed. 2000). Thus, obesity caused by overeating or lack of exercise is the result of the veteran's own behavior, and as such is not an "injury" as defined for VA purposes. See Terry v. Principi, 340 F.3d 1378, 1384 (Fed. Cir. 2003) (defining "injury" as "damage inflicted on the body by an external force"). The Federal Circuit also defined "disease" as "any deviation from or interruption of the normal structure or function of a part, organ, or system of the body." Terry, 340 F.3d at 1384, citing Dorland's at 511. Obesity that is not due to an underlying pathology cannot be considered to be due to "disease," defined as "any deviation from or interruption of the normal structure or function of a part, organ or system of the body." Id. The body's normal storage of calories for future use represents the body working at what it is designed to do. It is well settled that symptoms alone, without a finding of an underlying disorder, cannot be service-connected. See Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001)." - from a BVA 2009 Decision ---and--- "Obesity or being overweight, a particularity of body type, alone, is not considered a disability for which service connection may be granted. See generally 38 C.F.R. Part 4 (VA Schedule for Rating Disabilities) (2009) (does not contemplate a separate disability rating for obesity). Rather, applicable VA regulations use the term "disability" to refer to the average impairment in earning capacity resulting from diseases or injuries encountered as a result of or incident to military service. Allen v. Brown, 7 Vet. App. 439, 448 (1995); Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); 38 C.F.R. § 4.1 (2009). The question is thus whether the current obesity is a disability-i.e. a condition causing impairment in earning capacity. In this case, there is no such evidence. The veteran has not asserted that obesity causes impairment of earning capacity; instead he asserts that his obesity has caused other disabilities to manifest. There is also no other evidence that the claimed obesity is a disability. Inasmuch as the Veteran does not have a disability manifested by obesity and obesity is not a disease or disability for which service connection may be granted, the Board concludes that obesity was not incurred in or aggravated by service and may not be presumed to have been so incurred. This claim is not in relative equipoise; therefore, the Veteran may not be afforded the benefit of the doubt in the resolution thereof. Rather, as a preponderance of the evidence is against the claim, it must be denied. 38 U.S.C.A. § 5107(b) (West 2002)" - from a 2010 BVA Decision But didn't the VA as early as 2006 already characterize obesity as a disease? "Obesity is a complex and chronic disease that develops from an interaction between the individual’s genotype and the environment." - http://www.healthquality.va.gov/obesity/obe06_final1.pdf "The AMA's decision essentially makes diagnosis and treatment of obesity a physician's professional obligation." - Los Angeles Times http://www.today.com/health/obesity-disease-doctors-group-says-6C10371394
My sleep apena claim, started in Oct 2011 has been approved. My contention was that my apnea is aggravated by my weight caused by inactivity and drugs used for depression and chronic pain. When I get the decision I will analyze it and its relevant notes for the decision to see if I can identify anything that might be helpful to others. I was not diagnosed before discharge with apnea, nor was I receiving treatment in service. I didn't even get checked for it until September of last year, when a CPAP was issued. I've read so much on here about how difficult it is to get sleep apnea service connected, especially if you don't have an in service finding. Here's to hoping that my decision renders some insight into what their rationale was. Many others here and on VPN have tried to service connect apnea with varying degrees of success and failure, but the arrow seems to point more towards failure if there is no in service finding. In True VA Fashion ™ it makes little sense. I submitted all sorts of documentation, because id read on here that it is such an uphill battle to get this service connected especially with no in service diagnosis. My finding letter came, and despite the list of reviewed material, the actual Reasons and Basis is about 2 sentences long: "We have assigned a 50 % evaluation for your obstructive sleep apnea based on: 0-Requires use of breathing assitance device such as continuous airway pressure machine." Thats it, folks. No quoting my material, no quoting of things in my Dr's letter, not quoting of the record itself or the sleep tech's finding. I claimed it secondary to weight gain, pain and inactivity due to chronic pain, depression, and intervertebral disc syndrome. Ill post my Dr's letter below that was submitted. The rest of what I turned in was pretty standard. A statement from my wife, the sleep tech records, there was a C&P that was about 20 minutes long. I had some treatment notes that had been submitted for ED that I mentioned my issues sleeping with her as well, but I can't find those. Mr. Satterfield has been a patient of mine since October of 2000. The conditions that I examined him for are chronic lower back pain and sleep difficulties. I personally reviewed Mr. Satterfield's medical history including his service medical records from April 2001 to February 2002; and his VA rating decision rating decision C-file and C & P final report for service connection for degenerative disc disease dated September July 2002. His contention today is that he is having difficulty sleeping and that his wife says that he stops breathing several times a night during sleep. Mr. Satterfield was prescribed Elavil (10Mg) for sleep difficulties after his injury by Kenner Army Health Clinic, Ft. Lee, VA, and continued to take them after his discharge from service, and also takes Ultram, Flexaril, and Ibuprofen for pain, as prescribed by the VA. Currently he is prescribed Hydrocodone, Meloxicam, Gabapentin, Temazepam, Seretraline, and Omeprazole. It is my opinion that it is likely that Mr. Satterfield’s sleep difficulties are aggravated by his service connected degenerative disc disorder and chronic pain, and the weight gained because of it. I also feel that it is at least as likely as not that Mr. Satterfield’s continued obesity is aggravated by his service connected degenerative disc disorder and pain, since his continued efforts to consume fewer calories over several months have resulted in very little loss. Sleep disruption caused by obstructive sleep apnea can certainly be exacerbated by certain narcotic pain medicines, SSRI’s, and increasing weight. Mr. Satterfield has no prior symptoms of thyroid or metabolic issues, and had no reported sleep difficulties or weight related health problems prior to enlisting into the Army in April of 2001. He has been eating below maintenance for his weight and build, but continues to have difficulty losing weight. Because of these things, and the observations of his spouse it is likely that Mr. Satterfield has undiagnosed obstructive sleep apnea with an onset that started after his service connected injury and the weight gained as a side effect. Sincerely, CLAIM: Sleep Apnea W/CPAP secondarily aggravated by medications, pain, obesity, and depression due to service connected lower back injury. In Aug 2001 I was diagnosed with a lower back trauma that was LOD directly to an injury incurred during training at Ft. Jackson SC. At that time I was still actively serving, under profile with a weight of 192-195 lbs. I was transferred to Ft. Lee, VA for AIT to await a decision about a MEB/PEB. As I was under strict PT restrictions and duty restrictions, and in a state of constant (albeit treated) pain, my activity level plummeted and my weight started to increase. Being that I was in a training environment at Ft. Lee my diet and activities were still restricted as that of any other trainee. I left Ft. Lee in January of 2002, still just under 200 lbs. In the later part of 2001 I was prescribed Elevil to help with sleep disturbance issues by either Doctor _________ (Kenner Army Health Clinic) or Dr. ________(Kenner Army Health Clinic). I was not diagnosed with sleep difficulties prior to this time-having been married before enlistment, this would have been noticed by my wife. This prescription for elavil was filled to excess before I processed out of Ft. Lee, VA so that I would have time to set up civilian or VA health care. I continued to take Elavil for sleep disturbances, along with Ultram, Flexaril and Ibuprofen for pain until my prescriptions ran out a few months later. In that time I received a C&P for my lower back injury which was ruled service connected. During this time my weight continued to increase due to inactivity and pain. In my initial C&P examination by PA-C J_______ I was noted to be obese 4/29 /02. In December of 2002 . I sawcivilian _________ Medical center (Dr. _____) to refill current medications for pain and sleep issues, including elavil. In a later examination by PA-C __________, Lincoln VAMC I was noted in January 2003 to weigh 257 lbs when I saw him about pain and medications for pain. I declined to add elavil to my VA medications at that time, hoping that my sleep issues would work themselves out with better pain management. My psychology treatment records by Dr. R_______ indicate sleep disturbances, and my struggles with weight loss/gain as well, and they are incorporated into my overall rating for depression. Inactivity due to pain is also noted throughout, and prior history is established that I was active prior to military service (theater/music) and obviously during service until my injury. I currently weight (10/15/2011) 312 lbs. Post service I have struggled with my weight due to inactivity or due to medications taken for pain that have side effects of weight gain. I may lose 5-10 lbs on a severely restricted diet, or an increase in activity, but pain, motivation issues, and depression issues cause me to gain it back. I take one medication, Hydrocodone, in a direct attempt to BECOME more active to try to lose weight but thus far it’s results are unquantifiable because of the myriad other issues contributing to my weight. In October of 2011 I was diagnosed at the Omaha VA Hospital with Sleep Apnea, and, on the basis of the sleep study, issues a CPAP machine (thank you!) This has helped control my apneic sleep disturbances that I feel are a result of my weight gain from my medications, depression, and lower back injury. It may be that since Elavil was not prescribed until after my injury in 2001 that the beginnings of sleep apnea extend to that point where I started to gain weight before discharge from the Army, and have steadily increased since. PA-C D_______ (Omaha VAMC) opined during counseling that Sleep Apnea is a result of either genetics/physical jaw issues, medications, Psychological issues (PTSD, etc), or obesity, and that it can be caused by, or CAN contribute to obesity and depression, and that my issues with both most likely come at least in part, from this etiology. He also advised to “avoid etoh/sedative/narcotics (do not increase hydrocodone dosage)”. His advisement directly contravenes my attempts to be more active to lose weight, by reducing the options available to me for pain management. However, dying slowly in my sleep is not an attractive option, either, and so I am inclined to follow his reasoning. In doing so, however, I must limit my activity. My psychology treatment records, military medical records, and treatment records from Lincoln VAMC are in my CFile. My consult from Johnson County Medical Center is in my CFile. My Omaha records from my sleep study are in VISTA. Please find and adjudicate accordingly. Per prior rulings by the DVA, with sufficient evidence, Sleep Apnea post discharge has been granted service connection in cases as secondary to obesity , MH issues, and medication when one or more of those are service connected. Citation Nr: 0905272 Decision Date: 02/13/09 Archive Date: 02/19/09 DOCKET NO. 04-16 673A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida Thank you. Here is what I filed: