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Found 25 results

  1. Does anyone know if bruxism or TMJ can be SC secondary to sleep apnea? If so, how do I do that? Would a sleep doctor or dentist need to write a letter?
  2. so............... I WON MY CLAIM! sorry i had to get that out one more time. i am now 100% p&t. but my eed is december 2019 instead of the original claim date. i am trying to figure out what i need to do. should i file cue? should i just file a supplemental and ask for correction without cue? should i do something i am not even thinking of that you guys know better? reason i think cue is because in my letter, the judge specially says my original claim was 2013 and dx was 2008. it seems the vro clearly ignored this. also, they didnt even use the latest appeal date. i reopened the original 2008 claim back in 2013, but was denied and appealed multiple times and the last appeal was in 2019. Ill have to go through my c-file to get exact dates but this seems a big miss to me but maybe they are getting me on loop hole here because I didn’t reopen the original claim from 2008 until 2013, after the appeal window had closed. Any help or advice of course. Thanks guys for everything. I couldn’t have gotten here without your wisdom and encouragement! **EDIT TO INCLUDE PREVIOUS DENIALS FOR CONVENIENCE** here is the original denial: here is the the reopened claim denial: Denial for HLR: Denial for first CUE: Law Jude Decision.pdf decision-letter_osa_4-20-21.pdf
  3. A little background first on this specific claim to provide greater context for the readers. I had no idea that i had OSA until i got married and through the years my wife has told me about how i would snore really loud, stop breathing at night, choke, etc. pretty standard stuff for anyone that has it. I had buddies in the Marine Corps who told me the same thing after our first deployment, but i had always chocked it up to my dad snored so i snored, the stopping breathing thing was weird but i was 18/19 so your health isnt a primary concern and BAS is only for bones sticking out. I got out in 2006 and didnt make a claim for OSA until 2016. First i talked to my primary care then was referred to a VA pulmonologist. He ordered a sleep study and the VA fumbled it sending me to a private facility and did a in home test. When the results came back i saw in my VA health record the Pulmonologist was terse with his message saying he wanting a in facility sleep study so a month later i did mine at the VA overnight. I was diagnosed with Mild OSA and given a CPAP. When the CPAP arrived i spent a month trying to get it to work but every morning it would show only 45-60 minutes of time. I have nightmares at night, some i remember some i dont but would rip off the mask or when i woke up would be so worked up i didnt put it back on. I do cycles of trying it for awhile and stopping for awhile, giving it a chance because my wife is worried about the OSA and its health effects. My claim history was this, as i stated i made my first claim in 2016 and was denied. I reopened the claim (when that was still an option in 2018) and was denied again. What i submitted was bascially the VA medical record showing that i had it, that i was ordered a CPAP and sworn statements by myself, my wife and buddies in the Corps that stated they saw symptoms in 2003-2006. I had NO nexus or medical proof that it began in service I made a mistake in 2019 when it was denied again and NEVER filed a NOD as i kindof gave up when that and other new claims for increases were denied, but I DID make a intent to file back in July 2019. I was out of the VA regulation changes loop and didnt know that they had gotten rid of reopening and moved to the Supplemental evidence route so in February through April i decided to really focus on making a quality claim since my 2016/2018 claims were more shot in the dark hoping that the VA would just grant it. I went to specialists in the field for the claims i was making and got updated diagnosis of symptoms and effects, got my sworn statements (which in my opinion has more 'umph' than a buddy statement) more detailed in terms of observed symptoms, timelines and effects upon my life as well as i went out and got two IMO's. The first IMO was for PTSD from Dr. Elaine Tripi in Michigan whos IMO got the VA to drop their attempt to reduce my rating in 2015/2016 (and i suspect it was because her IMO made a case for an increased rating). In that IMO she detailed my history, current symptoms, etc as well as opined on how my PTSD affected my OSA symptoms and how it interfered with its treatment. I also got a IMO from Dr. Anaise who wrote a lengthy (near 50 pages) on how my OSA is aggravated by Tinnitus and PTSD and interferes with my ability to go to sleep, stay asleep and interferes with my treatment. When i submitted the claim (reopen was still available as an option on ebenfits) my new claims, increase and "reopen" were all lumped together as one big claim and sent off in April. As a sidenote whenever i send my claim i do so through ebenefits as well as fax AND send CERTIFIED MAIL WITH RETURN RECEIPT. i keep a copy of the USPS receipt with tracking, Cert Mail receipt and the return receipt and staple that together with my hard copy claim evidence in a folder for each claim ive ever made. The VA has a way of "losing" evidence and if you ONLY submit via ebenefits, regular mail and/or fax you cant prove they received it per say. This DOESNT mean they wont pretend they didnt get it but what it does is allows you to prove upon appeal that YES you did send it in the time window necessary for your claim AND that they did receive it because the return receipt shows Jim VArep did in fact get it on such and such day. So if you get denied its really important to look at your cfile after to see what evidence the rater actually looked at and if they dont have ALL the evidence in that file you can appeal on those grounds in conjunction with more evidence if necessary that X doctors exam or IMO proves your case, wasnt considered AND the VA had received it. So a few weeks after i submitted it, the VA sent me the normal letter stating they had received my claim for X,Y,Z New & increased claims but i didnt see anythign about OSA which was weird. a week later i got a letter from the VA saying that my claims for OSA were not new, had been denied previously and were not on appeal and gave me a list of options. I chose Supplemental Evidence since the IMO's were "new evidence" to be considered and met the criteria and it had been over a year since my denial so i couldnt submit a NOD and get the backdated effective date. This was my fault. One i gave up in 2019 and didnt file a NOD to hold my place and Two i didnt keep up to date with new VA regs regarding reopened claims, etc. Since that supplemental claim was received on 4/24/20 (todays date is 6/18/20) I have had two psych exams and two records reviews through QTC (private company the VA contracts to do DBQ/exams). The first pysch exam was related to my request for an increase for PTSD back in April and in May i had a NP contact me who was reviewing my med records for OSA and had follow up questions regarding my condition both current and past. In that conversation i talked about how i never went to go get checked because i never knew what OSA was at that time, thought it was normal to snore, etc., how BAS is frowned upon in the Marines for things like that, my history with it since i got out up to now and how my nightmares make me rip off the CPAP at night. I did ask her if she had seen my imo, other evidence and she said no JUST my medical record. I know examiners arent raters and all but I find it weird that VA will deny IMO's as valid if they dont "review veterans entire file" but will accept something from a examiner if its negative when only their VA med file is shared. Its great advice to always bring your evidence with you to a exam but given the current COVID situation ALL of my exams thus far have been telephone or video. I asked her what the exam was specifically for or what they asked her to examine and she said it was basically whether or not my OSA was service connected and occured in service. I do believe it was but i was making the claim as SECONDARY to PTSD and/or Tinnitus as an aggravation which she was unaware of. I fired off some angry messages via the IRIS system to the VA regarding this (no idea if they got included in my record or reached a rater since the only response i got was "thank you for contact us heres how to make a new claim"). Within the last 3 weeks i had a 3rd & 4th "exam". The third was a MD who was reviewing my records as well and asked alot of the same questions, she was also unaware this was a secondary claim for aggravation and had seen no evidence submitted or my entire file so i went through it with her again. The 4th exam was another psych interview which i was told was to examine my secondary claims to OSA, but knowing the VA i knew it was basically another review of my ENTIRE PTSD claim ive had as well. Vets should be aware that even if a exam is about something specific any evidence or statements made that can negatively effect an existing general disability & will be held against you. This was quite clear when he just asked about current PTSD symptoms and never ONCE asked about my OSA, etc. So i had to bring that up myself. VA.gov check claims hasnt been updated since a week after my claim submission. my OSA claim has said "we dont know your status" even now and my other new/increased claim stopped after "request for more information" (i.e. requesting new QTC exams). So ever few days i check that as well as ebenefits to see if any of the DBQ's show up in my blue button (none have but im guessing because QTC doesnt have to update the way in house VA does). Finally today i see on my disabilities list that OSA was granted secondary to PTSD for 50% bringing me to 90% with an effective date of 4/24/20. I know that this ISNT the same as a letter from the VA but i know someone who is a VA rater who has been giving me updates on my record so im 99% certain this ebenfits update is accurate. The takeaways are this. 1) Do the damn research and work the claim yourself, no VSO or rep is going to care as much as you do. You care about your case, they have 15,50,100 other vets whos cases they are working and even if they are a great VSO/rep they cant possibly give a crap as much as you do. dont hope the VA just "gives" you the rating you deserve make it so they cant NOT give it to you with the proper evidence. 2)IMO's are golden. I know not everybody can afford them, i couldnt per say and had to sell some things to come up with the $500 for Dr. Tripi and $1500 for Dr. Anaise, but they were well worth it, without them i definitely wouldnt have gotten my OSA approved. I think have both a MD stating both the phyiscal and mental nexus and a Psychologist stating the pure mental side gave it a one two punch. 3) Along with the IMO go to doctors/specialists in your area and get documented evidence of you issue, ask them to be detailed in the exam notes. I even emailed a couple time asking the doc (this wasnt for OSA but a different claim, but good general advice) asking them to update the notes to specifically include certain symptoms and effects upon quality of life. Having this helps alot, combined with IMO's its very difficult for a random NP to override their findings with one exam or phone interview. Remember the VA is military based in that the ranking officer rules. So if you only have a NP (nothing against NP's this is just how the VA works) from a urgent care saying you have OSA caused by PTSD or that your shin splints are 8/10 pain and they have a pulmonologist, MD or specialist say its only 1/0 and doesnt effect guess who wins. If you have two psychologists but yours has great bonafides and background and theirs has only been practicing for 5 years solely at the VA yours wins. Im not saying dont go to a primary care to document because youll only see a NP all evidence helps but be aware if they pull out a MD who counters that exams findings youre likely to lose. Because they will always want to lean to denial and if their person has more experience or is a specialist that will win over what you submit. Dont give them an option, and even if they do decide to rule against you, you can make a great appeal based on the fact they sided with their NP over a specialist in the field your making a claim for who knows more. 4) Never let claims die. Dont make a new claim until your ready to with great evidence (file a intent to file first though to preserve backpay/effective date) If denied make sure you keep a reminder about the NOD date and when you do file a NOD make sure that is certified mail with return receipt to prove you mailed it/VA received it before the deadline, because if you dont and they can make a case it was received 24 hours after the NOD deadline you lost you backpay date and possibly years of backpay. Now there are situations where claims die but if theres a opportunity to still make it on appeals hire a GOOD (there are alot of crappy ones) appeals attorney and move forward. I know they take 20%+ of your backpay but if you aent comfortable enough to navigate the appeals process its well worth it. 5) stay up to date on new VA regs, Hadit is a great source for this you dont want to be like me thinking that certain avenues are still open and they arent. If I had stayed up to date i wouldve been able to file earlier for the OSA and preserve YEARS AND YEARS of backpay now im only going to get 2 months. 6) I didnt do this for this claim although i should've and kept a diary of when i was using the CPAP, roughly when i ripped it off, data on how long i wore it, frustrations over not being able to wear it, info on my nightmares causing me to rip it off etc. years of diary entries wouldve been a help. I didnt need it in the end but if you cant afford a IMO things like this can help because theres NO SUCH THING AS TOO MUCH EVIDENCE. A diary is one of the key things that helped me win my migraines case. for months prior I kept a diary of my headaches and effects, then transcribed them into ebenefits health diary. I am not perfect at it but i now write as much as i can as often a i can in this diary about ANY service connected or possibly service connected illness (especially things that could be considered aggravated by a service/possible service connected disability). That way when you are making a claim or fighting a reduction you can pull out timestamped entries for months/years relating to it and it makes it harder for a rater to think you pulled this out your but last month to make a claim. A big thanks to everyone on HADIT. i did alot of research here through the years to help make my claims better and it worked Another big thanks to Dr. Anaise and Dr. Tripi for their outstanding IMO's that helped me win this.
  4. After Denials for OSA both direct and secondary to PTSD, this spring I decided to spend the money on a IMO and do the claim right. I contacted Dr. Anaise and was told to send all my records, decision letters and $1500. After about a week I was emailed with a final IMO report that was around 40-50 pages. It was excellent & well researched. Within 6 weeks of submitting the IMO with a supplemental claim OSA secondary to PTSD was approved. Yes IMO's dont guarantee anything and they can be expensive but they are definitely worth it when you have been denied already and have nothing else to submit and someone like Dr. Anaise will always outweight the NP the VA usually has doing exams.
  5. Good morning hadit, I have both ptsd and TBI and believe my diagnosed sleep apnea (mixed sleep apnea, with both central and obstructive sleep apnea) has been directly caused by my ptsd and TBI. I am not overweight, have no medical issues of the throat or the respiratory system that would cause it. My question to you all is if I want to file sleep apnea secondary to either of this conditions which one should i file it secondary to? I've found much more literature tying obstructive sleep apnea to ptsd but also found literature that ties both obstructive sleep apnea and central sleep apnea to brain injuries as well. Is it possible to file it secondary to both?
  6. I submitted a claim for Sinusitis, OSA,, and Tinnitus. My claim was denied for all 3. The tinnitus they claim was neither occurred in nor was caused by service. My job on active duty exposed me to gun fire, explosions, tanks, and tracked vehicles. I submitted the Duty Noise Exposure Spreadsheet that displayed my AFSC was rated as highly likely to be exposed to loud noise. In the first Exam they claimed I said my hearing loss was from jets flying overhead. Never said that, so they scheduled a second exam. This one they acknowledged the correct job but I was still denied. The evidence listed on the second decision dd not include the MOS Noise exposure chart I included on the first claim. I never went to sick call for ringing ears because that is just silly (had I known then) and was not something you did. I have had quiet office jobs since separating from The Air Force. What am I missing? For the OSA claim, I submitted Lay statements from my current wife and my ex-wife as well as explained to the doctor my symptoms and that when I was on Active Duty i had no idea sleep apnea was a thing. I assumed I just snored and was tired because I was working hard. I had a sleep study this past year and was deemed to have severe OSA. In my claim I listed that I believed my osa was related to my cluster headache disability. They responded Cluster headaches do not cause OSA even if there are many people with cluster headaches and also OSA. I experienced a stuffy nose during my headaches on the left side. This was completely different from the closing of my airway when I would sleep. It was just worst if both occurred at the same time. They claimed I have other risk factors such as being male, obesity, and advancing age. Something I did not include in my claim was the fact that I was on the Fat Boy program at one point on Active Duty and my SMR made a reference to obesity. Would this help support my claim. Also in the second decision they said I was a 73 year old male and I am no where near 73 so they probably mixed my records with someone else. What can I do about this? And Sinusitis, I have a couple diagnosis in my SMR's specifically listing sinusitis. I have had sinus issues since I was on Active Duty. I use a Netti Pot and have been diagnosed post active duty with sinusitis. The DBQ from the QTC Medical Doc claims I have rebound sinusitis because I mentioned using Afrin. I have always been aware of the danger of over use and in my VA records I discussed this concern whenever the VA would prescribe a nasal spray. What am I missing and how can I get this corrected. The errors on the 2 decisions make it seem as if they are not very organized and I have to suffer from their disorganization. Are they supposed to review all of the evidence from the initial claim when you submit a supplemental, or should I have resubmitted all the documents from the initial claim. Are the documents that contain research that supports your claim supposed to be on the evidence list as well? They were not on there and if they did not give those documents equal consideration what is my recourse. Any assistance would be appreciated Thanks for listening.
  7. Curious what to do with this piece of information. I was going through my c&p's and the one I had in Aug 2018 that bumped me to 100% has this line in it. "He reports breathing difficulties, diagnosed - Obstructive Sleep Apnea. " I was using my CPAP when my original C&P in 2013 was done. My record has all sorts of references to it, including the VA issuing me on and way. I have the Sleep Study results in my hands. So what paths are open to me? in the 2013 standards being issued a CPAP w/ an SC (PTSD) related condition should have given me a 50% rating. Today's standards say I need the medical opinion to state' "he will die without it" or other such magic word nonsense. what is my most likely path to getting it rated and possibly retro pay?
  8. Hey all I have been out of here for a while dealing with issues and am now in a wheelchair from leg surgery which just happens to coincide with my latest C&P results finally showing up. Before this latest I was at 100% plus few miscellaneous 10 and 0 %'s. The situation is complicated and I need to figure out my options in light of the changes between the legacy system, ramp and AMP (?). The first hurdle, is my original award in 2013 did not show evidence they evaluated my OSA even though it was documented, diagnosed in May 2013 and should have been in my medical records by the time they did the award. VAMC New Orleans claims to have "lost" those records but Tulane Hospital has provided them to me and I have notes in my record that I had one, that the records were annotated in my file (supposedly in my file) and that a CPAP was issued. I was never notified this was a compensable condition or that a C&P should be requested. I did not find this out until Aug 2018. There is also my tests done for Vertigo, including being waterboarded through the ear and having MRI's performed to find out if I had tumors causing the vertigo. VAMC New Orleans says they don't have these records but the same issue arises as with the OSA. I have the MRI, and my record has notes that the VNG was done. The award letter is silent on this issue. I have sent the VAMC FOIA requests on both issues multiple times and they don't even bother to answer me. When I call they just say there are no records and hang up on me. How can I reopen that original claim, and would it keep the original dates? To add complexity the original award denied me for hearing loss. The C&P examiner failed to look at my entire service record, instead she only looked at my first enlistment. I informed her of the Vertigo also but she made no mention of it in the report. On this particular issue, and the vertigo, the VA just rated me for 30% on vertigo and 0 for hearing loss. The dates for both were August 2108. At a minimum I want the hearing loss to be corrected back to the original date. It would also set up the argument for failing in their Duty to Assist and Notify on the Vertigo. I have my c-file and the notes and exams from external providers (sleep study and MRI). I believe this all constitutes New and Relevant (I guess that is the new term) Information. I just need to know how I process this under the new system? Is it a supplemental claim? will I get an EED? Other Factors: I will be filing a NOD on the recent 30% rating for Vertigo, the award letter has not yet arrived, it is over due, but the C&P doc was incompetent and my medical file shows that I am more in line with a rating of 60 or 100% for Meniures. I have VA treatment records recording my "drunk gait", nystagmus, and passing out from the vertigo. In 2013 time frame I would experience this 3 to 4 times a month in the worst months. Now it is 4 to 6 times a week, every time I roll over quickly or have any type of rapid head movement. So on the NOD, since it was for the August, 2018 claim, am I supposed to just file a typical NOD? can I ask for backdate (EED) based on the previous VNG and MRI from 2013 where they lost the records and failed to Notify or Assist me in filing a claim? My Vertigo has gone untreated and unassisted by the VA until 2018. It has grown significantly worse. This seems to constitute harm to me from their negligence. I want to note again in the decision about the August 2018 claim they did grant me SC for the hearing loss. Their error is clear and unmistakable. It is also tied to the Vertigo so the EED hearing would also seem to affect that; The VA does not send us for MRI's and VNG's (waterboarding) just for hearing loss, so they knew and started the process, they just dropped the ball in getting that info to the raters. Thanks for any help on the new processes.
  9. I was never diagnosed in service with OSA. I weigh 220 and I am 6' tall. I am rated at 70% for PTSD and the meds I take add to the OSA. I had my personal Dr. and the Psychiatrist I see both write letters to support that the meds I take add to and cause the OSA. My Dr filled out the DBQ and sent it in as well. I had a failed sleep study results sent in with my claim. I also have documentation I sent it that back up the fact that OSA is tied to PTSD and is aggravated by PTSD. Then sleeping with the prescribed CPAP machine adds to the PTSD. Just curious if anyone has ever won this claim? I am going to appeal but wanted to get any advise here first if someone has any to share.. not sure if there is anyone who has gone this route before and won? thanks!
  10. Hey everybody! Long time lurker, first time poster. My question is regarding the sleep apnea language that specifies that a prescription of a breathing assistance device is "medically necessary" for a 50% rating: Assuming that a vet is already prescribed a CPAP/APAP by the VA, does the sleep apnea DBQ portion under 2B "IS CONTINUOUS MEDICATION REQUIRED FOR CONTROL OF A SLEEP DISORDER CONDITION?" fulfill that language requirement?
  11. Okay so my C-file arrived, and did so amazingly fast. Less than two months, not bad time. Going through all the files and sorting them but one of the first things I need to get together is the claim on OSA. I know the rules have changed about OSA ratings and now the med file must have a doctors saying specifically OSA is a medical condition From the MR21-1MR “When determining whether the 50-percent criteria are met, the key consideration is whether use of a qualifying breathing assistance device is required by the severity of the sleep apnea.” “Use absent a medical determination that the device is necessary does not qualify. The regulation requires that the device be necessary and this is a medical question.” So here is my situation. On 07/07/2013 I had my initial PTSD C&P which noted serious sleep problems, chronic fatigue, hypersomulance but it did NOT mention the SLEEP STUDY diagnosis given on 4/13/13 At that time the simple issuance of a CPAP was considered sufficient to getting a 50% rating for OSA, but as the change listed above notes that is not the case now. I have already filed a claim for OSA secondary to my PTSD. I did this before my Review C&P for PTSD exam, which resulted in getting bumped to 100% PTSD P&T. With the change in MR21, I suspect they may disapprove the OSA claim. If they do, would my path be to file a CUE because the record showed the apnea existed and a cpap was issued when they rated me for PTSD. The retro pay would be awesome! That would seem to be an error on their part and under the old standard I would have gotten a 50% rating for OSA as well as my 70% for PTSD and 10% for Tinnitus. The 70+50+10 calculation is 87 which rounds up to 90 for pay purposes and getting that retro 20% difference for 60+ months would be a nice holiday or new years present to me In the alternative, would I submit a NOD with the same information? or would I have to get a DOC to say that the CPA was medically necessary and would that mean I needed another Sleep Study? Thanks in advance. I am just trying to get things ready for whenever they make a determination on the existing claim.
  12. 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
  13. Hello all, I separated in 2007 and was awarded 80% for a number of things (listed below) after awards I have never made another claim. Since I got out I've used the VA for some care for my eyes and CPAP gear but not for everything as I have private insurance. Last month on Dec 21st I had a heart attack at 37 years old (turned 37 2 weeks before on Dec 11th) with 1 each 100% blockage requiring a stent. I was not on cholesterol or BP meds and I receive no disability for any cardio related issue. I had an electrocardiogram and my heart looks great with 100% function and my non VA cardiologist said I have to take plavix for a year and likely statins and BP meds for life but other than that no restrictions and no other damage. I read that OSA causes issues including heart attack but I have had high normal cholesterol since I was active duty (ldl 150ish, tri - 100+, hdl 40s, total 210+) and normal BP always. My questions are: 1 - Can I tie the MI event to OSA? And if so can it cause the MI even if my BP and Cholesterol are not really considered high? 2 - If I have 100% function and no damage is it worth the effort? disabilities Disability Rating left knee strain 0% left ankle strain status post talar break 10% right ankle strain 10% multi-level degenerative disc disease, thoracolumbar spine (claimed as lumbar and thoracic back conditions) 10% bilateral keratoconus 30% tinea versicolor 10% allergic rhinitis (also claimed as sinusitis), status post septo-rhinoplasty 10% tinnitus 10% central sleep apnea 50%
  14. Retired in 2013 with 40% rating. 20-cervical strain, 10-knee injury, 10-degenerative arthritis. couple of questions, I am considering a sleep study for osa. I snore a lot and it disturbs my sleep. If I am diagnosed with osa, how difficult is it to connect to service. Is it worth my time to try. also, I suffer from lower back pain, loss of work, and some physical therapy. I've already been rated at 20 percent. How would I go about increasing my %, and is it worth my time. What's the success rate with the va after 4 years of retirement Thanks in advance for any help.
  15. My appeal to have my OSA service connected rating back dated to my original claim was completed in December. I've waited for the letter, but nothing. Just today I noticed that my effective date for the service connection on the OSA has actually been changed to 2004. I'm still waiting for the letter, but does that mean I'll receive back pay? I filed my initial claim two months after leaving active duty in 2004. The VA denied service connection because they did not have all of the information. I re-submitted for the OSA service connection, which they agreed was service connected but the effective date was 2014. I filed the appeal/NOD back in 2015 and it just now finished. Old effective date was 2014. New effective date is 2004. Will I get retro pay?
  16. 1970-74 weighed 130 in and 134 out, I had 4 yrs USAF Jet Engine Mechanic experience – much exposure to JP4, Jet Exhaust, PD-680 degreaser, carbon soot, noise, etc. I don’t have much medical information in my service records package, but I do have several pages of upper respiratory sickness, sore throats and earaches from one USAF base. None of my other medical records from other bases were in my service file. While in-service I married for the 1st time, we lived off base and thanks to my wife I was pretty good at getting to work on time. She would complain that I kept her up half the night with my snoring and would go back to bed after I would leave. She also described the loud outbursts and would try to put a pillow over my head to muffle the sounds – eventually she even bought some earplugs. The marriage didn’t last very long and we divorced in less than a year. After the divorce I moved back into the barracks, I was always tired and difficult to wake up and often fall back asleep. I eventually received an Article 15 for repeatedly being late for rollcall, and a reduction in pay scale for several months. Prior to entering service I had lived with my older sister Kathy and her husband. I did not exhibit the typical SA symptoms, I snored and I physically did not fit the profile. They told me I it got much worse after I got out and that I sometimes scared them when I would quiet down and suddenly let out a loud gasping/snoring sound… which sometimes woke me up too. I remarried in 85 and this was the first time I was told I may have sleep apnea. My wife Laura has a medical background and told my doctor what goes on at night and he made arrangements for me to have a sleep study done. It was confirmed and I received my first CPAP machine and have been using one ever since. My weight then was 203lbs. In 2006 I had this mysterious bout of ITP, of which I was hospitalized and transfused with platelets for several days. Aftercare was 6 months of prednisone, many needle sticks, bone marrow aspiration and finally tapering off they prednisone for 3 more months. In 2010 I had several significantly blocked arteries and underwent CABG dbl bypass at the San Francisco VAMC. During the surgery the urologist came out of the OR and ask my wife if I had any known bladder problems, which I didn’t, but their concern was that I was passing blood through my urine. He advised to follow up with urology once I recover and have it worked up. I had a cystoscopy and everything looked fine. In 2012 I put in a claim for IHD 60%, DMII 10%, MMD 70%, ED $125, Hearing Loss 0% and Tinnitus 10%, I was awarded, using VA funny math it was 90% scheduler with 100% compensation for TDIU plus SMC. At one of my recent psych visit I confided in something I never told anybody, not my wife, nor friends (not that I have many, quite the loner) or anyone else. Back in my last year of service I was sexually assaulted by another male, I was so ashamed I stuffed it for 40 yrs, but it just came out. I have been in several PTSD clinics and they helped me to realize I was a victim, that my assailant was a perpetrator, purposefully got me drunk and assaulted me in my sleep. Dec 2013 my wife gets annoyed with the VA doctors because they are all ignoring that some of my blood work always come back a little under the lower range so they blow it off. Via her pushing I get a Hem/Onc consult and it is discovered that I have an Ultra Rare illness called Paroxysmal Nocturnal Hemoglobinuria (PNH), is a rare acquired (not hereditary), life-threatening disease of the blood. The disease is characterized by destruction of red blood cells (hemolytic anemia), blood clots (thrombosis), and impaired bone marrow function (not making enough of the three blood components). It is closely associated with AA & MDS, all are bone marrow failures diseases. Benzene is known to be a toxic chemical which causes bone marrow failure illnesses. My illness is stable so it is in watch & wait state. I’m followed by Hem/Onc once a month to evaluate blood labs and I was prescribed Folic Acid for now. Jan 2016 it is discovered that I have L/carotid artery blockage at 80%, and R/carotid at 60%. I am supposed to have CEA on the left one but first wanted to consult with a well-known PNH specialist in New York NYU to discuss risks of thrombosis. He wants me on an intravenous medication call eculizumab (Soliris tm $$$,$$$ per year) prior to surgery for the carotid artery. Part of his workup for new patients is to check for venial clots with a Head MRI, Abdomen MRI and Lower extremity Doppler studies. No clots found, but I apparently had a chronic lacunar infarct of the left caudate head (stroke) that apparently was asymptomatic. The report also indicated that Scattered areas of white matter signal abnormality in a configuration most suggestive of chronic small vessel ischemic disease. Not sure what that means but it sounds interesting… Now here are my questions: Should I leave well enough alone with my TDIU award or file some additional claims? PTSD due to MST or should I file for increase in MMD PNH due to toxic chemical exposure (Agent Orange, PD680, Carotid artery due to IHD Chronic small vessel ischemic disease in the brain due to IHD Exacerbated my non-SC Sleep Apnea due to PTSD (central & OSA) previous reports only show OSA I am revisiting this since I saw the post on this site that the VA doctors can no longer hide behind not filling out a DBQ because they were told not to. I’m sure I’ll still need to get IMO for the non-SC items.
  17. Hello HadIt Community, TL:DR Skip down to bold section “So that brings us to today….” I've been a bit of lurker on the forums, searching and researching information already presented, hence the lack of postings. I was not quite sure where to post this, in the “Appeals” section or the “Disability and Claims” section.” I decided on the “Appeals” section due to the fact that the claim was already submitted and decided on, and so the next step logically would be an appeal. Moderators, if it needs to be moved, please move it to the correct section. I know that there is a lot of postings, questions, and information in regards to sleep apnea and trying to get it service connected, namely to PTSD and/or TBI. I hope that by sharing my path/progress it will help others who are in a similar situation. I am SC for TBI (70%), PTSD (50%), Mechanical neck pain syndrome (10%), tinnitus (10%). Total combined rating with fuzzy math puts me at 90%. This path of medical issues and nuances began in 2007 when I was in the Marine Corps, and it has taken my up until this year to really get most of my issues addressed and sorted. What delayed the entire process would be attributed to not knowing the secondary effects to injuries. Certain things were obvious (a head injury has secondary consequences like memory issues), but other things (namely the PTSD) were not. The VA, for me, has done an excellent job in diagnosing things, as well as the therapy afterwards. I know that this is not the case for everyone, but I was persistent and proactive towards trying to learn about myself and the changes I was going through and had been through. Not having considered PTSD as a problem for me (denial maybe?), I had attributed everything (headaches, poor sleep, attention problems, behavioral changes) to the head injury. Turns out that a lot of the symptoms of TBI are shared with PTSD, making treatment harder. Is the poor sleep because of the head injury or the PTSD? If the memory and lack of focus because of the head injury or the PTSD, etc. It took me a year and a half, after 6 months of initial therapy, to go through the medicine trial run. Try different medications, see if I feel any different. If I do, do I feel better? Once the right medicine is found, then it’s about finding the best dosage for me. Because everyone is different, and we are all wired differently, no 1 chemical will react the same way for everyone. At times, it felt that nothing was really working, and it didn’t help that the trial period takes time for your body to adjust to the new drugs. But with an open line of communication with my psychiatrist made it easier to track changes and make the changes so that I felt better. For me, it’s been a night and day difference. Looking back and remembering how I felt, it was almost as if my brain was in a constant fog. I was awake and aware of things, but almost as if things were in a dream-like state. I don’t know how else to describe it, but it felt like the drag I had on my mind and shoulders was eased. There are still bad spells and moments, but that is where the discipline and focus really comes into play. It hasn’t been easy, and I can’t even begin to imagine how it is for those who have a bigger challenge than I. But what I do know, is that you need to be wanting to make things better for yourself. It’s a bit of a process. Therapy isn’t the easiest, as you need to revisit certain areas in your life that you don’t want to. It takes time, and you feel quite low during certain times. In some ways, it allowed me to learn more about myself, and what I needed to do and go through to make myself better (know yourself and seek self-improvement…). But it gets better, I promise. Biggest takeaway from disability claims with the VA, is to make sure you have your paperwork in order BEFORE you submit things. At the beginning I did not know what I had, how the VA system worked, or anything at all. So my first claim consisted of: neck pain, lower back pain, headaches, memory problems. Very broad and generic symptoms. They were denied, but through the intake process, I did learn that I should talk to the VA clinic, namely the poly-trauma area to have my TBI assessed. From there, it was evaluation after evaluation to try and get an answer as to why I was having problems. TBI led to tinnitus and neck problems. TBI therapy then lead to depression screening which led to PTSD screening. PTSD screening then led to therapy. Once those two main areas (TBI and PTSD) were stable enough for me, I started to address other issues, namely sleeping problems. Headaches every day when I wake up, cold sweats every other night (changing sheets couple time a week….), nightmares. I had attributed all those symptoms to the head injury, but that was when I had learned that it could be partially the head injury, and partially the PTSD. More research lead to asking for a sleep study done. I figured that if there is something going on while I sleep, maybe it’ll show up on the results and give me a better idea to what’s going on. Having a better idea, it would allow me to attack the problem from a different angle. I found that throughout the entire VA process (starting in 2007), the best way to tackle things is to focus on it like a puzzle. Define the problem, get a better idea of what it is, and this then leads to knowing how you can attack it head on. I don’t know what exactly I was expecting out of the sleep study, but I certainly did not think that I would have an issue with breathing while I sleep. I had assumed that my combination of injuries was manifesting itself while I was sleeping (my most relaxed state). Long story short with my sleeping habits from the past, the sleep study showed that I had mild sleep apnea, namely obstructive sleep apnea. CPAP machine was then issued. Now to me, that didn’t make any sense at all. I don’t fit the OSA poster-boy, at all. Overweight? Thick neck? Older? I’m 28, 6’, 165 lbs. But I had some answers. My shallow breathing would cause decreased oxygen intake which causes an increase in CO2 in my blood. Heart pumps faster, fight/flight response starts, body is working harder to supply blood to muscles, cold sweats start to try and dump CO2. Then I wake up and I have to go use the bathroom, 1-2 times per night. I just figured I was well hydrated…haha… With the answer of sleep apnea of the obstructive kind, I started to research causes for it, and correlations to different injuries. One thing leads to another and there are correlations between head injuries and PTSD. So at that point (more answers…yay), I go back to VA research and learn that there can be claims filed for OSA. Since I was diagnosed with OSA outside of service, then I would need to either prove it happened while I was in (no evidence, so scratch that), or have a secondary connection to a service connected disability. Seeing that I was SC for TBI and PTSD, that would be the route I would take. What this meant was that I would need to present information to the VA showing a correlation between the injuries, and have the weight of a doctor behind it. I made sure to file an Intent to File notice so that my date was locked in for retroactive pay. With this date locked in, I needed to go about finding information on IMOs. Researching and learning, I decided to go with Dr. Anaise and get an Independent Medical Expert Opinion. $1500 later I had a nice sizeable book with him stating (and with evidence too) that he opined that it is more likely than not that my sleep apnea is secondary to my service-connected PTSD, TBI and tinnitus. With my new information and medical opinion in hand, I submitted a Fully Developed Claim, since I had no more information to submit (IMO from private doctor, and the VA had all my medical records including the sleep study). 6 months of waiting and checking eBennies (torture….) and it finally finished and showed that a decision had been made. Paperwork comes in the mail and the claim is denied… Frustrated? Not really, since I had expected that it would be denied. Most claims, unfortunately seem to be denied the first time around. Bit let down sure. But it is what it is, I can’t change that, so now time to look at how to keep pushing forward. So that brings us to today…. I do plan to submit a Notice of Disagreement to have it reviewed again. I have been told that the reviewal process is in the time length of 2-5 years (frustrating but backpay will be nice…). My posting on HadIt is based on wanting to get other people’s input and a fresh set of eyes on the information I have and what the next steps are, different viewpoints, and maybe anything I missed/am missing, as well as posting my information and path on here for others to read and learn from. Medication: Venlafaxine 300mg for PTSD Zolpidem Tartrate 5mg for sleep (Ambien) -------------------------------------------------------------- VA Decision letter verbatim: Issue/Contention sleep apnea Explanation The evidence does not show that sleep apnea is related to the service-connected condition of traumatic brain injury, nor is there any evidence of this disability during military service. Service connection for sleep apnea is denied since this condition neither occurred in nor was caused by your service. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. The evidence does not show an event, disease or injury in service. The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. The VA examiner stated that your current sleep apnea is due to the airways in your throat relaxing too much to allow normal breathing and closure of your muscles than your service connected TBI, tinnitus, and/or PTSD. ------------------------------------------------------------------------------ VA Examination I was not there for the exam because verbatim: [X] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. Verbatim: MEDICAL OPINION SUMMARY ----------------------- opinion ---OSA 2/2 to PTSD LESS LIKLEY THEN NOT THE OSA IS 2/2 TO PTSD -- RATIONALE --OSA IS A OBSTRUCTIVE DEFECT Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the soft palate, the uvula ? a triangular piece of tissue hanging from the soft palate, the tonsils and the tongue. When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood and cause a buildup of carbon dioxide. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it. You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night /es/ *Name removed* FNPC PRIMARY CARE PROVIDER -------------------------------------------------------------------------- IMO excerpts verbatim “After reviewing the veteran’s c-file and the pertinent recent medical literature, I opine that is more likely than not that the veteran’s sleep apnea is secondary to his service connected PTSD, TBI and tinnitus” “After reviewing all of the veteran’s medical and military records, it is my expert medical opinion that it is more likely than not (50% or more) that the veteran’s sleep apnea is secondary to his service-connected PTSD and TBI. The scientific observation that the derangement of REM sleep prominent in the PTSD patient is the cause for sleep apnea is of particular importance in this case. It is more likely than not that the veteran’s sleep apnea is secondary to his service-connected tinnitus.” --------------------------------------------------------------------- The report is 7 pages long with 5 5 exhibits of evidence (scientific journal reports). If needed for better clarity, I can scan the 7 pages in (edited for privacy). I can also post the findings from the sleep study if needed as well. I don’t want to provide my thoughts and input on this just yet, as I would like to see what the community’s thoughts are on where things are so far, based on what there is. What I ultimately am looking for, besides getting my claim granted, is to gain a better idea of what route I should take based on what I have. The VSO who I was working with suggested a simple medical statement that says my medication for PTSD affects my OSA (throat muscles relaxing), was also recommended to have a DRO review the case (instead of a RO?) since it might speed up the process because it was more ‘in-house’. De Novo review? CUE? Thank you in advance for your thoughts, view points, and suggestions The CPAP machine, took a bit of time getting used to, but it is a night and day different (no pun intended ha). The nightmares are less, the cold sweats are essentially gone, morning headaches aren’t there, and I feel rested now when I wake up and throughout the day. Getting sleepy while driving isn’t there anymore. I wanted to see its effectiveness, so I decided to try sleeping 2 nights without the mask, and the first night, instantly the prior symptoms came back. Headaches, cold sweats, over tired all day. My conclusion, from my personal experience, is that if you have PTSD, TBI or both, get a sleep study done. There is strong enough correlation between the three to have symptoms overlap and exacerbate one another. I may not know the exact scientific workings behind it, but logically it makes sense. PTSD or TBI, get testing and therapy done to better understand the challenge that YOU have, and how to better work through/around/over it. If they recommend medication, ask why. Not to push back against it, but so that you understand what the purpose of it will be, how it will help you. Self-knowledge and self-learning are very important in order to have a better grasp of things pertaining to you. Be patient with medication, and be honest with your prescribing doc. Everyone reacts differently to medication, and only YOU can determine how you feel. I might even recommend keeping a small journal of how you FEEL throughout either therapy or medication trials. Be patient with your meds. Medicine doesn’t work overnight, especially finding the right one and dosage. Be patient with therapy. Not during therapy necessarily, but in the length of things. It takes time depending on severity. You will feel worse some days more than others. Therapy, like medicine, is unique to YOU. What worked for me, may not work exactly (or at all) for you. But you need to be honest with yourself and with your guides (therapists and docs). I had a small ‘good luck charm’, a grounding tool, that I would touch and hold when my mind would start to wander. Helped to keep/bring me back to reality. Grounding techniques worked wonders, but you need to be disciplined about it. My good luck charm was a 550 cord bracelet I made when I was in. Feeling the knots and mentally talking to myself kept me ‘here’. Doesn’t have to be something big. Just a small item that has meaning and significance to YOU. You don’t even have to tell people what it is or does or anything. But it gets better, I promise.
  18. In my recent denial for sleep apnea secondary to service-connected asthma, the medical opinions stated that OSA has several primary causes, such as obesity, advancing age, sinus congestion etc... The VA provider referenced the many events of sinus congestion in my medial records and initial sleep apena diagnosis and implied is was more likely sinus congestion than asthma... I am now looking to file a reconsideration and am thinking to service-connect the sinus congestion/post nasal drip with OSA as a residual. Essentially, OSA secondary to Sinus congestion. I would be interested in thoughts about this strategy: 1. Does this seem like a viable or potentially helpful strategy? 2. Does this nexus letter seem appropriate to try and connect sinus congestion? Here is the Nexus Letter Draft: XXXXXXXXXXX -- Sinus Congestion and Post Nasal Drip. To whom it may concem, I am wrriting this VA Nexus letter at the request of Mr. XXXXX has been under my care since 9/29/2015 for asthma and allergic rhinitis with clu·onic sinus congestion, and clu·onic post nasal drip . Mr. XXXXXX's moderate to severe clu·onic sinus congestion and moderate to severe clu·onic post nasal drip are currently treated daily with maxintal medication therapy including saline sinus rinse, fluticasone and azelastine as well as salt water gargle. I have examined Mr. XXXXX's VA Claims File (cfile) and service medical records. I am familiar with his medical history and have also performed physical exarninations over the course of his 8 visits to om clinic, most recently on 10/17/l 6. It is my medical opinion that the veteran's sinus congestions and post nasal drip is more likely that not related to his military service and associated with his service-connected asthma; the rationale being that. Mr. XXXXX demonstrated no prior history of asthma or allergic rhinitis including sinus congestion, and post nasal drip prior to military service, as annotated on his medical entrance exam, and was while in military service diagnosed with "reactive airway disease" in 1992 and noted to have a positive methacholine challenge in 1994 consistent with an asthma diagnosis, and was seen on multiple occasions for sinus congestion, post nasal drip, acute rhinitis, and upper respfratory infections. Mr. XXXXX reports recurring symptoms since leaving service and often patients that develop astluna also develop other atopic conditions such as allergic rhinitis with symptoms or clu·onic sinus congestion and clu·onic post nasal drip. Mr. XXXXX's medical record demonstrates that these sinus congestion and post nasal drip symptoms manifested in service and have been clu·onic ongoing medical conditions up to the present time. Please do not hesitate to contact us if you have any additional questions or needs. Sincerely, XXXXXX, MD Board certified in Adult and Pediatric Allergy & Immunology, The American Board of Allergy and Immunology Board certified in Internal Medicine, The American Board of Internal Medicine Redacted Nexus Letter.pdf
  19. I will have been on a CPAP come a year Dec. 1st. As I understand I have to turn my CPAP into my local VAMC, which I assume is to show the actual usage in order to get prescribed for another year of usage. My question is what is VA looking for inside the CPAP besides obviously the conisitent usage, and what actual data is there for them to see and evaluate? I read somewhere that they can see if your apneas have increased or decreased......is this true? Has anyone ever actually gone from moderate or severe OSA to no apneas ? If this is true..........I do not understand how it can go lower in apneas when other conditions are still involved like allergies, sinus, deviated septum, etc.? Just curious what is involved and what is the data extracted from CPAP. I do have a claim in for SA as a NOD. Thanks for any help on this subject.
  20. The Veteran is SC'd for TBI. A VA sleep study indicated central sleep apnea. Assuming a nexus has been medically determined between the TBI and the central sleep apnea: Questions: 1) Is central sleep apnea (CSA) a separate ratable neurologic brain disorder apart from TBI or is it rolled into the TBI rating? and, 2) While obstructive sleep apnea (OSA) is considered and rated as a respiratory condition, why is that the same for CSA, which has it's etiology associated with an organic brain dysfunction?, Should CSA be considered a "chronic sleep impairment" to be rated analogous to a sleep impairment a mental health condition like PTSD, depression or an anxiety disorder etc. might cause? ( 6847) Sleep Apnea Syndromes (Obstructive, Central, Mixed)
  21. I'm asking for help on behalf of another veteran who just got SC'd for adjustment disorder with mixed anxiety and depressed mood at the 50% rate based, in part on, "chronic sleep impairment". He already has had for years non-service connected obstructive sleep apnea (OSA) and uses a CPAP machine. The question is: can his non-service connected obstructive sleep apnea, (a respiratory condition), be aggravated by the "chronic sleep impairment" from his SC'd mental health condition...thereby getting his OSA SC'd?
  22. I'm rated at 50% for OSA with CPAP but was declined "reactive airway disease" or asthma in my initial claim. I'm thinking about submitting a claim for asthma now that I'm on ADVAIR daily. Does anyone have any experience in winning this? However, been reading on HadIt which highlighted 38 CFR 4.96(a) §4.96 Special provisions regarding evaluation of respiratory conditions. (a) Rating coexisting respiratory conditions. Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. However, in cases protected by the provisions of Pub. L. 90-493, the graduated ratings of 50 and 30 percent for inactive tuberculosis will not be elevated. One post from 2010 pointed to BVA citation number 0610557 which indicated one interpretation of the above regulation as being that not permitting DC 6600-6817 from being combined and 6822-6847 from being combined but that a disability from each group could be rated separately. But I just found BVA citation 1448605 in which a veteran used this exact argument to attempt to separate his OSA and asthma, and the BVA found the opposite - that 6600-6817 and 6822-6847 could not be combined. So they've ruled both ways. I'm not the best at looking at CAVC cases, but I didn't see anything that addressed the interpretation in their rulings, although I easily could have missed something. Asthma is 6602 and OSA is 6847. Based on the more recent BVA decision from last year, it seems like it's not worth it from a rating increase standpoint. If I'm successful, the RO will combine the ratings and keep me at 50% for both as a single rating. My OSA is more severe than my asthma. If my asthma was worse, maybe I could argue for a combined rating of 60%? Is my understanding on this right?
  23. Hi, I hope everyone is having a great Memorial Day weekend. As always, thanks to all the Elders and everyone who make this place possible! I have to submit my NOD by June 18th, 2014 - soon, I know. I'm hoping Berta, Carlie, Bronco Vet and/or the others can weight in on how/whether to file my NOD. First, do I have a legitimate NOD for either or both: My OSA rating being combined with other ratings, when OSA is supposed to stand on its own? Seeking a 60% rating for CFS because the decision letter cites "no compensable symptoms"? Regarding CFS, my symptoms rise to the 60% level, as they stand all on their own. So, am I missing something here? In other words, does the CFS being secondary to OSA neturalize the 60% rating, rendering that condition a 0% rating? I am puzzled; however, NOT SURPRISED if this a V.A. overisght - in their favor of course. Decision Letter of June 18, 2013: I TRIED UPLOADING MY LETTER; but, it was 11MB. T-bird is there anyway I can post it? I will e-mail it to those who can help, if not. With appreciation, PJ
  24. Hi all, currently have osa on appeal as my initial claim I didn't have an IMO. I'm 70% ptsd, major depression/panic w/agoraphobia, 20% bilateral shoulder dislocations (major and minor), 10% HTC, 10% Tinnitus...90% combined. I have increase tdiu for ptsd and appeal on my b 70% from July. Guy said I should be 100 but Cuz I worked 2 yrs ago, he had it at 70. My osa I use full face sleep mask pressure is 13.0.. Finally got sleep study in 2010 were was diagnosed. Complained for 5 yrs prior. I believe my osa is due to my massive 150 lb weight gain due to. My ptsd...I'm in Boston area, who can someone recommend. Don't have insurance. Ch 61 retiree from usmc for shoulders and ptsd. I also recently was diagnosed with type 2 diabetes last February. Any Suggestions? I'm currently in 3rd week of CUP program for ptsd at VA.
  25. Ok. Went for my epidurail this AM and when I awoke from the sedation, The RN that was assisting the my pain management doc said I need to get checked out for it. Wife says I display some of the symptoms of it while at home as well. My question is can this be claimed as a secondary to IHD, DMII, or Gerd. I am not SC'd for the DMII and IHD as it is part of a claim for AO presumptives that I have working now. The gerd is from a hieatal hernia from the middle 70's while in service.
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