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  1. 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
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