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Hello Vets! I read on one website concerning Sleep Apnea that in accordance with VA Adjudication Manual M21-1, Part III, subpart iv, chapter 4, Section D updated April 18, 2016; There is no longer the requirement to have been diagnosed with SA prior to leaving the military to receive a rating. First, I looked at the cited manual and Section D, does not pertain to Respiratory issues, Section F does. So I'm just looking for clarification. Clarence

Hello All, I am planning on filing a claim for sleep apnea, which was not diagnosed while I was on active duty, as well as cervical pain and Allergic Rhinitis, which were noted in STR's but not officially diagnosed until a few years later, despite continuous treatment for them by the VA. While there is some reference to sleep issues while I was deployed, and treatment records in service for the other two, I want to make my claim as strong as possible from the start. Having read through many of the posts here and elsewhere regarding the nexus to service connection, I believe I will need an IMO to connect the in service event (injury on deployment) and my current diagnosis for sleep apnea, since it was diagnosed about 9 years after I left active service. My spouse is willing to write a statement regarding the symptoms she has witnessed since I left service until my diagnosis, and I have had two sleep studies confirming a diagnosis of sleep apnea (both done at the VA, 6 years apart). I plan on trying for direct service connection (unlikely but worth a shot) as well as secondary service connection (I have other SC conditions, but only rated at 20%, to connect it to). The pulmonologist at VA said my chronic pain likely contributes to my sleep apnea, but I am guessing this is not affirmative enough language for the VA rater, which is why I plan on seeking an IMO, for all three issues I am claiming. My primary care Dr is at the VA, and tends to write in generalities, so I don't think she will be a good choice for writing the IMO/DBQ (she tells me I have to wear my CPAP or I will stop breathing or die in a car accident, but only writes in my chart that "CPAP is recommended"). I have been looking (unsuccessfully) online for doctors who specialize in providing IMO's, and have read about the ones reviewed here, but was wondering about another I keep seeing pop up in the google searches - VA Claims Insider. Seems like a one stop shop, but I have not found much information about them other than what is offered on their website and Youtube channel. Also, the idea of paying after a claim increase seems like a good option, since multiple IMO's can be expensive, but I would think this could present a conflict in the eyes of the VA, since the fee increases with the size of the award. Also, I'm not going to lie, I think it would be great to have someone go over my records and possibly identify issues that I can rightfully claim that I am just not aware of. That seems to be the service they also provide, along with IMO's. So, any guidance or reviews would be appreciated. I am pretty confident that I will need the IMO's. I just don't know where to get them without a potentially awkward first visit to a new Dr, "Hi, I know that we just met, but can you write this very detailed letter for me so I can get disability compensation. No pressure." Thanks, and thank you all for the great info on this site. P.S. - I do not intend for this to become a thread to bash one service over another, or to endorse any particular service. I would just like some honest opinions about any of the people you folks have used. The nexus letter seems to me to be the deciding factor in many of the BVA appeals I have read. Despite its importance, I have had difficulty finding solid info and advice about getting one. Also, I assume VA Claims Insider probably reads this forum, and I don't want to disparage anyone who is trying to help vets.

Moderator, you might want to Pin this somewhere, as this seems to be a recurring trend. I have given out this information to others, but I will post it here so that others can find it rather than searching through the forum. First and foremost, claiming and getting sleep apnea secondary to PTSD or Mental disorder is not easy. I have personally seen more lost than won, however, it can be obtained and I myself have personally received it. If you had sleep apnea diagnosed while in active duty, it is usually a slam dunk........for the rest of those trying to get it, it could require a lot of work. I suggest trying to get it both direct and secondary service connected. It is easier to get sleep apnea as a direct service connection obviously, however, most Veterans do not get it diagnosed while in service. Best way to get that resolved is through buddy statements. I suggest getting 3-4 (I personally had 7-8) or more. Do not have them only say that they saw you snoring.......that is great and all, but that is not a symptom of sleep apnea.......it is incidental. They would need to say that they saw you gasping for air, choking, etc. Preferably roommates. If you were deployed, it would be easy to have many people saying that they saw/heard this as you would have more than likely been in an open bay setting at some point in time. You can also have your spouse write up a statement. This all needs to be during active duty periods of times and dates need to be included. M21-1 reference III.iii.2.E.2.b "Types of Evidence VA May Use To Supplement or as a Substitute for STRs" allows for buddy statements to act as STRs for medical evidence.........if they are certified "buddy" statements or affidavits.............having them written on VA Form 21-4138 solves this issue as it has the appropriate verbiage written near the bottom. Under M21-1 reference III.iii.1.B.7.a and 38 CFR 3.200, it meets the certification criteria..........problem solved. From my experience, getting all of the buddy statements needed can take longer than you originally anticipate....plan ahead. Now, for secondary criteria. Have you ever been diagnosed with alcohol abuse (it is frequently written as "ETOH")? If so, has it been attributed to your mental disorder or did it exist prior to that and is it considered willful? If you have been diagnosed with alcohol abuse, and it is attributable to your mental disorder, guess what, alcohol consumption is attributable to sleep apnea. would suggest that you start doing your own academic research. You might be able to locate peer-reviewed academic journal articles (those are the types of articles that you want to submit) through https://www.researchgate.net/. If not, another alternative is using a college database to search academic journals through. Ah, but you need to be a college student to use the database to search academic journals through. One might make an argument that you could register for classes at a local community college (you can even register online nowadays without even stepping foot on campus) and even register for "late start" classes, and have access to the aforementioned database immediately (hint hint, look in the academic journal Chest); one could easily find within a 60 minute search at least 5 appropriate and recent journal articles clearly establishing a link between specific mental disorders and sleep apnea; there is a clear link between PTSD, anxiety disorders, depression, and especially schizophrenia. One might make an argument that you could simply then disenroll from the classes that you enrolled in by the date specified in order to get a full refund, thereby being charged nothing. Save the academic journal articles as pdf files, and create a work cited page (bibliography) for them in APA format (google is your friend.) You now have a choice........... Submit your claim with the buddy statements, mental health notes from a private provider, and evidence that you have and go with either a VA exam or vendor exam (whichever is given) or you can get an IME and IMO from private providers. If go the latter route, I would schedule one with a sleep specialist, why, because sleep apnea is their specialty. Pulmonologists also fall within this scope as well, though I suspect that you will have better luck finding a sleep specialist believing there to be a link between mental disorders and sleep apnea. You will get a Sleep Apnea DBQ and an IMO. Make sure that you have your C - File first as an examiner is required to have access to it and state that they have seen it on the DBQ for it to acceptable proof to the VA. I would also get one from your psychologists/psychiatrist (Make sure that they are a psychiatrist or a psychologist.....if a psychologist, they need to be PsyD or Ph.D., or under the observation of a Ph.D.). Make sure before you solicit those medical opinions, that you acquire "buddy statements" from 3-4 (or even more) people with whom you served. Roommates would be best, or people who slept in close proximity to you.........again, this is only if you believe that sleep apnea developed while you were in Active Duty service. Make sure that they are written on VA Form 21-4138. Make sure they say that they witnessed clear symptoms of sleep apnea i.e. gasping for air, choking sounds, moments where they visibly or auditorily could determine that you ceased breathing etc. Remember, you will want the sleep specialist and the psych professional to have your academic journal articles and buddy statements. Once you have all of them, solicit your medical opinions from the two aforementioned providers. Ideally, you would love for the IMOs to say that they believe that you could be both direct service connected for sleep apnea or secondary due to mental disorder, possibly even say that the mental disorder and sleep apnea aggravate one another (which there is medical evidence to support.) If you opt to go the route of getting the private IMO and IME, you will obviously submit those with your claim, and all medical records from private providers pertinent to sleep apnea and your mental health treatment, buddy statements, academic journal articles, and a nicely written statement written by yourself on a VA Form 21-4138 talking about the issue at hand and summarizing everything concisely. Mention everything that you are providing that you wont to be considered for the claim, and when the issue first manifested.

Hi all, looking for feedback regarding my progress and chances, along with any other suggestions. I served in the Navy from 1999-2005, Honorable discharge as a nuclear mechanical on subs. Sadly, like many I rarely reported medical issues while I was in, didn't want to hurt the command with absences. If only I knew then right? In 2015 I filed put my first claim in, Rhinitis (this was well documented inservice) sleep apnea, i had symptoms inservice that were documented but never diagnosed and hypertension secondary to OSA. I thought I had a good package, I had buddy statements and an IMO from Dr Ellis. Well the VA disagreed. They granted SC Rhinitis at 10% and declined SC for OSA and HTN. I applied for a denovo review and they upheld the first rating. I then let my 1 year expire and things ended there. A few years later my sinuses were getting worse. I saw an ENT who diagnosed severe sinusitis a deviated septum and polyps. We tried steroids and antibiotics and then went with a pretty complex sinus surgery. Post op several rounds of steroids and still have polyps. I currently use daily steroid irrigation. That sucks. My OSA of course was diagnosed with a sleep study, it was rated as severe and I use a CPAP daily. I strongly feel that the fact that I can barley breath through my nose makes it a lot worse. The diagnosis on all of these are unarguable. Its the SC that will be the battle. HTN: I have pretty severe HTN, it is controlled with 3 meds daily. The literature is pretty clear that OSA worsens HTN. And for what its worth, I don't use the VA for health care. So my packet: I had hoped to try the DRC process as, I am very lucky to have the resources to build my own claim. I used Bethany who is a PA at Valor 4 Vets to do my DBQs for Rhinitis /Sinusitis, OSA and HTN. She also wrote IMOs for each with literature cited. The least as likely then not phrase is there for every condition. I'm happy to post if it will help anyone. I also wanted an IMO from a doc with a little stronger CV so I went with Dr Aniase, I know he's been talked about here and like others have said the service was great. Also he is a former lung transplant surgeon, who has focused a lot on OSA so I thought that was a good fit. He put together a solid 65 page letter with a lot of literature and medical rationale that OSA is make worse by Rhinitis and that HTN is made worse by OSA. He went on to say that sinusitis is only caused by rhinitis and pointed out the rationale for increased rhinitis. I of course had all of my private medical records. I took these to my local VFW service officer on 4/17. I had no problem doing the claim myself by a DRC claim has to be submitted by a VSO. She tried to discourage the DRC process as it shifts the responsibility to the Vet and the VSO. I get that but I already have everything and hopefully wont need additional exams as I have my DBQs. She relented and took all of my compiled paperwork to submit. Well shockingly while her cover letter asked it to be processed as a DRC, it wasn't uploaded to the DRC portal and is now showing as a regular pending claim. The OSA and HTN are re-opens. So I think i have a pretty bulletproof packet. What thoughts do you all have? Is there anything else I should do?

My VSO let me know that my OSA appeal was denied. My original claim was a direct service connection. I read the sleep apnea field manual from Chris Attig and appealed the decision. On appeal I stated the OSA should be secondary to PTSD and sinusitis. I obtained an IMO from Dr Anaise and a DBQ with the at least as likely as not and medically necessary (CPAP) statements from my psychiatrist. My question is on appeal can you submit evidence to make it a secondary condition or does it need to be filed as secondary from the beginning? I haven't received the RAMP appeal denial letter yet. Also is there a section in the 38 CFR regarding secondary conditions with an original direct service connection claim?

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?

I am just wondering to what extent does the VA's Duty to Infer reach? I keep seeing it mentioned but I am not finding any particular bounding rules or interpretations, so any links or opinions would be great. Take for example a post I read this morning. OP was initially rated as 70% PTSD and was not/had not been working. Said it was in his file. Asked if VA should have inferred IU. So what has to be in their file to trigger the Duty to Infer? Is simply stating they are unemployed enough to trigger the question? is a mention in their intake memo enough? from their Primary Care doc? Psychiatrist? does a discussion with the 1-800 number trigger this duty? What if they are homeless or near to becoming homeless is that enough? Do they have to have an extensive statement saying they have not worked in two decades (or whatever) and don't think they ever will again? Would the duty to infer by itself require the VA rating decision to mention IU or send the IU form with an explanation? For example my latest rating decision for SMC K include a statement that I might have a claim for Voiding Dysfunction and tells me to file a "new" claim if I want to explore being rated for it. To my mind this is a Duty to Infer action on the part of the Rater; taking that back to the 70% PTSD example should there also have been a statement inferring possible IU and the forms needed to process such a claim? What about something like sleep apnea? I know the rules have changed on needing a statement that CPAP is "Medically necessary" but what if under the old rules a sleep study is done, a cpap issued and following that a C&P finds the veteran to be Service Connected for PTSD and has Chronic Sleep issues? Should the rater 'infer' that C&P is in order, or does the veteran have to intuitively know (yeah right) that SA is a ratable condition and then has then file a new claim? what about under the new rules? how would a new veteran know that their sleep apnea might be a ratable condition if service connected? doesn't the VA have an obligation to tell us if some condition is potentially a ratable condition or secondary to a rated condition? I cannot imagine it was the intention of Congress for Veterans to have to know things and rules they could not possibly be aware of before they file claims, particularly veterans new to the VA process. In that light it makes zero sense that legal requirements such as a Duty to Infer would/could be narrowly interpreted. Any links, discussions, BVA or CAVC results, etc would be appreciated.

I need to learn more about inferred claims and how they are decided/spotted by the va raters and acted on. The situation is I was rated 70% PTSD in 2013 around july was that C&P. In april 2013 I had a C&P for Bilateral Hearing loss and one for Sleep apnea. I knew nothing about secondary conditions, inferred claims, etc and by this time my VSO was awol dealing with pancreatic cancer (so I don't blame him). This year in July I was notified about a Review PTSD C&P, and that started me on the information hunt. I learned that ED, which was well documented in my VA med records before the first C&P, was/could be a secondary to PTSD. I also learned the Sleep Apnea was/could be a secondary to PTSD and my Sleep Study produced a CPAP and diagnosis of OSA and my Epworth Sleepiness Scale: 20/24 Since I knew nothing about secondary claims then I did not file for them then. With the PTSD Review this year I filed a claim for SMC-K for the ED. Today when Ebenefits was unaccessible I called Peggy who told me the claim was partially complete and a letter had been/was being mailed out today. The only issue left was on dizziness. This was in the A.m. Around 1 p.m. I tried ebenefits again and it was up. Under my disabilities tab it shows that I am 0% for ED Service Connected and awarded SMC-K1 with an effective date of 20 Aug 2018 the date I filed that claim I have filed an ItF on the SA claim but was waiting until this cleared. What I need to find out are the boundaries on "inferred claims". Meaning what does and does not need to be in the record for me to claim an EED back to the date of my PTSD claim. The ED was in my record before the PTSD C&P and the doc and I discussed it. He did not opine either way and the benefits award letter is completely void of any reference to it. Is it likely to be worth the trouble trying to file a claim for the EED on this? the evidence is there but no statement tying the two together back then, but I feel i should have been inferred by the rater. The SA claim is the same but a little different. The VA recently changed its requirements for granting service connection for OSA. It used to be, until this year, that being prescribed the CPAP was considered to be sufficient to read as "being medically necessary", but the new regs require that specific statement in the file. For this claim I know I have to have the diagnosis made as service connected as a secondary to PTSD so what I would like opinions on are what the value of asking to have the VA decide based on the old standard as I was unaware it was even a ratable condition. No one at the VA mentioned it. The rater on my initial Claim did not comment on it in the Award Letter. I believe this should also have been inferred. the two items are all over my records as being present months before the C&P and I am hoping that the Duty to Assist which includes a Duty to Infer will cover my claims. Any thoughts?

Facts regarding claim: Sleep Apnea secondary to insomnia Date of diagnosis: 7/18/2014 Current disabilities relevant to claim: Tinnitus – Service Connected - 6/5/2017 Insomnia – Servicee Connected - 4/13/2018 Facts regarding claim: Sleep Apnea secondary to insomnia Date of diagnosis: 7/18/2014 Current disabilities relevant to claim: Tinnitus – Service Connected - 6/5/2017 Insomnia – Servicee Connected - 4/13/2018 Status of claim: CUE submitted due to errors in claim by Rater Status of Cue: In process. Mistakes accepted as grounds for CUE Purpose of claim: Establish to VA my service connected disabilities Insomnia and tinnitus are aggravating the symptoms of my non-service connected disability sleep apnea. Sleep Apnea Symptoms: Hypersomnolence & Fatigue Service Connection Justification: Per CFE > Title 38 > Chapter I > Part 3 > Subpart A > Section 3.310: Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. Narrative: My service connected secondary insomnia and my service connected tinnitus are responsible for my sleep deprivation which is aggravating my sleep apnea symptoms: hypersomnolence and fatigue. Incident: On 27 September 2018, I went to my scheduled C&P examination expecting to answer questions about my sleep apnea symptoms (hypersomnolence and fatigue) being aggravated by the sleep deprivation I am experiencing due to my service connected tinnitus and insomnia disorder. When I got to my appointment, the C&P doctor just wanted to see my 2014 sleep study. There were no questions asked. I asked what was the reason for this C&P exam? The doctor stated he just needed dates from my sleep study. Since the VA already has this information, I was very confused as to why I was asked to attend an appointment to gather information that they already possess. I then contacted QTC who notified me of my appointment and according to the claim specialist the one question that the C&P doctor was tasked to answer was "Is the veterans sleep apnea at least likely or not proximately due to or the result of tinnitus" This question the C&P physician was tasked to answer has nothing to do with what my claim is even about. My tinnitus didn’t exist when my sleep apnea was discovered. The CUE for which was created because of a mistake made much like this one on the original claim clearly states: Because of the constant ringing in my ears that never changes in volume or goes away at any time (severe tinnitus), I am suffering chronic secondary insomnia as well as chronic migraine with tension headaches. My service connected secondary insomnia is responsible for my sleep deprivation which is aggravating my sleep apnea symptoms (hypersomnolence and fatigue). Request compensation for the aggravation of my sleep apnea symptoms (hypersomnolence and fatigue) from my service connected tinnitus and insomnia disorder. I submitted a VA Form 21-4138 and said stated: The question you tasked the C&P doctor to respond to does not at all pertain to the purpose of the claim you are evaluating. Since my sleep apnea was diagnosed in 2014, and my tinnitus was service connected 6/5/2017, how would you expect this doctor to provide a credible response to your question? My tinnitus didn’t exist in 2014. I stated: Did you not thoroughly examine the CUE (clear and un-mistakable error) and claim you are responsible re-evaluating? Are you not supposed to do this before sending someone to a C&P examination appointment for apparently nothing? Did you not check the service connection dates of my disabilities: tinnitus and insomnia along with the date of my sleep study? Doing this would have provided you vital information about my claim in that my sleep apnea was present before I was awarded my tinnitus service connection. This is a secondary service connection by aggravation claim. Please read carefully the Claim and then the CUE created because of how badly the original claim was handled. It states the circumstances leading up to my sleep deprivation I am experiencing which is causing the aggravation of my sleep apnea symptoms hypersomnolence and fatigue. I ended it with this question. How could anyone expect to get a fair claim decision if the VA representative handling their claim doesn’t bother to examine all information pertaining to the claim they are evaluating? There it is. I also put in a complaint using IRIS including everything you see on this post. I am expecting to do another CUE. My question after all of this. Is my claim valid?

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

Hello Hadit.com Members, I am new to the site, but I have reviewed a lot of information throughout the different forums and I must say the collaborated efforts to assist an in need fellow veteran is refreshing. Hopefully I am not too much of a burden with my situation and hopefully I can benefit from your guidance because right now I am at a loss on how to approach my claims. I am currently service-connected for TMJ - 20%

So to make a long story short, I was active duty since 1994 and medically discharged in 2005. Since around 99/2000 I have suffered from what I now know as sleep apnea. I was never tested for it during service, but I had no idea what the heck it even was. Only knew I was being woken up by my wife, and when in the field or deployment soldiers, because I would snore loud and then stop breathing. I placed an initial claim for this in 2010 after I had a surgery at the VA, and I was placed in the ICU due to low oxygen levels and having sleep apnea during surgery. 04/2010, I did the first claim on my own and it was quickly denied. 10/2010, I re-opened the claim with 3 buddy letters of soldiers who witnessed me in the same close sleeping questers during deployment, stop breathing. Had a C&P exam, with a doc who spent all of 3 minutes asking me directing questions. It too, was denied. 04/2012, I re-opended it again after I had my actual VA doc write me a nexus letter claiming it was "more likely than not" related to service and a new buddy letter from a service member who shared quarter with me in various units, and from my wife. It too, was denied. 02/13, I submitted the NOD, and had a DRO review, it too was denied. 02/15, I submitted the appeal, with the help of Military Order of the Purple heart. It was received 03/2015 and and it was been sitting since 09/2015 at "Awaiting place on docket" Anybody have this type of claim? Trying to use secondary evidence and Nexus letters because you have no service record of it? The advice I have been given depends on who I have asked. I have been told, I should have been awarded due to mixed views and having the benefit of the doubt. I have been told I have no chance without a record of it in service. I have been told it is just the process I have to go through, the VA denies denies denies and dwindles down the hopefuls to very few who will take it all the way through appeals. I have been told both do do a congressional investigation because it worked, and to not do a congressional because I will only provoke a quick "no" answer. I am hoping someone who has been in my shoes can tell me what they went through. I have no idea how long I will be in this appeal process, but I am now going on six years fighting this thing, although for the VA they only go back to the last time you re-opened so for them 4 years.

Finally got my Sleep Apnea DBQ and Nexus Letter back from my doctor. E-Benefits is showing Disabilities Claimed: sleep apnea to include due to aggravtion by ptsd (New) I had my military treatment records, C&P Report for PTSD, VA Claims File for the doctor's review, but he said that he wasn't comfortable stating that he reviewed these documents since it would take him several days. Just wanted to see what everyone's thoughts are on my DBQ & Nexus letter that doesn't state that he reviewed my VA documents or military treatment records. Thanks! OEF 21B Sanitized Sleep Apnea DBP and Nexus Letter_27 JUL 15_Redacted.pdf

Just saw on E-Benefits that my Sleep Apnea claim as secondary to PTSD was granted at 50%. For the Sleep Apnea: - No history of sleep issues while on active duty or in STRs - VA Psych requested sleep study, Sleep Study completed by VA-Outsoursed Hospital, Diag. w/mod. Sleep Apnea and issued a VA CPAP in May 2013. - My private Sleep/Pulminary Doc completed Sleep Apnea DBQ & wrote nexus letter stating "Based on my evaluation of the veteran, it is my opinion that it is at least as likely as not that Mr OEF21B's diagnosed OSA is aggravated by his service connected PTSD. I also feel that it is at least as likely as not that Mr OEF21B's PTSD is aggravated by his OSA." (17 JUL 15) Filed Sleep Apnea claim 28 JUL 15 - Sleep Apnea C&P in AUG 15 with the Veterans Evaluation Services (VES). Brought copy of DBQ and Nexus Letter as well as some of the articles linking PTSD & SA. I thought the C&P went well and the Dr. said that she would add the articles as well as my DBQ & Nexus letter to her final report. IMHO, I believe that my private doc's completion of a DBQ as well as his Nexus letter was key in meeting the requirement for service connection secondary to PTSD. I also believe that providing these along with the articles listed here in various places, and providing all of this to the C&P examiner helped. Semper Fi

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%

Has anyone had any luck with claiming Sleep Apnea as secondary to Hypertension and/or Arteriosclerotic Heart Disease ? My husband has service connection for both hypertension and heart disease and now a current diagnosis and medical equipment for sleep apnea. I've read where VA has approved hypertension secondary to sleep apnea and heart disease secondary to sleep apnea, but not the other way around. If anyone has an archived VA citation in this regard, or personal experience, would greatly appreciate hearing about it. Thanks all.

Is there a way I can service connect my diabetes and my sleep apnea. I have been suffering from sometimes severe back pain from a service related injury. How can I connect the two if was never mentioned in my service records. I injured my back while on a rotation at NTC. After injuring my back i was on a profile for the last 16months, before they Chaptered me for weight control (218lbs). Before my injury I never had a problem with my weight. when I finally got my c-file i learned that i was up for the MEB, but they chaptered me before that. Again, how can I sc diabetes and sleep apnea?

HI, New here. Found the community through google. I'm still learning to navigate the site, so please bear with me. Searching got me in the right direction but not close enough. I was recently diagnosed with Service connected PTSD through the VA. I have not done a C&P exam yet. On the same day I was diagnosed with obstructive sleep apnea through a VA sleep study. I've read that there is a slim chance to connect my sleep apnea as a secondary to my PTSD. My VA psych Dr said they aggrevate each other, but a pulmonologist opinion would have more power than his. I've seen some advice from other members talking about letter templates, DBQs and supporting articles. However, I haven't been able to find them here. I've scheduled a civilian Dr. appointment with a pulmonologist in about 2 week and would like to come prepared with any information I can. Any help would be greatly appreciated. Thanks, Nova

I applied for Sleep Apnea secondary to PTSD (Aggravation). I submitted a FDC on 9/17/17 with the following evidence Nexus Letter provided by my VA doctor stating " it is more likely than not Mr. xxxxx Sleep Apnea aggravates his PTSD and his PTSD aggravates his Sleep Apnea". DBQ filled out from my VA Pulmonologist stating "Veterans PTSD and Sleep Apnea is at least additive" VA Sleep Study showing Dx of Severe Sleep Apnea. Evidence showing prescribed CPAP from VA Statement in Support of Claim from Wife, and fellow NCO I served with observing my symptoms. 2 Studies providing link of Sleep Apnea and PTSD in returning Iraq/Afghanistan Veteran On Ebenefits my claim status went from Under Review to Preperation for decision without a C&P Exam scheduled. My question, is it possible I provided enough evidence to grant my claim? Or it is just being denied very quickly?

I still active in the ARMY. Im been using my CPAP machine for more than a year. I got the machine because the ARMY send me to the hospital because I cant sleep. The hospital exam show that I have a moderate condition. The question is, Can I request another sleep study exam? If so, How long I have to wait? Maybe if my condition is worse I can get a 100% when I get retired.

Thank You in advance! (First question after reviewing this book I wrote here should probably be, do i need to separate all of these questions into the different subject forums or is this OK ?) I've been procrastinating now for almost 10 years (mainly because of denial, I volunteered, tough guy, I know guys that seen/did worse and horror stories with the VA) and have just this year decided to attack this VA Claims Process. Putting it off for too long and ready to get the information needed to hopefully (fingers crossed) have a smooth process. I have not filed for anything, have no medical records or injuries documented while active or since (I have just requested my military records from the right place after all these years, because I assumed the VA would have them and keep them safe, so I didn't need a copy. MISTAKE #1, Naive I know) and have not been to see a private doctor for anything. I medicate with over the counter and always have, but have never been officially diagnosed with anything. Just last month I made an appointment with advice from an amazing local veteran group with a psychologist outside of the VA and she diagnosed me with PTSD. It was extremely hard to even talk to her, I've never talked to anyone about it just denied it or pushed it back. (I know I'll still need a VA exam). I was also seen by an outside, but VA referred hearing specialist and was diagnosed with tinnitus in the 3k range and hearing loss. 6 months after release from active duty in 2007 I was seen at the local VA for hemorrhoids and treated. I have had issues with roids, constipation, diarrhea etc ever since. This is also the only thing I have ever been seen for at the VA. My wife has also complained for years about sleep apnea and me startling her in the middle of the night when I sleep, should I get an evaluation for sleep apnea. She doesn't remember ifI did it when active or not, but does that matter for service connection ? I have already made the intent to file as of last month and am wondering how I should proceed from the above mentioned. I have not been seen for IBS, by any professional but it reads like that is a high possibility, so do I need a diagnosis from outside of the VA or should I get one prior to filing? Should I file IBS, if diagnosed under "presumptive illness" (BALAD IRAQ 2005-2006) ? Should I get on the Burn Pit or Gulf War Registry (Is there anything I should know prior to going to these registry appts) ? Should I file for PTSD with just an outside evaluation (How are stressors confirmed, all mine are personal accounts and encounters) ? Should I file for hearing loss or tinnitus or both I served as a firefighter and have read that as being on some list hearing related jobs ? And finally, Should I file for all of these now at one time or should I wait and do them individually ? My main concern is going into this and not being fully prepared, if there is anything you believe would aid in the above filings please let me know. I know there is a long road ahead, but I don't see any point in going alone and appreciate you all. Thanks again!

What's up Fellow Vets, I am new to this site and I wanted to explain my case and get advise. I was medically discharged from the Army in 2004 due to a diagnosis of asthma (30% disability). I never had any kind of respiratory problems until I arrived in Germany in 2003. I started experiencing difficulty breathing, shortness of breath, excessive snoring, dry mouth, fatigue, ect. After several trips to the doctor and several tests, the Army doctors diagnosed me with having asthma. I never had asthma so all the symptoms i was experiencing were new to me. Fast forward to 2017, I was having trouble with the hormones in my body. I was experiencing ecessive daytime sleepiness, fatigue, memory problems and loud snoring (ask my wife). After several tests and appointments, it was requested by my doctor that I have a sleep study performed. I didnt know why I would need this test but reluctantly, I agreed and took the test. After the test, I was diagnosed with severe obstructive sleep apnea with an AHI 77.5. Moderate is 5 and severe is 10+. So it turns out that the symptoms i was experiencing while in the army were of both asthma and severe OSA. The doctors in the Army never even mentioned or tested me for sleep apnea. I had a DBQ done at the VA Hospital in which i am being treated. In the DBQ, the Dr states: a. Describe the history (including onset and course) of the Veteran's sleep disorder condition (brief summary): Veteran reports excessive daytime fatigue and sleepiness, unrefreshing sleep ,snoring and frequent awakening. He had a sleep study at Northport VAMC on 8/11/2017 whihc showed severe obstructive sleep apnea with AHI 77.5 events per hour. He had a CPAP titration study on 8/23/2017 which showed improvement to AHI of 12.9 events per hour. He just got his CPAP machine yesterday. As of now, he gets about 4 hours of sleep per night. He does not restorative sleep. He does find himself falling asleep during the day. Does the Veteran's sleep apnea impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of the Veteran's sleep apnea, providing one or more examples: he is tired throughout the day. His poor sleep has led to foggy thinking and poor short term memory. I just went on ebenefits and submitted a claim for sleep apnea and Unemployability. Do you think i have a valid claim?

What's up Fellow Vets, I am new to this site and I wanted to explain my case and get advise. I was medically discharged from the Army in 2004 due to a diagnosis of asthma (30% disability). I never had any kind of respiratory problems until I arrived in Germany in 2003. I started experiencing difficulty breathing, shortness of breath, excessive snoring, dry mouth, fatigue, ect. After several trips to the doctor and several tests, the Army doctors diagnosed me with having asthma. I never had asthma so all the symptoms i was experiencing were new to me. Fast forward to 2017, I was having trouble with the hormones in my body. I was experiencing ecessive daytime sleepiness, fatigue, memory problems and loud snoring (ask my wife). After several tests and appointments, it was requested by my doctor that I have a sleep study performed. I didnt know why I would need this test but reluctantly, I agreed and took the test. After the test, I was diagnosed with severe obstructive sleep apnea with an AHI 77.5. Moderate is 5 and severe is 10+. So it turns out that the symptoms i was experiencing while in the army were of both asthma and severe OSA. The doctors in the Army never even mentioned or tested me for sleep apnea. I had a DBQ done at the VA Hospital in which i am being treated. In the DBQ, the Dr states: a. Describe the history (including onset and course) of the Veteran's sleep disorder condition (brief summary): Veteran reports excessive daytime fatigue and sleepiness, unrefreshing sleep ,snoring and frequent awakening. He had a sleep study at Northport VAMC on 8/11/2017 whihc showed severe obstructive sleep apnea with AHI 77.5 events per hour. He had a CPAP titration study on 8/23/2017 which showed improvement to AHI of 12.9 events per hour. He just got his CPAP machine yesterday. As of now, he gets about 4 hours of sleep per night. He does not restorative sleep. He does find himself falling asleep during the day. Does the Veteran's sleep apnea impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of the Veteran's sleep apnea, providing one or more examples: he is tired throughout the day. His poor sleep has led to foggy thinking and poor short term memory. I just went on ebenefits and submitted a claim for sleep apnea and Unemployability. Do you think i have a valid claim?

I just had two C&P exams this morning and am trying to keep a positive mindset, but the glass looks half empty to me. Maybe someone else can offer some insight on my situation. Since April, I have been rated at 60%; 50% for PTSD and 10% for tinnitus. The claims process for those went pretty smoothly, really, and I was awarded my disability ratings in very short time. I have since then filed three additional claims. My intent to file was back in April, but I submitted the claims on July 25. These three claims are for hypertension secondary to PTSD, sleep apnea secondary to PTSD and for hearing loss. Today I had my C&P exams for the hearing loss and hypertension. I have heard nothing about scheduling a C&P for the sleep apnea. My first exam this morning was for hypertension. I was diagnosed with hypertension, by a private doctor, about 4 years ago and have been on medication since then and am currently being treated by the VA for my hypertension. My hypertension isn't very severe, but it is outside of normal parameters and has been this way consistently for quite a few years. Even though I wasn't officially diagnosed until 2013, I have (and submitted) evidence of prior medical records that show high blood pressure readings well before my actual diagnosis. I don't think I meet the criteria for anything more than a 0% rating, but that's all I really want, or need. I believe I have bradycardia (abnormally low pulse), as a result of my high blood pressure. My blood pressure has always fluctuated and spiked in relation to my PTSD symptoms, so I certainly think the PTSD aggravates my blood pressure, but I don't feel good about my C&P exam from this morning. The doctor was one of the weirdest people I've come across at the VA, so it was hard to get a good read on him. All he did was take my blood pressure 3, or maybe 4, times, all from my right arm, while I was seated. He wanted to know when I was first diagnosed and how many times they had taken my blood pressure during the visit in which I was diagnosed. I told him it was in 2013 and, although I didn't recall how many times they took a blood pressure reading, I did remember how high it was when I was diagnosed. I tried to discuss the evidence I had submitted to support my having actually had high blood pressure before my 2013 diagnosis, but he shut me down. He said anything that I sent in with my claim wasn't his concern. All he was doing was "checking the boxes" on my blood pressure exam and someone else would look at everything that was submitted. This doesn't make sense to me. Isn't the purpose of the C&P exam to look at the evidence, as well render an opinion? I have already been diagnosed with hypertension and am receiving treatment. I'm guessing my blood pressure readings from the C&P exam are within normal parameters...that's what the medication is for. I don't understand the point of putting me through this dog and pony show, but I certainly didn't walk out of there feeling good about it. Next, I had my audiology exam for my hearing loss claim. I just had a audiology exam a little less than 2 months ago from a VA contractor and was subsequently issued hearing aids from the VA about a month ago. As I mentioned earlier, I already receive compensation for tinnitus, so part of me feels like the VA has already conceded that I had sufficient noise exposure in-service to cause damage, but I have also heard of people winning on tinnitus and losing on hearing loss. Since I had just recently had an audiology exam, I was only given an abbreviated C&P exam for my hearing. The audiologist stated that the contractor had not "submitted a full report", or something to that effect, so she only needed to do a partial test today. She asked me a little about my in-service noise exposure, as well as about my civilian occupations. It was over pretty quickly. I didn't feel quite as bad, or confused about that one as the hypertension C&P, but both of them seemed rushed and indifferent. When I got home, I logged in to eBenefits to check on something unrelated and decided to look at my claim status. It had gone from Gathering Evidence to Preparation for Decision, since the last time I had checked on it. How could it be in Preparation for Decision? Mind you, I just had two C&P exams a couple of hours before. There is no way those reports had been sent in and considered already, so it had to have moved to Preparation for Decision a day, or more ago. Since I have not been scheduled for a C&P exam for my SA secondary to PTSD, I suspect now that they don't plan to give me an exam for the sleep apnea. The fact that they'd already moved my claim to Preparation for Decision before my exams leaves me with the impression that my claims are doomed to denial. Realistically, both the hypertension and hearing loss should each be rated at 0%, so that won't get me an increase in disability pay anyway, but a positive decision on the SA would. I also need the 0% ones, though, because of their relationship to other problems I have. I'm a little confused by all of this and am certainly not feeling hopeful about my prospects at this point. Am I jumping to conclusion prematurely, or am I making a reasonable conclusion that things aren't going my way? It's been less than 30 days since my claims were filed and it's already been moved to Preparation for Decision before my C&P exams. I don't know what that means, but it doesn't seem good.

After failing a sleep private study and required to sleep with a CPAP machine and meds, my private psychiatrist wrote me a NEXUS letter linking the sleep apnea as secondary to the PTSD. Also I had my Dr fill out a DBQ also linking them together. I have been waiting on them to send me info on when to go to a C&P exam but nothing yet. So I called my Veterans Services Rep and they looked it up and said they see where the information has been sent out for a medical opinion. any idea if this means NO C&P or if they are looking info to see if they will even schedule one? thanks!