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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?

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?

Good morning, I filed a Fully Developed Claim on May 16th for Sleep Apnea secondary to PTSD.I included a DBQ from my Civilian Primary Care MD, a Sleep Study,a letter from my MD that the CPAP was medical necessary and an Independent Medical Opinion, claimed just moved to Prep to Decision . . I hope I did everything correct? Any thoughts on if I missed anything.I will let everyone know how it goes

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!

Hello everyone, I served in OIF at the onset of the war from 3/2003 - 4/2004 as a front line medic.I also did a tour in 2008. I am currently 70% PTSD/Major Depression, 20% Cervical Radiculopathy and receiving 100% IU P & T as of 5/2013 but have been receiving 100% IU for my PTSD since 2/2010 . I also receive 80% CRSC for both of those conditions since 2013. I was denied service connection for asthma/COPD and Sleep Apnea. Since 2013 new information, and I assume evidence, has come out to establish burn pits as a cause for COPD and that sleep apnea can be a secondary condition to PTSD. My question is 1. Should I attempt to get these two conditions service connected with the goal of a 100% scheduler rating rather than IU or will that most likely adversely effect what I have now? 2. Is sleep apnea secondary to PTSD and COPD linked to burn pits, combat related? So I can keep my CRSC or possibly get it increased?

I filed my first claim and recently received va decision. 10% awarded for tinnitus, sleep apnea denied, wrist tenosynovitis denied, and hearing loss denied. I have county VSO but I know they are very busy and want to put paperwork in good order before I file the NOD with them. I was only given audio exam from VA but no other exam. I retired from the Air National Guard and have twenty years of service. The service history is convoluted but I have all the records involved 3 DD214's (Active Duty Army and Air Force), Title 10 orders for (Air Guard), and NGB22 (Air Guard and Army Guard). My career was Infantry to start and Flightline Avionics for the latter part. I have my Air Force medical records. What I don't have is my Army medical records covering Active Duty Army (including initial entrance exam) and Army National Guard. Somehow Army records never crossed over into the Air Force but I located (after many requests) the records in MO and have requested 8 months ago. The recently confirmed that received the request but said it would be about 2 more months...I was not able to provide any Army medial records with my initial claim. I have request my C-file last week by fax and certified mail so hopefully I will receive soon. Just wondering what else I should be doing while I wait for those records to show up. Sleep apnea: The denial letter stating the sleep study date was wrong, I had it 10 years previous to the date they mentioned. So I figure I would point that out first thing. Also believe I will have evidence in Army medical records to back up the claim but there is the waiting game. Wrist Tenosynovitis: For this I have complaints on webHA and civilian medical records but it was aggravated by fall from helicopter. Stupidly I did not file an incident report, wrist hurt but also was embarrassed and just want to "shrug it off". I did have witness and maybe I could get lay statements....but this was also preexisting condition, but also aggravated by regular flightline work. Hearing Loss: I was told that I that I have left ear hearing loss but i didn't show service connection. I remember being told by Army medical on exam that I had hearing loss related to gunfire and that "I would want to keep these records.". I was very young at the time and was ignored it but now those are the records in MO that I am waiting on. I was also recently diagnosed with severe and recurring depression and prescribed medication and have long history of diagnosed sleep disorder and medication. I don't know weather to purse these as separate claims or as part of sleep apnea, which are symptoms. I do qualify for both gulf war exam and burn pit registry exam due to Kuwait deployment I and am wondering what the difference between those two are and if they are worth pursuing? I had throat surgery for diverticulum and diagnosed with barretts esophagus that could be related as well as forest fires in Idaho (Army) as well as fires during LA riots (Army Guard) and breathed in massive amounts of dust driving personal carrier in Mohave desert during 4 Ft. Irwin rotations. Once all my C-file and Army medical records show up I was considering going to the Ellis Clinic for exam and report to file with NOD...I figure I could fly out and pay for exam less than $1000 and was wondering if anybody else thought it was worth it? Sorry, that is a lot info to throw out there but I'm trying to figure my way through this claim process and would just appreciate any advice form the community. Thanks!

This probably could have helped me out to know this sooner instead of being dx with insomnia now there are saying a tested positive for sleep apnea. Are these related? I know nothing of what this is other then usually you snore is a sign. The doctor said in two weeks their coming out here to put in a cpap machine and to fit test me. just when I think I'm done filing something else pops up.... Life

Hello folks! I have recently submitted a claim with the VA to reopen my previously denied PTSD, depression diabetes and sleep apnea secondary to pain, medications, weight gain and depression and TBI and TBI residuals with headaches. I got a call yesterday from VES and I have never heard of them. Anyone have input on them? It looks like the only C&P they ordered was for TBI. Any reason why they wouldn't ask for a C&P for the other claimed conditions? Thanks for any and all help!

Good day all. Hopefully I can explain this clearly without confusion. I received my BBE in Sep 16, and immediately filed for a NOD with more evidence (related to neurological issues/damages). However, I am 0% service connected with sleep disturbances/sleep apnea. Recently, as in two weeks ago, I was diagnosed with apnea and required to wear and was given a CPAP. Long story short, my claim is with the DRO for appeal and review, and although I am not contesting/appealing the sleep apnea for increase, I have the necessary medical evidence including the VA form for sleep apnea completed by my sleep physician/dr stating my condition as well as the results of my sleep studies. How should I submit it? Should it be a file for increase, or submit it as I would with additional medical evidence to the evidence intake center to be reviewed by the DRO along with the other evidence submitted for the conditions I am actually appealing? Any advice would be appreciated. Thanks so much. Also, to make sure that I have the correct fax number and address, could you include that as well. That would be greatly appreciated as well. Thanks all.

Hi, I am a 30 year retired vet. I retired 13 years ago. I as recently diagnosed with "very severe" obstructive sleep apnea. The machine they gave me is preset on the highest output flow. My episode exceed 35 times an hour with some lasting more than 30 seconds. I was diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record. In fact, they wanted to operate on my uvula. There lies the rub. The operation could have ended my career so I didn't persue. Additionally, while on active duty I developed severe chronic sinusitis and allergic rhinitis and this also is documented in my service health record. I have been living with this and chalking it down to getting old. Fast forward...I recently got a machine that they say I have to wear for the remainder of my life. I just learned that Tricare Prime does not pay for it all. So, I researched online and submitted a claim the E-benefits and it has been received and was under review until today when they changed this to "gathering of evidence" Development Letter Sent. Does anyone know what this means? What do I have to look forward to concerning the process. I watch the news. It doesn't look good, right? thanks in advance.

Hello, Army OIF/OEF vet here. In 10/2015 I initially filed for claims with little/no evidence. Most were of course denied. Through appeals I am now at 40% SC for IBS and tinnitus. I appealed my anxiety denial and was given a C&P exam in 06/2016, fast forward to 01/2017 and the VA sends me an SOC along with the VA form 9. I hired Vet Comp and Pen to help me gather supporting documents. (I think they did an excellent job) and submitted my VA for 9 along with new documents (02/2017) and waived my hearing before the BVA to help expedite things. Much to my surprise I was told I should still expect to wait about a year or so for the BVA's decision. In the meantime I have been developing a FDC for sleep apnea. Should I go ahead and file it even though the BVA currently has my anxiety claim or should I wait until it is decided? Thanks, and hopefully my post wasn't too lengthy.

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 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.

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

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.

I'm new here so I hope I am doing this right. I am actually the wife of the vet that is filing a claim. In April of 2011, 2 weeks before being placed on TDRL for a heart condition, my husband had a sleep study done at a VA sleep center. The result was sleep apnea and recommendation was a CPAP machine. Because he was on TDRL he did not pursue VA benefits. He also did not receive (didn't ask either) for a CPAP machine. We didn't realize that was recommended until recently when we requested the diagnostic paperwork. My husband has been completely separated from the Air Force since October of 2015 (no longer on TDRL). In Nov 2016 he filed a claim that included sleep apnea. The sleep apnea was denied in May of 2016 as it said it was not service connected. That's when we called the sleep center and requested the diagnosis to be printed. We assumed the VA would have access to this because they said they did not need him to send any medical records, they could filter through them on their own. Once we got it printed from the sleep center he "reopened" the case (didn't know he should have just appealed) and included the diagnoses paper. As far as any other history related to sleep problems while he was enlisted.. it is documented a couple of times that he visited the military hospital post deployment for sleep issues and was told to take Benadryl. He never thought of going to the doctor because he snores a lot.. we always assumed he had sleep apnea but honestly didn't realize how dangerous it could be so he never went to the doctor about it while active duty. He just went for the study before being put on TDRL because like I said, we knew by his symptoms he had it and he wanted it documented. We are in the process of waiting to see if he will get denied again. I'm including the diagnosis information we have. Based on what you guys usually see.. do you think he has a chance of getting benefits? He was rated at 0% for his heart so no benefits currently *Overall sleep architecture was consistent with sleep disordered breathing. The patient demonstrated a severe degree of sleep fragmentation (arousal index 82.6/hr). The majority of these arousals were secondary to sleep disordered breathing(SDB). The patient slept 114.4 of 282.0 minutes in the supine position. The lowest oxygen saturation was 86%. The patient had a periodic limb movement of sleep (PLMS) index of 0.9/hr and a PLMS arousal index of 2.77/hr. The EKG revealed no abnormalities. EEG no abnormalities. IMPRESSION: Obstructive Sleep Apnea RECOMMEDATIONS: 1. Discuss with patient treatment options considering CPAP or surgical evaluation the rest is just about if patient was CPAP what to do.

Thanks for your time guys. I currently have a claim in and have all of my C&P exams on 16 September. I claimed sleep apnea secondary to ptsd but they didn't order a c&p for it. Is this good or bad? I went to my private sleep specialist and had him fill out the dbq and he provided a nexus statement and I submitted that in the claim. I sort of feel like they already want to deny it and that's why there's no exam. I claimed tinnitus, left knee condition, ptsd and SA second to ptsd. C&P's for all the others except SA is scaring me. I had to have surgery on my knee and when. I woke up in recovery the orthopedic surgeon had diagnosed me with presumptive sleep apnea and told me to get to the doc for it. I submitted that paperwork too as well as buddy statements about the symptoms and onset from my roomies and one from my wife (a nurse). Are there any chances of an award here?! Thanks!

Hello Everyone, I'm in the middle of a claims process with the VA for sleep apnea, and I just wanted to share my story and maybe get some feedback. Since I started this process, I have spent some time surfing these forums and finding my information on Google. Mostly I have found claims for sleep apnea as secondary to other things or advertisements for E-books on how to get approved. I separated from the Navy in August last year after 9 years of service. I never sought treatment for apnea while I was in, but I did go to my civilian doctor (Tricare Prime Remote) in 2011 for trouble sleeping/falling asleep and snoring. He prescribed some mucinex for congestion and recommended a neti pot to help my breathing (he is a very natural-approach doctor which normally I appreciate). I never saw any improvement, and since he didn't think it was a serious concern, I never bothered to ask for a referral to someone else. I deployed right up until getting out of the Navy, and after I got back (June of 16) my wife starting waking me up in the night worried that I had stopped breathing. She also started consistently sleeping in the other room because of my snoring, which had never been quite as bad. I got a sleep study done and diagnosed with moderate central and obstructive apnea in February this year (6 months after discharge), and started the claims process in March. The local VSO was pretty rude and didn't seem interested in helping me, so I waited for the ebenefits site to start working again, and filed the claim online. I submitted all of my recent records and sleep study results, as well as the record of my doctor visit in 2011 with sleep complaints. I went to a scheduled C&P exam two weeks ago, and here are a few of the notes: Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran have or has he/she ever had sleep apnea? [X] Yes [ ] No [X] Obstructive ICD code: G47.33 Date of diagnosis: 2/2016 [X] Central ICD code: G47.31 Date of diagnosis: 2/2016 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's sleep disorder condition (brief summary): veteran states did not seek treatment for sleep issues in service however did have difficulties and wife confirms starting around 2010. The veteran was diagnosed with sleep apnea within the year of discharge. He currently wears cpap 5. Diagnostic testing --------------------- a. Has a sleep study been performed? [X] Yes [ ] No If yes, does the Veteran have documented sleep disorder breathing? [X] Yes [ ] No Date of sleep study: 2/2016 Results: AHI 24.8 with 84% oxygen nadir TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: The veteran has recently been discharged from active duty 8/2015 and within the first year diagnosed with obstructive and central sleep apnea. It is as likely as not that the veteran experienced sleep apnea in the service. The veteran and veteran's wife notes he particularly noticed sleep issues around 2010 while in service. The following week, my claim status in eBenefits went to "Preparation for Decision", and that is the latest as of now. Should I bother with obtaining my C-File at this point? I haven't heard of it until the past couple of days. It appears that all of my records have been reviewed. What do you think are the chances of being awarded service connection for this? I really have no idea what to expect. At any rate, I just wanted to get my story out there. If anything, it may help someone like me who is trying to figure out the chances and what to expect. But mostly, I think posting this will help with the stress of this whole process. Thank you for reading! Willy P

I have a question regarding getting an appeal approved for sleep apnea now that I am out of the military. While I was active duty, I was given two sleep studies that did not show enough apnea for a diagnosis. I also had throat implants and a sinus surgery to help with breathing, fatigue from poor sleep, and snoring. Nothing seemed to help. I did get a service connection for sinusitis with zero compensation. Last month my doctor sent me to another sleep study which revealed sleep apnea and then I followed up with another test using the CPAP. Now I'm wanting to go back to the VA and submit a claim and I'm wondering if there is any advice on what to do. I am having my doctor look at my service medical records to see what is in there. Thanks for any advice you folks have.

First bullet says, "We have assigned a 50% evaluation for your sleep apnea..."But here's where it's interesting. The second bullet says, "A higher evaluation of 100 percent is not warranted for sleep apnea syndromes unless the evidence shows:Carbon dioxide retention; or Chronic respiratory failure; or Corpulmondale; or, Tracheostomy required." (underlining is mine)I thought it had to be chronic respiratory failure AND carbon dioxide retention? So, if I'm reading this correctly, according to this letter, all I would have to prove is carbon dioxide retention and I'd be rated at 100%?

It's easy to get sidetracked. You talk to a VSO, who "tells you" things like, "You can't get SC for sleep apnea unless you had documented symptoms in service". (Not true, OSA can be service connected secondary to service connected conditions without any evidence of an "in service" sleep apnea condition.) So, you wrongly focus on getting buddy letters to say you snored in service, and you completely forget what is important. That is, your sleep doc needs to opine that your sleep apnea is at least as likely as not due to service connected PTSD. Then, he needs to cite some of the multiple scholarly research articles which indicate PTSD causes sleep apnea. FOCUS ON WHAT IS IMPORTANT. For service connection that's The Caluza Triangle. Remember, you dont need an "in service event" for secondary conditions, you need only a nexus link to your PRIMARY condition, where the in service event is presumed. This article from AskNod is a great example: https://asknod.org/ COVA– CALUZA V. BROWN–TOTAL RECALL BVA–CALUZA V BROWN 20 YEARS LATER

I have obstructive sleep apnea (diagnosed by the VA) I think the VA will deny my claim regardless of the evidence I present. This post is lengthy, but I thing is may be helpful to others in the same situation. I have COPD determined to be service connected by the VA I find a BVA case that identical to my circumstances: In Citation Nr: 1228135 Decision Date: 8/15/12 , the Board of Veterans Appeals found that sleep apnea was aggravated by the veterans service-connected COPD and that service connection for the Veteran's obstructive sleep apnea was warranted. In this case: - The VA determined the veteran had service-connected COPD with emphysema, (that's me) - There was no evidence that the Veteran suffered from this sleep apnea during his active service. (mee too) - The veteran was a former cigarette smoker and had mild dyspnea on climbing two flights of stairs (one flight for me) - A C&P exam concluded that the Veteran's obstructive sleep apnea is less likely than not related to his in-service dyspnea and other respiratory complaints. (me too) - Despite that, the board rules that since the veterans OSA was exacerbated by his service connected COPD, and therefore, OSA was service related. Also, I find this case and show it to the C&P examiner: In another case: BVA9415915 DOCKET NO. 93-01, the board of Veterans Appeals found “Obstructive sleep apnea is causally related to service-connected chronic obstructive pulmonary disease“. They found the veteran to be entitled to service connection for obstructive sleep apnea as secondary to service-connected chronic obstructive pulmonary disease. - In this case, the veteran had been previously granted entitlement to service connection for chronic obstructive pulmonary disease. The VA found that obstructive sleep apnea, which presented only after the veteran was discharged, was causally related to service-connected chronic obstructive pulmonary disease and granted entitlement to service connection for chronic obstructive pulmonary disease. I showed this case to the C&P doc. She ignored it. I got a decision letter. I'm not considered service connected. Is there anything I can do? I point out that the VA’s own web page suggests a deleterious link between OSA and COPD The VA/DoD “Clinical Practice Guideline for the Management of Chronic Obstructive Pulmonary Disease” indicates that: “Patients with COPD may also have a longer latency to sleep onset, more frequent disruption and stage changes, and decreased sleep efficiency than in the general population”. “Sleep disorders also seem to increase as patients with COPD age” Patients with signs or symptoms of a sleep disorder should be referred for a diagnostic sleep evaluation, which may include diagnostic tests and diagnostic interviews. Congestive heart failure, cardiac ischemia, or gastroesphageal reflux are listed on the VA’s own web page as comorbidities of COPD. I show these articles from the medical literature: 1. Marin, Jose M., Joan B. Soriano, Santiago J. Carrizo, Ana Boldova, and Bartolome R. Celli. "Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome." American journal of respiratory and critical care medicine 182, no. 3 (2010): 325-331. 2. McNicholas, Walter T., M.D., "Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease." American journal of respiratory and critical care medicine 180, no. 8 (2009): 692-700. COPD is a major risk factor for cardiovascular morbidity and mortality, even after adjustment for confounding risk factors such as age, smoking, and body mass index (BMI) (7, 11). 3. Owens, Robert L., and Atul Malhotra. "Sleep-disordered breathing and COPD: the overlap syndrome." Respiratory care 55, no. 10 (2010): 1333-1346. 4. Weitzenblum, Emmanuel, Ari Chaouat, Romain Kessler, and Matthieu Canuet. "Overlap syndrome: obstructive sleep apnea in patients with chronic obstructive pulmonary disease." Proceedings of the American thoracic society 5, no. 2 (2008): 237-241 5. Chaouat A, Weitzenblum E, Krieger J, Ifoudza T, Oswald M, Kessler R. Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am Rev Respir Dis 1995;151:82-866. What I got back was "With regards to whether the veteran's COPD caused his sleep apnea , we can look to the experts. Recent articles on this subject make the point that COPD and sleep apnea are common and thus, by chance alone , some individuals will have both diagnoses . Result from the Sleep Heart Health Study showed that sleep apnea and hypopnea syndrome (SAHS) was not more prevalent in those mild COPD than in those without COPD." My response (which I'm still working on) is COMMENT: This same study, these same experts showed that even for patients without atrial fibrillation, the risk for ischemic stroke was very significantly increased in the population of patients with OSA. The most cited research that indicates that "There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome” is from Bednarek et.al. First, and very significantly, this was a very small population study (N=365 males) of randomly selected people from voting rolls in WARSAW, POLAND. Among the population, 16% of the population were diagnosed with OSA; 10.7% were diagnosed with COPD. Conclusions from that paper were drawn from statistics for roughly five males among a random selections of voters in WARSAW, POLAND. Conclusions from Bednarek et.al. were drawn from statistics for roughly five males among a random selections of voters WARSAW, POLAND. In Warsaw, Poland, roughly 11% of the population were diagnosed with COPD; in the United states, the number of people diagnosed with COPD is roughly HALF OF THAT. One need to be careful in the application of statistics. Meaningful statistics concerning American veterans can not be drawn from these data. FOOTNOTES Bednarek, Michal, Robert Plywaczewski, Luiza Jonczak, and Jan Zielinski. "There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome: a population study." Respiration 72, no. 2 (2005): 142-149 Mannino, David M. "COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity." CHEST Journal 121, no. 5_suppl (2002): 121S-126S. The veteran is not a medical doctor, but he is an MIT educated engineer and he is qualified to apply statistics to data. BOTTOM LINE APPEARS TO BE THIS FROM THE C&P EXAM SUMMARY: "Given the veteran's other risk factors, there is insufficient evidence to say that COPD caused the veteran's OSA. " COMMENT: “Given the veteran’s other risk factors” is assumed to mean weight and neck size. However, as shown below, neck size and weight are critically flawed indicators, the probative value of this statement must be decreased. According to the Mayo clinic(http://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/basics/risk-factors/con-20027941), risk factors for OSA include "Being Overweight. Around half of people with obstructive sleep apnea are overweight." COMMENT: Half. Meaning fully 50% of people with OSA are overweight. Therefore, since 40% of American men are overweight (Nguyen Dang M., and Hashem B. El-Serag. “The epidemiology of obesity.” Gastroenterology Clinics of North America 39, no. 1 (2010): 1-7.), as a risk factor, patient weight is useless. More to the point, the probative value of these assertions of risk is actually proven to be negligible by the statistic presented. To further illustrate the difficulty of citing this statistic, consider the study conducted by Lettieri et.al. where it was shown that among patients at the Walter Reed Army Medical Center, Washington, who had undergone bariatric surgery at Walter Reed and who had significant weight reduction over a period of one year, only 4% of them had resolution of OSA. Lettieri shows that if the supposed cause is removed, the result remains. That, is confounding, from a statistical perspective. One could say “without resorting to mere speculation, it’s not possible to say what it means when (an already dubious) risk is removed, and nothing happens”. On the other hand one might conclude if the (an already dubious) risk is removed, and nothing happens”, “it’s time to reconsider the risk.” Having a Large Neck. The size of your neck may indicate whether you have an increased risk. A Thick Neck may narrow the airway and may be an indication of excess weight. COMMENT: Here, neck thickness is stated irrespective of stature. Clearly, however, a 17” neck circumference on a 5-foot tall person should be expected to have different ramifications for airway restriction than a 17-inch neck circumference on a 6-foot 5-inch person. More significantly, since a thick neck is stated to be “an indication of excess weight”, the probative value of neck circumference (stature notwithstanding) should be assumed to have precisely the same probative weight as being overweight (NAMELY, ZERO). One early and well cited study found that neck circumference was an indicator of OSA grouped metrology data for men and women TOGETHER. They found the mean neck circumference of non-OSA patients to be 39.1±3.7 cm and for OSA patients to be 41.2±3.5 cm. For those of us who buy our shirts in the U.S. the non-OSA group ranged from 14”-15.4 in, and the OSA group ranged from 16.2 -17.6 in. A 6-foot 5-inch tall man who wears a size 14 or 15 shirt is dangerously underweight. The statistic is seriously flawed because it fails to recognize that men and women have different stature, and grouping metrology data for them together is frankly, stupid. Failure to account for stature makes the result incredible; to suggest that a 6-foot 5-inch man like myself should have a neck circumference of 14-inches is simply incredible. Finally, I point out: The combined disease of COPD and OSA is so well known it has it’s own name among clinicians. A simple Google search for ““Overlap Syndrome” OSA COPD” yields 10,400 hits about sleep disordered breathing and COPD. Overlap syndrome is well known to exacerbate the pernicious diseases of COPD and OSA, beyond what might occur if either existed alone. I'm at the RO-level now. Is there anything I can do to get the VA to consider the evidence?