Sleep Apnea - Do I Have A Shot?

[joeyjoeyb]

Been lurking around for a while and decided to join from a friends referral. Here is my story...I am going to piece it together as best I can:

I kind of summerized my story...please let me know what you think. Like I said, everything is submitted...so I am just waiting now.

I am going to try and make this short. I always knew I had sleeping problems, but never got a sleep study while on active duty. Anyway, had a bunch of medical stuff going on at the end of my 20 years in the Air Force. ( I retired with 20 years in) Anyway, I did say something to my primary care manager at the time, that I was really tired all the time. Blah blah blah…He told me to take care of my other medical issues going on at the time and we would get to that later. (had my gall bladder removed in march of 06…. retired sep 06). I went to a transition assistance class I believe in April of 06 and a VA person came in to brief us. I remember him saying (and wrote it down in my little packet) that you have a year to claim something from VA that is not in your service medical records. I took that to heart and knew that I would have plenty of time to request a sleep study after I retired. (mistake number one) My retirement is official 1 Sep 06. Request a sleep study from my new PCM in October 06. Diagnosed with SA in December and got a CPAP machine. Went to my C&P examine in April 07 and ADDED SA to my claim (was not on the original because I did not know I had it yet)…give her the sleep study and CPAP order. Life is good. I get rated at 40% and was denied sleep apnea because it was not in my service medical records!!! No mention of anything. Now there was a mention of alergies and gerd. I still take claritin and nexium everyday.

Well I did not go through a VSO to start with. (mistake number 2) So I have one recommend to me and meet with him. He tells me some things I can do, but says VA will stick with the LAW and will not over turn their decision because I have no proof in my SMR. So I ask for a REQUEST FOR RECONSIDERATION. So I dig my SMR's out and go page by page. Nothing in my records at all about complaining of my sleep problems. BUT in 1993 I had an ECG done and says it was normal except for sinus bradycardia. Doing a little research on the NET and the 2 can be connected.

So I get a buddy letter from a friend of mine that deployed with me several times and used to want to kill me that I snored so loud. My wife writes on up for me (she has seen the worst of it), a letter from my PCM saying that it is more likely then not, that my SA started in the service and a letter from the doctor that read my sleep study test saying:

""I interpreted the overnight sleep study showing mr. xxx has obstructive sleep apnea and peridic limb movement disorder.

"while I have not met the patient, I can assure you that patients in gereral with OSA and PLMD have had these syndromes and their signs and symptoms for a number of years prior to knowing of the formal diagnoses"

A pretty general letter, but that was the best I could get. Plus I wrote a statement on my behalf.

Here is the letter from my wife and my Primary Care Manager:

My name is XXXX, I am the wife of XXXX I have known my husband since September 1997, and we were married in June 1999. I have been with my husband every day since 1997, except when he was assigned to temporary duty (TDY), and have observed the effects of significant sleep disturbances throughout the duration of our marriage.

Whether sleeping at night or while napping, XXX routinely snores. Over the years, the snoring has gotten progressively louder, and occurs during every period of his sleep. In addition to the snoring, I have often observed him experience periods of silence and pauses in breathing during his sleep. Following these breathing interruptions, Mike will gasp for air, and either wake up or resume snoring.

Mike's snoring is a major contributor to his overall restless sleep. While sleeping, Mike routinely moves his legs throughout the night. Our bedding is regularly disturbed; sheets become twisted, blankets and pillows end up on the floor, and I have witnessed visible signs of wear on our fitted bed sheets at the location of Mike's feet. For years, Mike has complained of daytime fatigue and frequently makes statements to the effect, "I feel like I did not sleep at all." As a result of Mike's restlessness, I often experience daytime fatigue as well. It is not uncommon for Mike to move to the living room or guest bedroom during the night. On numerous occasions I have asked Mike to move to the guest bedroom as a result of his snoring. On many other occasions, he has relocated due to his restlessness or concern that he will wake me from my sleep.

It came as no surprise to me that Mike was diagnosed with obstructive sleep apnea and periodic limb movement disorder. I can attest with certainty, the symptoms associated with these diagnosis's were present for many years prior to the diagnosis date of ___.

I hereby certify this information is true to the best of my knowledge and belief.

This letter is in regard to Mr. XXX diagnosis of Sleep Apnea and the fact

that it was diagnosed after his retirement date of 01 September 2006.

Although it was diagnosed after 01 September Mr. XXX was having symptoms

long before he was tested and it as likely as not that the sleep apnea began

in service. The reason he was not tested prior was because of other health

problems took precedence. He had his gallbladder removed and then developed

complications including gastritis, prostatitis. Mr XXX did mention to his

PCM at the time Dr. XXX that he was having trouble sleeping, felt tired all

the time and he was having complications with his legs, as in, involuntary

movements that kept him awake at night. Dr. XXX instructed Mr. XXX that he

should take care of the surgery complications now and then his other

symptoms could be addressed at a later time. Due to these complications I

feel that Mr. XXXs retirement date arrived before the sleep apnea issues

could be addressed.

Please consider the fact that he did have the symptoms for years prior to

being diagnosed and treated for Obstructive sleep apnea and restless leg

syndrome.

So that is where I am at. I gave all this stuff to my VSO. And he still says that VA will stick to their guns and go by the LAW and say that there is nothing in my SMR's to connect me to having sleep apnea. I mean 3 months after I retired. Are you kidding me. I have submitted all this to my VSO around Jan - FEB 2008. So I guess my question is…..DO I HAVE A SHOT IN HELL ON THIS ONE?

Sorry for the long post....but wanted to opinions out there.

Mike

[joeyjoeyb]

Ricky,

Thanks again for the help. I will talk with my Gastro doctor today and get an appointment with my PCM to see what they can do. I always feel weird about asking for these things, but hopefully they will be able to help. Like I said, I really thought me case was good to go with what I had.

[Berta]

I bet 90 % or more cases are good from the git go- but we are dealing with a phenomenally broken VA claims system-

better that we see any potential landmines here and tell you- than have the VA do it.

The more the medical evidence you have to support your claim the better.

I think the rep you have is on the ball to suggest the reconsideration request- but he/she is unwilling I think to raise any expectations you might have.

I think you will succeed on your claim.

Leaks or holes in a claim are one thing but VA looks for a break in the Hoover Dam.

[joeyjoeyb]

Well I know I should have went through a VSO when I first started. But when I went to my C&P exam after I was diagnosed with SA, I thought my sleep study and order for a CPAP machine was all I needed to get SC'd. I did not have any buddy letters or anything from my doctors, because I thought that is all the VA needed. I think that was a big mistake on my part. If I had all that first off, I think it would have been different. As a matter of fact when I did my GWR in Dublin, the examiner was shocked that I did not get SC'd for SA since it was only 3 months after I retired. Just hate all the waiting. Would love to get an answer and then just move on the next step, if I have one.

[joeyjoeyb]

Well just got back from the gatro doc and it was a no go for the letter. She did not feel comfortable writing something up for me. I did not press the issue. So I will see my PCM next week to see if she can write a better letter with some meat in it!! LOL