hypertension Qq To Dr. Tayo - Sleep Apnea Claim

[bob_abad]

I would like to do this upcoming Reopen Claim correctly.

You think I will be okay to reopen claim for Obstructive Sleep Apnea(OSA) as secondary to DM-II, Diabetic Neprhopathy, Tinnitus, & Hypertension service connected? My ED(SMC) was recently approved also.

Been diagnosed with Sleep Apnea since Y2002. VA has all my sleep related medical records, and they have been supplying me w/ masks/tube/filters parts as needed. I am also scheduled to receive a new CPAP equipment(VA=>Apria Health Care=>Bob) this coming Friday(12/26/08). I was originally denied(NOD) less than 2 years ago, as I applied for OSA as secondary to AO exposure..Lesson learned from this one!

Hope to hear from you or from others also. Thanks in advance.

[bob_abad]

Tayo,

Thanks for getting back. I am taking my time researching for correlation of OSA with DM-II, Diabetic Nephropathy & HTN.

I have gained 90 lbs(fr. 150 to 240) since my discharge less than 4 decades ago. Marriage/family/computer oriented profession, etc.. I am 5' 7"; neck circumference is now 20 inch.

FYI..@google, there are few medical science topics/information when I search such as:

"association of sleep apnea and diabetes mellitus"

"association of sleep apnea and hypertension"

"association of sleep apnea and diabetic nephropathy"

"association of sleep apnea and tinnitus"..."link between sleep apnea and tinnitus"

Also curious to know there are many Gulf War vets granted w/ OSA claim while in a very short stay/assignment in that area.

Keep in touch....Thanks!

[Berta]

I think the OSA due to the DMII might be the strongest case you could make.

http://www.medindia.net/News/Type-2-Diabet...nea-37852-1.htm

http://www.ama-assn.org/amednews/2008/06/23/hlsb0623.htm

http://www.diabetesselfmanagement.com/

There are many sites on the net showing a distinct correlation with diabetes and sleep apnea.

However, I feel that you will need a strong independent medical opinion to get the OSA service connected as secondary to your diabetes.

A good IMO doctor will state treatises or studies, etc other forms of medical literature in their IMO to bolster their opinion.

There is nothing wrong with sending any IMO doctor ,any abstracts or medical literature that would help support your claim for them to consider.

I sent many abstracts to my IMO doctor that I could associate with specific medical records.

He however had access to some medical texts that the general public doesn’t have and which are which are advertised on the net for purchase-(very costly)but one cannot obtain free downloads of the literature they need from the sites.

This is one important aspect of IMOs- when a doctor refers to treatises and abstracts and then associates those findings with a veteran’s clinical record, the VA gives this much more credence that when a vet tries to do this on their own.

I have certainly seen claims awarded solely on medical abstracts and they might have helped award my past claims for which I had no IMOs-

Still- these studies are not specific to a veteran’s specific case and it takes lots of detailed medical association directly to the med recs to succeed on medical texts alone.

I used along with IMOs for my present claim, numerous abstracts and studies that supported the clinical records and supported the IMOs.

I prepared significant correlations of brain and heart problems my husband had with copies of autopsied heart and brain and the exact locations of his numerous lesions and brain traumas as based on his MRI and autopsy.I had plenty of medical litraure to support my point for all that - to show that these areas or atrophy,and brain damage were totally consistent with uintreated diabetic involvement through atherosclerosis to his brain(as well as heart)

This work took me many weeks to complete-and VA ignored it all.I enclosed all of this with my IMO cover letter to Dr. Bash.

My point is when I got the IMOs Dr. Bash stated that his Neuroradiological background had revealed the same type of specific brain trauma in "thousands" of diabetes whose MRIs he had read.

In one sentence Dr. Bash did what it took me weeks to do with a full medical rationale based on his years of experience.

Also if there is no other known possible etiology for you OSA but for DMII_ then VA would have to consider service connection,if you continue to try to prove the association yourself.

But it is far better to get a real doctor to strongly state that in an IMO then depend on the VA fully considering the evidence you send them.

The VA accepted my full medical rationale as a lay person in my past 1151 and FTCA claims- but that was miserable -as they ignored my evidence for 3 years.

They even 'lost' a Peer review medical report from the VA itself that totally supported those claims 3 months after I filed them.

Again- the VA HAS awarded claims solely on medical abstracts and lay statements-

but in my opinion, an IMO-while costly- can save a vet or wiodw weeks and weeks of work that is often quite probative but the VA rejects it anyhow.

What did the VCAA letter say you needed to obtain for this claim?

[Tayo]

Hello again,,, I was sooo happy to research this. I had a friend of mine come over. They love to see me excited about something.

I spoke with a friend of mine. His specialty is Family Practice and he treats many people with DMII, HTN, and OSA. He says that weight is usually the problem when those patients. And because of the weight, they may have OSA. I asked him if OSA can be secondary to HTN or DMII.

His answer: Depending on the level of DMII and the blood pressure,,, initially; diet can control the two,,, thus weight loss decreases the OSA occurrence.

Then we started talking about OSA and HTN. Now mind you,,, he actually came over to my house (great friend). We pulled out our books and went REAL deep. Nothing in the book said anything. So,,, we took it step by step.

1. What is OSA: Basically,,, pt stops breathing for a period of time,,, usually 30 to 60 seconds.

2. If the patient stops breathing,,, can that cause stress to the heart? Possibly. If there in no O2, esp. in chronic situations, there is stress upon the heart,,, the heart works harder, etc., etc., etc.

3. We came across this website: http://www.chestjournal.org/cgi/content/full/131/5/1379

In that cite,,, we focused on the Discussion. Now, keep in mind that this is just a study. VERY INTERESTING!!!

VUALA: in this study,,, there is a correlation. Now, we didn't know the specifics of your condition but,,, look at it and see what you think.

:D

Tayo

[poolguy11550]

Tayo- Chicken or the egg argument, which came first- sleep apnea or obesity? I think that I read somewhere that weight gain is one possible symptom of OSA.

[Pete53]

Little known but true. Many diabetics who get their blood sugar under good control gain a lot of weight. Its also fairly common for people to gain weight cause of meds they take.

[bob_abad]

Dr. Tayo,

Thank you very much for your research time. There is indeed a correlation between OSA & HTN.

Berta,

As always, you are a gem! Thanks also for your update. In my initial Reopen claim, I applied for OSA as secondary to AO exposure. Not a good one, was denied, had it cancelled for time being w/ the objective of reopening again after a year+. VA for a while(in my case) was getting confused when I had 2 concurrent Reopen Claims....

My private doctor is very helpful, thorough, & pro-veteran. She help me out w/ IMO for HTN w/c was diagnosed after DM-II & Diabetic Nephropathy diagnoses. Be working w/ her after the holiday to acquire another IMO for OSA <=> DM-II, HTN.

Thanks again....