ptsd Sleep Apnea Secondary To Ptsd

[Guest VetWife Advocate]

Sleep and Breathing, VOl 6 Number 4, 2002. Barry Krakow. bkrakow@salud.unm.edu

"To Breathe, Perchance to sleep: Sleep Disoordered Breathing and Chronic Insomnia Among Trauma Survivors"

I will have to send you an attachment; I don't know how to do it otherwise. Brenhay@aol.com

Looking for a solid approval to SA secondary to PTSD at BVA/COVA. He has both COSA and Central Sleep Apnea and is on 02 at night!! Central is supposed to be RARE, but I am seeing a lot of Nam Vet come up with this. You all should have a sleep study. Also AP connected to Coronary Artery Disease!!! Can't come up with anything solid???

Help appreciated.

Thanks,

Brenda

[Guest VetWife Advocate]

Sleep and Breathing, VOl 6 Number 4, 2002. Barry Krakow. bkrakow@salud.unm.edu

"To Breathe, Perchance to sleep: Sleep Disoordered Breathing and Chronic Insomnia Among Trauma Survivors"

I will have to send you an attachment; I don't know how to do it otherwise. Brenhay@aol.com

Looking for a solid approval to SA secondary to PTSD at BVA/COVA. He has both COSA and Central Sleep Apnea and is on 02 at night!! Central is supposed to be RARE, but I am seeing a lot of Nam Vet come up with this. You all should have a sleep study. Also AP connected to Coronary Artery Disease!!! Can't come up with anything solid???

Help appreciated.

Thanks,

Brenda

Found, with help of another Site two COVA cases. Anything else appreciated. Thanks, Brenda

[RichL]

Would you provide those COVA cases information. I too, am trying to link sleep apnea to PTSD.

[RockyA1911]

Citation Nr: 0102100

Decision Date: 01/25/01 Archive Date: 01/31/01

DOCKET NO. 99-22 315 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in St. Louis,

Missouri

THE ISSUE

Entitlement to service connection for sleep apnea as

secondary to service-connected post-traumatic stress disorder

(PTSD).

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Richard A. Cohn, Associate Counsel

INTRODUCTION

The veteran served on active duty from April 1970 to December

1971.

This matter comes before the Board of Veterans' Appeals

(Board) on appeal from an August 1999 rating decision of the

Department of Veterans Affairs (VA) Regional Office in St.

Louis, Missouri (RO) which denied service connection for

sleep apnea as secondary to service-connected PTSD.

FINDINGS OF FACT

1. The record includes all evidence necessary for the

equitable disposition of this appeal.

2. There is competent medical evidence linking current sleep

apnea to the veteran's service-connected PTSD.

CONCLUSION OF LAW

The veteran's sleep apnea was aggravated by his service-

connected PTSD. Veterans Claims Assistance Act of 2000, Pub.

L. No. 106-475, 114 Stat. 2096 (2000); 38 U.S.C.A. § 5107,

38 C.F.R. § 3.310(a) (2000).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran attributes sleep apnea to his service-connected

PTSD. The veteran does not contend that he incurred or

aggravated sleep apnea during service and there is no

evidence of sleep apnea or other sleep disorder in the

veteran's service medical records SMRs.

Procedurally, this appeal is developed fully and ready for

Board adjudication. The RO has verified the veteran's period

of service; there is no issue as to the substantial

completeness of the veteran's application for VA benefits;

the veteran has undergone VA examination pursuant to the

application; the RO has requested and associated with the

claims file all available service and postservice medical

records pertinent to this appeal; VA is unaware of other

unrequested records pertinent to this appeal, and; the

evidence is sufficient to permit the Board to proceed with

appellate review. See Veterans Claims Assistance Act of

2000, Pub. L. No. 106-475, 114 Stat. 2096, (2000).

A veteran may be entitled to service connection for a

disability under either a direct or secondary analysis.

Direct service connection is warranted for disability

resulting from disease or injury incurred or aggravated in

service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. §

3.303 (2000). Secondary service connection is warranted both

for a disability caused by a service-connected disorder and

for a disability aggravated by a service-connected disorder.

38 C.F.R. § 3.310(a) (2000). In the latter case,

compensation is limited to the extent to which the service-

connected disorder increased the severity of the secondary

disorder. Allen v. Brown, 7 Vet. App. 439, 448 (1995); Jones

(Wayne) v. Brown, 7 Vet. App. 134, 136-37 (1994). A service-

connected secondary disorder becomes part of the original

disorder. 38 C.F.R. § 3.310(a).

The veteran is a decorated former Army combat soldier whose

PTSD has been service-connected since July 1995. SMRs

include no evidence of a sleep disorder in service and the

veteran claims none.

VA medical records confirm that the veteran underwent sleep

studies in February and October 1998 from which he was

diagnosed with sleep apnea. A VA psychiatric progress note

from February 1999 briefly reviewed the studies' findings and

applicable research and concluded that PTSD and its treatment

"in all probability has aggravated the obstructive sleep

apnea." The note further states that "it is certainly as

likely as not that this veteran's sleep apnea is directly

related to his PTSD." The VA physician who examined the

veteran in July 1999 identified two likely causes of his

sleep apnea: enlarged tonsillar tissue and obesity. The

physician found no etiological connection between PTSD and

enlarged tonsillar tissue. However, he acknowledged that

"an argument could be made" linking the veteran's obesity

with PTSD although the veteran's medical records did not

include another medical opinion to that effect.

In the Board's judgment the record presents adequate evidence

upon which to base a finding that the veteran's PTSD

aggravated his sleep apnea. The opinion expressed in the

February 1999 progress note is neither ambiguous nor

equivocal on that point. The July 1999 examination report is

more tentative -- finding only a medical possibility of

attenuated causality under a different rationale.

Nevertheless, the July 1999 opinion does not refute the

February 1999 opinion, and it is well established that VA

itself may not refute expert medical conclusions in the

record with its own unsubstantiated medical conclusions.

Colvin v. Derwinski, 1 Vet. App. 171, 175. (1991).

Therefore, absent medical evidence actually denying a causal

linkage between PTSD and sleep apnea in this case, the Board

reads the two opinions together as providing, at minimum,

evidentiary equipoise which must be resolved in the veteran's

favor. See 38 U.S.C.A. § 5107(B). Accordingly, the Board is

constrained to find that service connection for sleep apnea

is warranted here under a secondary analysis. See 38 C.F.R.

§ 3.310.

ORDER

Service connection for sleep apnea is granted secondary to

service-connected PTSD.

WARREN W. RICE, JR.

Member, Board of Veterans' Appeals