Sleep Apnea Sc Nexus/imo Letter & Claim Help

[MLR]

I'm in need of some guidance. I'll try to give all of the details.

I was in the Army from 1989 to Feb 2000. I was medically discharged @ 10% for left knee.

Currently rated @ 40%, which breaks down as:

20% = Chronic neck pain Degenerative Disc Disease

10% = Left knee limit of extension

10% = Left knee instability, secondary to ACL deficiency

I have a claim in now for Sleep Apnea. I have had SA since 1993 or early 1994 but I do not have my full service medical records to see if there were any complaints of sleep issues. I have not requested a copy of my SMR due to them being in St Peterburg...while I'm in Atlanta & I was told that it would slow down the claim process...

I have recently been diagnosed with depression (by a VA doc) due to the chronic pain also but have not started a claim on that cuz I figured I need to see a doc a few times before filing. Is that right?

OKay onto the actual claim at hand....Slepp Apnea as service connected.

I was medically discharged Feb 2000....SA diagnosed Jun 2002 by civilain doc & sleep study. My current civilain sleep doc has agreed to write a letter for me. He was going to write it connected to my knee injury & weight gain cuz that is actually around the time it all started. I realize that the weight gain avenue IS NOT the way to go.

I do have several buddies that will write statements as to the fact that they witnessed me "stop breathing or choking" in my sleep. Those letters wiill come from my wife, my father, my mother, 2 army buddies that knew me before the onset of SA & also experienced the "stop breathing in sleep" episodes while I was still in service. 1 buddy that did not know me before the SA but did experience an episode of mine while we were at NTC in Ft Irwin approx 6 months before I got out of Army.

My "Report of Medical history" filled out for my medical board proceedings has the "frequent trouble sleeping" box checked & the physicans summary also lists "trouble sleeping" in the doctors handwriting.

QUESTION: Where do i go from here? How should I proceed with this? What is the difference between an IMO letter & a nexus letter? DO I need to connect it to to something else or can Sleep Apnea stand on it's own merit with the info I've provided thus far?

Please undersatand, I'm not trying to get over on the system BUT I KNOW that I had this condition while on active duty but I never knew what Sleep Apnea was!! I just thought that "that's just the way that I am".

Also, I was an excellent soldier BUT I did have 1 area that needed work ever since 93 or 94 & that was making it to PT or 1st formations in the morning. I recieved a few COMPANY grade article 15s for being late but they were all company level & were only kept in my local training file...unless someone knows something different on how to locate them.

I don't know if it can be connected to my c2 thru c7 issues & spinal stenosis in the same area. It really truthfully started after I hurt my knee.

PLEASE ANY & ALL help is appreciated!!!!

[dwilli12]

MLR,

Check out my posts about SA....I think they may help you. I think it's IMPERATIVE that your current sleep doctor review ALL of your medical records, especially your SMRs, so that he can issue an opinion that says he has reviewed the SMRs and in his opinion your SA began in year X. That was key to my success.

Good Luck!

Dwilli12

[MLR]

Thx dwilli12!

The decision leters & ime's that u posted in one of those previos posts, would not work for me. I know it's ALOT to ask but could u possibly re-post them or please point me in the direction to find them.

I gained some valuable info from reading thru ur posts, it is truly appreciated!

[kw34]

I did not see it in your post do you have a cpap machine. You need to be treated for the condition.

[MLR]

Oops, I forgot that.

Yes I do.

Have had a cpap since jun of 2002. Started on the pressure level of 10 back then & was upped to 14 in 2005...still on 14.

I also have leg jerks while sleeping.

[broncovet]

IMHO Sleep Apnea is a difficult claim to win. Reason: What injury did you incur that caused your sleep apnea?

To answer your question about the difference between an IMO and a nexus letter:

A SUCCESSFUL nexus letter would be someting like your VA doc saying, to the effect:

"I have examined the Veteran, and in my opinion the VEterans sleep apnea was at least as likely as not due to a facial injury incurred during military service".

An IMO, on the other hand, is usually used when your VA doc indicates that there is little/no connection between the Veterans sleep apnea/military service. You can hire a doctor to write an opinion. You want to have the doctor review your your medical records, and state so, and offer an opinion which would include: "I have reviewed the Veterans medical records and "VEterans sleep apnea was at least as likely as not due to a facial injury incurred during military service". Then your independent doctor should sign it.

[MLR]

Does Sleep Apnea need to be caused by an injury or does it just need to have "hadit's" onset during active duty? I have approx 7 people working on buddy letters now & some of those folks knew me before the onset of SA & also experienced my issues after it began.

I had no facial trauma while in but it did start after an injury, probably due to my weight gain & I also think a motor vehicle accident increased it more (had neck issues after that) & ultimately eneded up gettting discharged due to the neck issues & original knee injuries. I believe my neck isssues may have been, at least, partially misdiagnosed but I will talk to the pain mgmt people to see if i may have fibromyalgia cuz all of the symptoms of that will be in my records. I found a bva decision where SA was found to be 2ndary to fibro.

Anyway, I ordered my inpatient & outpatient SMRs yesterday thru the E-Vet-Rec website. I know that I know my body & issues better than any1 but my med records are the key to everything....& without those, I'm really just trying to get background guidance.

Broncovet, thats for the explanation of the IMO & Nexus letters. I appreciate it...

Not trying to "trick" the system here, just trying to figure out the best way to approach it.

Thanks to all that have responded!!!!

[vaf]

Sleep apnea can caused by medical conditions such as hypothyroidism or other metabolic disorders, use of steroid medications to treat such disorders, and also weight gain that results from a disease or injury that might in fact be a service-connected condition, or medication to treat that condition. If this is the case, sleep apnea would then be considered a secondary outcome of a service-connected disability, and therefore itself service-connected.

That means although it might have first occurred during active duty military service, it may not develop until after discharge, and as a result of or related to other conditions that might or might not be injury-related, but have already been deemed service-connected.

Google "Causes of Sleep Apnea," and you'll find a significant amount of information as to potential causes of each type of sleep apnea (although obstructive is the most common, not necessarily caused by an "injury").

[MLR]

Thank you VERY much vaf!!

I had noticed a few days ago while researching on the net that Naproxen is known to effect SA in a negative way. I know I was prescribed that for a long time by the VA & also morphine.

Y'all are awesome, every piece of info seems to open up things to add to my case!!

Thanks a million to all of u that take time to chime in on these posts cuz every little bit helps immensely!

[broncovet]

My sleep doctor (I have sleep apnea and use a CPAP) said that my OSA (Obstructive Sleep Apnea) was caused by "excess tissue in the throat", which is a result of my obestity. He further said that if I lost weight, it would help my OSA and sometimes even cure it.

I have gone through this sleep apnea thing and maybe my story will help.

I first found out that I had sleep apnea about 2 years ago. I had chest pain and went to the hospital. (The VA was full so they sent me to a heart hospital). The cardiologist told me that I had an enlarged right side of the heart, caused by sleep apnea, and that I needed to get a sleep study done.

I did so, and the study revealed I stop breathing 67 times per hour of sleep.

I got a CPAP machine, and feel much better..more alert and dont fall asleep during the day. Less tired.

I applied for SA through the VA.

They denied me, of course.

[yelloownumber5]

VAF,

Do you have first hand experience with hypothyroidism? or with sleep apnea? I retired Dec 31 2003 but hounded my PCM about my thyroid for a couple years before he left the command. He did fully panel tests but never an US, Iodine nor sent me to a specialist. Ironically while under his car in 2001 a VA doctor noted "check out thyroid" but he never did.......my PCM also noted "consider sleep study" but never did.

Actually in 2006 the Gastro doctor during an endoscopy found something around the C5 (I believe) anyhow this was equal to my thyorid. When the internal medicine doctor found out he had to feel and of couse like everyone else cannot feel a nodule, however, bless his heart he had a US done and this found a nodule, which a FNA was done to confirm two nodules but non cancerous.

Ever since this I've been on meds and seeing a specialist.

Long story........but I wish some of this so called "advocates" would get off their soap box stand to realized not everyone is trying to get over and to understand that doctors DO NOT always do what they probably should. NObody is trying to get over but trying to:

A. Save my life by being treated

B. Get better

C. get the entitlements that I am entitled to.

Thanks for the info.

Sleep apnea can caused by medical conditions such as hypothyroidism or other metabolic disorders, use of steroid medications to treat such disorders, and also weight gain that results from a disease or injury that might in fact be a service-connected condition, or medication to treat that condition. If this is the case, sleep apnea would then be considered a secondary outcome of a service-connected disability, and therefore itself service-connected.

That means although it might have first occurred during active duty military service, it may not develop until after discharge, and as a result of or related to other conditions that might or might not be injury-related, but have already been deemed service-connected.

Google "Causes of Sleep Apnea," and you'll find a significant amount of information as to potential causes of each type of sleep apnea (although obstructive is the most common, not necessarily caused by an "injury").

[Commander Bob]

VAF,

Do you have first hand experience with hypothyroidism?

When I had chemo and radiation treatments for metastasized neck, lymph node, and tonsil cancer, my thyroid was burned out. I was diagnosed with hypothyroidism. It just takes a simple specialized blood test, to find out. My PCP found it. I take a synthroid ( 100 mcg ) tablet daily for it. What are you taking for your condition?

[Papa]

All the aliments listed below, I have. For the jerking legs, you most likely have lazy leg and Requip is the med. that I take.

I just had my meeting with a QTC psyc and he found that I had moderate PTSD. I strongly believ that my PTSD is the cause of my overeating, my hypothyroidism, and sleep apena. I actually had the Lap Band surgery and lost a 100 pounds. It limits my food intake, but not my eating. It did lower the settings on my cpap machine. But, even with this surgery it did not take care of them totally. Has anyone had any luck connecting all these to PTSD as secondary?

Papa

[vaf]

"Do you have first hand experience with hypothyroidism? or with sleep apnea?"

Yes, both my husband and I suffer from hypothyroidism, both using synthroid. His was the result of a pituitary brain tumor (the pituitary gland controls the "master switch" for the entire endocrine system). He also suffers from sleep apnea, which we just received notice of two days ago that the VA service-connected. The Rating Decision stated,

"Service connection for obstructive sleep apnea has been established as related to the service-connected disability of status post transspenoidal hypophysectomy for pituitary tumor."

The connection was made due to the use of testosterone intramuscular therapy that became necessary after surgery for a pituitary tumor. Sleep apnea is a potential complication of testosterone therapy.

[yelloownumber5]

VAF,

Congrats on getting the SC.

I will address the sleep apnea and hypothyroirdism with my endo as she has been willing to write an IMO for my hypothryoidism, I just have to gather the C&P examin and rating criteria for her.

I never heard about hypothyroid and sleep apnea but nice to know.

My wife is a doctor and she will tell me not to wear my androderm and not to take synthroid when I'm really swollen. I did have the low testerone around the same time..........it's a shame you have to complain of tiredness all the time before things are checked.

Do you know about Serum amyloid A (SAA) protein, I'm looking for a biochemist to answer some specific questions.

Thanks again,

YN5

"Do you have first hand experience with hypothyroidism? or with sleep apnea?"

Yes, both my husband and I suffer from hypothyroidism, both using synthroid. His was the result of a pituitary brain tumor (the pituitary gland controls the "master switch" for the entire endocrine system). He also suffers from sleep apnea, which we just received notice of two days ago that the VA service-connected. The Rating Decision stated,

"Service connection for obstructive sleep apnea has been established as related to the service-connected disability of status post transspenoidal hypophysectomy for pituitary tumor."

The connection was made due to the use of testosterone intramuscular therapy that became necessary after surgery for a pituitary tumor. Sleep apnea is a potential complication of testosterone therapy.

Edited July 16, 2009 by yelloownumber5 (see edit history)

[vaf]

You might find the following link helpful, but there's a lot of information on the internet regarding the association between OSA and hypothyroidism:

http://ajrccm.atsjournals.org/cgi/content/full/158/5/1379

VAF,

Congrats on getting the SC.

I will address the sleep apnea and hypothyroirdism with my endo as she has been willing to write an IMO for my hypothryoidism, I just have to gather the C&P examin and rating criteria for her.

I never heard about hypothyroid and sleep apnea but nice to know.

Thanks again,

YN5

[yelloownumber5]

VAF,

Congrats on getting the SC.

I will address the sleep apnea and hypothyroirdism with my endo as she has been willing to write an IMO for my hypothryoidism, I just have to gather the C&P examin and rating criteria for her.

I never heard about hypothyroid and sleep apnea but nice to know.

My wife is a doctor and she will tell me not to wear my androderm and not to take synthroid when I'm really swollen. I did have the low testerone around the same time..........it's a shame you have to complain of tiredness all the time before things are checked.

Do you know about Serum amyloid A (SAA) protein, I'm looking for a biochemist to answer some specific questions.

Thanks for that link as well....appreciate it.

Thanks again,

YN5