ptsd Goofy But Serious Question

[clw4514]

ok, im finally filling out my ppwk for my claim. getting it reviewed tomorrow a.m. before i submit to varo. i know alot of us with PTSD are prone to obesity. is that a valid claim with the va? im labelled on my file at the va as obese. hurt my feelings.....i prefer "fluffy" myself

[clw4514]

purple, ur right. i did admit it was my own fault. i put the alcohol and food in my mouth without anyone holding a gun to my head but at the same time, i would have never had that if i didnt have ptsd. i never sd i expected the va to pay for it but if it is determined to be secondary to the claim of ptsd (which i have been diagnosed with) then ur darned tootin' i want them to pay for it. like john999 sd, if other addictions can be secondary why cant an eating disorder? wasnt intended to ruffle ur purple feathers. this is a forum to learn and guide others. and if nobody has posed the question of whether or not its going to fly, then im going to claim it and see what happens. its not a frivolous claim at all. it has merit. besides, the worst the va could do is say no and decline it. if that happens, then i will inform others on here and its a done issue.

[WHOLESALE]

Yep, you have to go through a class first and you have to be "not too big" for the procedure. I had a friend that went through it but he opted out at last minute since he couldn't lose enough weight for the procedure.

Frank

Yup, Pete is correct, the VAMC Dallas does, apparently, a LOT of lapband procedures.

Go to your VAMC and ask about the MOVE program. It has something to do with the weight loss program and the surgery.

I went to one meeting.........the gal that was head of the program was 5 ft (in any direction). I figured that if she was the "leader of the band" then I darn sure didn't want to wind up playing the trombone!

[sharon]

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(. 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

[LarryJ]

Thanks, Sharon.

That is a very good "find", and may very well have bearing upon several of our members and their claims.

It certainly seems like a good decision from the BVA. And, directly links obesity, as a secondary condition, to existing PTSD, thereby making the resulting OSA a concomitant secondary disability, also.

CLW4514.

Mark this BVA determination. Print it out.

It's a "goody", and would seem to bear directly upon your claim(s).

[MikeR]

It's not a goofy question. Weight gain causes a whole host of conditions, and are secondary to other things as well. My ankles for example cause me not to run. I try to watch what I eat, and it's really hard. I found that I can ride a bike pretty well. So my thought is to try and live as long as I can so I can make them pay me for as long as they have to. :>)

[WHOLESALE]

I don't understand. This is for sleep apnea, not obesity.

Ok, I see it now...

Frank

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( . 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

Edited July 25, 2009 by WHOLESALE