hypertension Denied Secondary Sleep Apnea

[tanker267]

Today I received what I had hoped to be "Good News". But Noooooo! I was denied!!

Sleep Apnea, bi-lateral knee increase and Hypertension now 0 percent service connection (only plus). I had to retire under disability from the USPS with 33 years because of my service connected disablities. I submitted a claim for Obstructed Sleep Apnea and Hypertension secondary to my knees and having had Sarcoidosis in my lungs, and 18 months of prednisone treatments in the early 80's. The VA Doctor who did the C&P in Aug at the Albany, VAMC stated "The veteran had a pillar procedure in an attempt to correct a flaccid soft palate. This, rather than central fat deposits, was more likely than not the cause of the Veteran's obstructive sleep apnea."

I am SC 40%, 30% for bi lateral Osgood- Sclatter's Disease, 10% for tinnitus , Sarcoidosis 0%, 0% for hearing loss. I submitted various VA-4142's, VA 21-4138 from my wife along with 2 sleep studies, one conducted at the VA.

My Family DR. wrote it up "as least as likely as not" caused by Service Connected Bi-Lateral Osgood- Sclatter's Disease and lateral meniscus tear/right knee. Due to his physical limitations he is unable to participate in cardio-vascular exercise, this has led to his weight increase, obstructive sleep apnea and hypertension.

To add another bit of info, I had the Pillar Procedure done in May 2006 for severe snoring at the VA which helped for several months, it wasn't successful. The C&P Dr even stated that it "failed".

I met and was treated in the VA Hospital in 1981 by my family Doctor! He was a resident there. He has been my PCP since then, so he is completely familiar with my medical history.

The denial letter said that my Doctor didn't review my SMR and the C&P Doctor did. WTF????

The decision also stated that I was seen at the Buffalo VAMC, wrong.

They left out thePillar Procedure done at the Albany, VAMC completely. They didn't review the VA clinic notes which showed my BP on two separate occassions over 100 distolic. Instead they showed the C&P BP = 125/ 90, 122/92 and 125/95 ( on medication )

They stated that I had arthroscopic surgery to repair my lateral meniscus tear /right knee - Not True

I feel I have been, like many here completely let down by the system. There were many other technical mistakes made in the decision and C&P. What are your suggestions? I haven't been able to get a hold of my VSO. Please Help! Thank You!!

[tanker267]

Bergie, Teac & halo2 -

Thank you all for the great inforamation, insights and tips. You surely make this site a "Band of Brothers" and Sisters.

One of the most revealing statements in the SOC was "When weighting the medical statemet from Dr_____ and the VA examiner's opinion, it is noted that Dr._______ did not base his opinion on a review of your claims file to include service treatment records. The VA examiner reviewed your entire claims file to include your private treatment records. As a result, greater weight is given to the VA examiner. Resonable doubt is not resolved in your favor as a preponderence of the evidence is unfavorable. Service connection for obstructive sleep apnea is denied."

That being said, yes my DR.'s statement was sent in before I had my C&P. The day before I received all my treatment records from the VAMC. So now I will let the Dr. have them. By the way he has been my civilian PCP since I met him in 1982, as a resident in the VAMC!

[broncovet]

Whenever raters see OSA, they have a rubber stamp "Denied..no OSA symptoms present on SMR"

You can overcome this, but be prepared for a long drawn out fight..tooth and nail..just like the VA does with all benefits.

[tanker267]

broncovet,

I believe you hit the nail on the head! I see many flaws in the Decision letter. Now I have to fight with stronger words. For instance:

The VA Doctor who did the C&P in Aug at the Albany, VAMC stated "The veteran had a pillar procedure in an attempt to correct a flaccid soft palate. This, rather than central fat deposits, was more likely than not the cause of the Veteran's obstructive sleep apnea."

Central fat deposits and a flaccid soft palatte to me mean the same thing - fat deposits and lost muscle tone due to lack of cardio-vascular exercise.

[broncovet]

tanker

Yes..this way the rating specialist saves time. It takes time, for example, to look up the side effects of medications the Veteran is on to see if any of them cause weight gain, for example. Even though the link of certain medications..to weight gain...to excess tissue in the throat...to OSA is a solid scientific link, it is much easier and faster for the rater to just deny OSA based on no OSA symptoms in the SMR, and to not bother with the scientific evidence supporting the Veterans claim.

The VA is only interested in Science when science supports their decision to deny.

I recommend you "google" each medication you are on, or have been on in the past. Then go to the drug makers website, and pay close attention to side effects. If a medication you are on has a side effect of weight gain, print out that statement from the drug maker. This statement will be based on clinical studies, that is, science.

Then, do some research on OSA. My sleep doc told me my sleep apnea was due to my weight, that is, I am too fat. If your sleep doc wont say that, you should be able to find some evidence of the link of OSA to obesity online. Print it out.

If you have all your medical records, I am guessing that you can document your weight gain, while on certain meds. That is, maybe in 2002 you weighed 220 and you were on no meds. Then you started on, say, anti depressants, and your weight went to 250 pounds in 2009.

Send in a 21-4138 with documents demonstrating all this, maybe highlighting the drug makers statement that their drug can causeweight gain. Then show that your weight increased from 220 to 250, and you started showing symptoms of OSA on .......date, with your weight at 245.

Its a fight..and a pain..yes. In your appeal, clearly show that your OSA was secondary to your meds for SC conditions. If you have the evidence and can document it, then you probably will win upon appeal in about 5 years.

Edited December 15, 2009 by broncovet

[carlie]

tanker,

After you accomplish what broncovet posted - then approach

your doctor/s and see if they agree this information also

relates to you and your medical situation and see if they are

willing to write an opinion stating it is at least as likely as not

related to active duty or secondary to a SC'd disability.

jmho,

carlie

[broncovet]

Tanker..

Carlie is right. You have 2 burdens to prove, not just one. You have to prove generally, and specifically, to your case. In other words, for example while medication x may have a weight gain side effect listed on the website, that does not mean that it necessarily affected YOU that way. Theoretically, you could have gained weight because you gave up your gym membership and got an xbox 360 instead....or because your grandmother who makes fantastic pies moved in with you.

Tell your doc...geee..I noticed that med x that I have been taking causes weight gain. Do you think this is responsible for MY weight gain, considering that I gained 25 pounds since 2007 when I first started this medication?

Later, see if he recorded in your med exam notes that conversation, if he says, "Yea..it sounds like your ....medication caused your weight gain." If he did not, then ask him next time to record it, tell him you need it in your medical records. If he wont do it...get another doc.

You have to prove everything with the VA..not just that med x causes weight gain in some people, but that it "most likely" caused weight gain in you.

It also may not work if its the other way around. In other words, as an example, if the doc says, "Vetrans weight gain most likely due to wellbutrin necessary for treatment of (SC) depression", but the wellbutrin website does not say it causes weight gain, then the Va wont beleve your doc..unless he has scientific evidence to back it up. (I do not know if Wellbutrin's website says it causes weight gain or not, I am simply using this as an example.)

Yes, its a pain in the neck to do all this, but concrete evidence should eventually win your claim, even tho it will probably not win it until you have appealed several times, 5 years or so later. But....you can look forward to spending your retro if you have dotted all the I's and crossed all the t's.

Edited December 15, 2009 by broncovet