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]

broncovet & Carlie,

Thanks for your insight. Very good ideas. My weight gain and OSA started after my knees gave me trouble and I couldn't do cardio-vascular exercises anymore. I was on Vioxx, celebrex, nabumetome, relafin and ibrupofen at different times from 2001 to present. Now on atenolol for hypertension and simvastatin for chorlestoral. My knee surgeries in 2003 and 2004 put me out of work . The last one I was out 7 months 100% for VA comp. I retired under federal disability May 05. This really set me up for OSA. I was finally VA diagnosed in Dec 05. I didn't get cpap from the VA but had the Pillar Procedure there which didn't last. Just got on a cpap in Apr 09 from my civilian Dr. who won't give his IMO on OSA. So now I will get ready to win this, which I feel I will. They awarded me 0% for hypertsion for my weight and inactivity but not OSA.

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.

[broncovet]

tanker..

Ok..here is the scoop on OSA. If you are on a CPAP, and your OSA is service connected, its rated at 50%. If you have OSA and are not on a CPAP, then I am pretty sure its zero percent. I am pretty sure that is right.

The important thing to remember is that to get Service connection, you need a nexus. These are available at your local Toyota dealer...Ok..I cant be serious all the time.

No a nexus is a statement from your doc linking military service to your OSA.

Good: "Veterans OSA was most likely caused by military service"

Almost as good: Veterans OSA was at least as likely as not caused by ..... in military service.

BAD: "Veterans OSA May have been caused by military service." This is speculation and your claim will almost certainly be denied.

[Bonzai]

Worst: "The veteran died while waiting for a decision..." - The ultimate goal of the bad guys

[jbasser]

6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed):

Chronic respiratory failure with carbon dioxide retention or cor

pulmonale, or; requires tracheostomy 100

Requires use of breathing assistance device such as continuous

airway pressure (CPAP) machine 50

Persistent day-time hypersomnolence 30

Asymptomatic but with documented sleep disorder breathing 0

Broncovet, you forgot the 30 percent rating for day time hypersomnolence.

Then it goes to 0 percent.

J

[broncovet]

J Basser..

Thanks for correcting me. Hmmm.. I wonder how "Persistent day-time hypersomnolence" is rated. Is this primary hypersomnia or recurrent hypersomnia? Wikipedia shows the causes to be:

Causes

Hypersomnia can be caused by brain damage and disorders such as clinical depression, uremia and fibromyalgia. Hypersomnia can also be a symptom of other sleep disorders such as narcolepsy, sleep apnea, restless leg syndrome and periodic limb movement disorder. It may also occur as a side effect of taking certain medications (i.e some psychotropics for depression, anxiety, or bipolar disorder), of withdrawal from some medications, or of drug or alcohol abuse. A genetic predisposition may be a factor.^[2]

People who are overweight may be more likely to suffer from hypersomnia. Although studies have shown a correlation between a lack of sleep and weight gain, sleeping at the level of a hypersomniac can also lead to considerable weight gain. This is because excessive sleeping decreases metabolic energy consumption, making weight loss more difficult. It is also the case that sleep disorders of this nature provoke or initiate weight gain due to a tendency to attempt to manage low energy levels by eating non-comple