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Confusion On C And P Exam

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I have had several C and P Exams via the VA now. I am currently at 30% for just PTSD and trying to get that raised. I have a CPAP machine for Sleep Apnea but the VA says it is NOT service connected even though THEY issued it to me! Well, I just had another C and P Exam last week and thought it would be for both the PTSD and Sleep Apnea. I am trying to get service connection for the Sleep Apnea. It seems the VA only set me up for just a C and P Exam for the Sleep Apnea and not the PTSD. Does this mean I need to have another C and P Exam for an increase for the PTSD? I am 100% disabled via SSDI for Social Security. I am just wondering what is going on and what is next? I think I have had a total of 4 or 5 C and P Exams now in the past 2 years. I feel like I am getting messed with and getting frustrated. Comments?


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The VA is more apt to look at the PTSD. (See Sleep Apnea below):

DSM-IV-TR criteria for PTSD In 2000, the American Psychiatric Association revised the PTSD diagnostic criteria in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)(1). The diagnostic criteria (A-F) are specified below.

Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning.

Criterion A: stressor

The person has been exposed to a traumatic event in which both of the following have been present:

  1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
  2. The person's response involved intense fear,helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

Criterion B: intrusive recollection

The traumatic event is persistently re-experienced in at least one of the following ways:

  1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
  2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content
  3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes,including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.
  4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Criterion C: avoidant/numbing

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

  1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma
  2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
  3. Inability to recall an important aspect of the trauma
  4. Markedly diminished interest or participation in significant activities
  5. Feeling of detachment or estrangement from others
  6. Restricted range of affect (e.g., unable to have loving feelings)
  7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Criterion D: hyper-arousal

Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:

  1. Difficulty falling or staying asleep
  2. Irritability or outbursts of anger
  3. Difficulty concentrating
  4. Hyper-vigilance
  5. Exaggerated startle response

Criterion E: duration

Duration of the disturbance (symptoms in B, C, and D) is more than one month.

Criterion F: functional significance

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than three months

Chronic: if duration of symptoms is three months or more

Specify if:

With or Without delay onset: Onset of symptoms at least six months after the stressor


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.
Sleep Apnea is difficult to prove as service connected without another underlying cause such as injury to the mouth, soft palate, throat or tongue in some way. If you were not injured in the military where the facial structures were affected, it will most likely not be found as service connected. The VA is your medical provider and recommended the CPAP machine for medical reasons, not for service connection. Here are some causes for Sleep Apnea:

What Causes Sleep Apnea?

When you're awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles are more relaxed. Normally, the relaxed throat muscles don't prevent your airway from staying open to allow air into your lungs.

But if you have obstructive sleep apnea, your airway can be blocked or narrowed during sleep because:

  • Your throat muscles and tongue relax more than normal.
  • Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe.
  • You're overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow, which makes it harder to keep open.
  • The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
  • The aging process limits your brain signals' ability to keep your throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse.

Not enough air flows into your lungs if your airway is fully or partly blocked during sleep. This can cause loud snoring and a drop in your blood oxygen level.

If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound.

The frequent drops in oxygen level and reduced sleep quality trigger the release of stress hormones. These compounds raise your heart rate and increase your risk of high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats). The hormones also raise the risk of, or worsen, heart failure.

Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk of obesity and diabetes.

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When you post material that is obviously not authored by you,

please post a link to it and put it in quotes.

Try to keep to a snippet of quoted information and members

can go to the link for further research.

Some information is covered by copy write laws.

Carlie passed away in November 2015 she is missed.

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This still didn't answer my question. I already know the stuff that you copy and pasted. Please read my question.


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  • HadIt.com Elder

The answer depends upon the VA C&P examiner's findings and written opinions.

The examiners can connect sleep disorders to PTSD or not, as they choose.

If the PTSD is already service connected, the examiner may not want to connect the two. If you already have IMO's that do, it might be to your advantage to

show the examiner the IMO results. The examiners often are RN's or PA's with VA "special training".

An IMO from a board certified doctor or doctors supposedly has precedence, at least in the appeals process.

Currently, due to untested new PTSD VA regs, there is a lot of uncertainty as to how things are going to go.

This still didn't answer my question. I already know the stuff that you copy and pasted. Please read my question.


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Great someone else from San Antonio. If, you want an increase on your 30% for PTSD you have to request it and put in the right documents. That will mean another C&P Exam. Just because the VA gave you a CPAP Machine does not make you service connected for sleep apnea. Do you have a copy of your Military Medical Records? If not, you need to get them and go through them to see if you were ever treated for sleep issues. When I was in they had zero clue about sleep apnea, they just told us to sleep on our sides, and hope no one shot us for snoring so loud :rolleyes:. I'm currently rated 30% for PTSD also, and the VA told me that I had to do another P&C exam to be reevaluated. I have been waiting since Oct 2010 for the VA to reply. Good Luck, and do not give up.


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