tdiu Denied Initial Claim For Sleep Apnea

[navydoc2]

I recently received my denial letter from the VA a few days ago. I had started a claim for sleep apnea with C-PAP secondary to weight gain from psych meds namely abilify which put more than 70 pounds on me in the year and half I took it. I am currently TDIU service connected at 80% with 70% major depression, 10% left knee, 10% tinnitus. I was seen by my psych nurse practitioner initially in Sept 09 where she first suggested I talk to my primary care Doc about sleep apnea. I did that and was scheduled for a sleep study in late Nov 09. I was issued a C-PAP and then started a claim. This the reasons and basis for the denial.

EVIDENCE:

* Service Treatment Records Feb 1990 - Dec 1998

* VA Form 21-4138 statement in support of claim received Nov 10

* Outpatient Treatment Records May 10

REASONS AND BASIS FOR DECISION:

We have denied service connection for sleep apnea with CPAP related to weight gain due to depression medication. Service Treatment Records are negative for complaints, diagnosis, or treatment of sleep apnea.

In your statement received Nov 10 you informed us you were claiming this because of your significant weight gain due to medication for depression. Outpatient Treatment Records obtained and received in connection to this claim presented you reporting you have sleep apnea. Entry dated Jun 10, presented you reporting you get headaches if you do not wear use CPAP. Entry dated May 11 shows you were issued replacement CPAP supplies.

The evidence does not show that sleep apnea with continuous positive airway pressure (CPAP) related to weight gain is related to the medication you take for service connected condition of major depression, nor is there any evidence of this disability during military service.

Attached is the sleep study I was sent to by my primary care doctor at the VA. How could they say there is no outpatient record of it; when it is the VA docs who sent me for a sleep study to rule it out? Also I was issued the CPAP by the VA after the sleep study.

Please help or guide me in the right direction after reviewing information. Thanks in advance.

/doc

Edited August 3, 2011 by navydoc2

[Berta]

Benefit of Doubt (BOD) applies when the evidence is in equipoise.

VA will weigh evidence for and against the claim and if they find it equal, they will award under BOD.

However we all need to remember that VA owns the scale they weigh it on.

Berta I'm not sure what you mean by "nexus is missing per the VA."

I meant In my opinion you would need an IMO to support that the weight gain is due to the SC meds.

Unless you have evidence in your service records they overlooked regarding the sleep apnea.You still need a nexus for that.

_ Nexus” is VA talk -meaning the documented link from a current disability to one's service.

It could be from a documented condition in a vet's SMRs, or symptoms that would warrant service connection, or from a med prescribed for SC, that has caused an additional disability.

Certainly many meds can cause weight gain but you need a strong medical opinion with full rationale

that your weight gain is “as least as likely” solely due to the SC meds with no other known etiology and this caused the sleep apnea.

An IMO doc would need to review your medical records to determine what your general weight was before and then after taking this med.

VA denied on both direct SC and also on the med situation:

"The evidence does not show that sleep apnea with continuous positive airway pressure (CPAP) related to weight gain is related to the medication you take for service connected condition of major depression, nor is there any evidence of this disability during military service."

But you only need to succeed in one way- either there is something in your SMRs or you could get buddy statements linking the apnea directly to your service period, or you can pursue that the apnea was due to weight gain from SC meds.

Edited August 4, 2011 by Berta

[Papa]

I personally do not believe taking out ones Tonsils will rid you of sleep apnea. Years back, doctors wanted to remove my Tonsils, adenoids, do surgery in my nose, saw through my chin bones on each side, and pull out my chin. Also, shave my Tongue down. Pain Pain Pain. When I ask them what was the percentage of success that this would cure my sleep apnea, less then 50 percent. Not good enough for me. They decided not to do it because I have Hereditary Angioedema, and did not think I would live through the surgery. Good old CPap works great.

Now, when the VA decided that I needed a second PTSD C&P, I do not think they were counting on their Shrink to link my PTSD as causing my overeating. She clearly linked the two together. It was not my personal doctor, it was the VA's doctor. I'm taking many drugs, and don't know if they cause weight gain or not, but in my case it would not matter. Food is my drug.

Papa

[navydoc2]

Papa I would have said no to that myself. I can make a copy of the insert for abilify; as well as my psychiatrist saying he was stopping it due to significant weight gain. I started abilify weighing 200lbs after I was taken off of it I weighed 285, let me tell you that was life changing for me. I have tried but am having a hard time getting it back off I keep losing and gaining the same 20 pounds. ARg!

[navydoc2]

I went to see my VSO to file a NOD on my claim denial for sleep apnea. He told me I had a year to file the NOD. He would like me to get more evidence; since I can't afford an IMO, I was wondering if I could use medical literature that connects obesity to sleep apnea. I already have a statement from my former psychiatrist that he stopped the abilify because it put significant weight on me. That is my claim in a nutshell that the weight gain from the psych meds caused my sleep apnea. I would like to know if some of the medical evidence can come from citations that were published here in the America, but originate from say Canada. I'm sure that I can find lots I've started looking as soon as I came home. I figure that maybe I will get lucky when I write these individuals to ask for permission to use their work, someone my give me a statement supporting my claim more directly. What do you think. Thanks.

/doc

[Bigred122]

Sometimes I wonder if the VA looks up anything medical. They are running me in circles as well on my sleep apnea claim. No denial yet, but have lots of info about it. Timelines are tough to prove when I was in service 1971-1972, yet the CPAP machine first proto type wasn't created till June of 1980 by Colin Sullivan. If I had a time machine and found out what I was going to need to prove Sleep Apnea in 2011, I'd be probably dead now. I can just imagine asking a buddy to climb into bed with me in 1971 and see if I quit breathing or not.(I already knew that I didn't snore from first wife) I'd probably be dead by morning. And I don't think that it was sleep apnea that made me quit breathing.lol Now that might be different in 2011, but in 1971 things were a whole lot different. I'm enclosing a link that has the timeline for sleep problems. I'm hoping the information along with my letter of Life and Times in 1971 will change their thinking. ( I betting claim adjuster is probably in mid 20's and only knowledge of 70's is from the TV show about the 70's and our famous times of Drugs, Sex and Rock n' Roll) I hope I don't throw them into some kind of time warp!! Mike

http://www.discoversleep.org/Timeline.aspx

[navydoc2]

I have been looking for a hobby to fill some of my time. They have lit a fire under me this time and I will immerse myself in VA regs and info. All the information that I've read has said that obesity is a major contributor for sleep apnea. Let me know how things go. Good luck.

/doc