ptsd Received C&p Notes For Sleep Disorder Secondary To Ptsd/and Gulf War Presumptives(Wags?)

[Whirly Bird]

All, I have a claim in for service connection of Sleep Disorder secondary to PTSD/Gulf War Presumptives. I just received the following C&P medical opinion and was hoping that some of you in the know might be able to give me some WAGS? Will this most likely be rated as Sleep Apnea with use of CPAP? 50% Rating?

thanks in advance

Sleep Apnea
Disability Benefits Questionnaire

Name of patient/Veteran: XXX

Indicate method used to obtain medical information to complete this
document:

[ ] Review of available records (without in-person or video telehealth
examination) using the Acceptable Clinical Evidence (ACE) process
because
the existing medical evidence provided sufficient information on which
to
prepare the DBQ and such an examination will likely provide no
additional
relevant evidence.
[ ] Review of available records in conjunction with a telephone interview
with the Veteran (without in-person or telehealth examination) using the
ACE process because the existing medical evidence supplemented with a
telephone interview provided sufficient information on which to prepare
the DBQ and such an examination would likely provide no additional
relevant evidence.
[ ] Examination via approved video telehealth
[X] In-person examination

Evidence review
---------------
Was the Veteran's VA claims file reviewed?
[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the
Veteran's VA claims file:

VA electronic medical records (CPRS) reviewed.
VBMS reviewed.

If no, check all records reviewed:

[ ] Military service treatment records
[ ] Military service personnel records
[ ] Military enlistment examination
[ ] Military separation examination
[ ] Military post-deployment questionnaire
[ ] Department of Defense Form 214 Separation Documents
[ ] Veterans Health Administration medical records (VA treatment
records)
[ ] Civilian medical records
[ ] Interviews with collateral witnesses (family and others who have
known the Veteran before and after military service)
[ ] No records were reviewed
[ ] Other:

1. Diagnosis
------------
Does the Veteran have or has he/she ever had sleep apnea?
[X] Yes [ ] No

[X] Other sleep disorder, specify: other and unspecified sleep apnea
ICD code: 780.57 Date of diagnosis: February 15,
2005

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's sleep
disorder condition (brief summary):
The veteran served in the Gulf War from August 1990 through April/May
1991 he is claiming "unspecified sleep disorder", treated as sleep
apnea
with CPAP for the past 9 years. Symptoms at the time of testing
included headaches, dizziness, confusion, unrestful sleep, and
witnessed
apneic episodes during which the veteran would awaken, gasping for air.
He has been using a CPAP machine for the past 9 years with moderate
relief of symptoms. He is claiming that Gulf War veterans are awarded
service connection for "undiagnosed sleep disorders" as a presumptive
Gulf War condition.
He is also claiming that the condition is secondary to, but separate
from, PTSD.

b. Is continuous medication required for control of a sleep disorder
condition?
[X] Yes [ ] No

If yes, list only those medications required for the Veteran's sleep
disorder condition:
Hydroxyzine pamoate, prazosin

c. Does the Veteran require the use of a breathing assistance device such as
continuous positive airway pressure (CPAP) machine?
[X] Yes [ ] No

3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms attributable
to sleep apnea?
[X] Yes [ ] No

If yes, check all that apply:
[X] Persistent daytime hypersomnolence
[X] Other, describe: Difficulty with concentration, fatigue.

4. Other pertinent physical findings, complications, conditions, signs
and/or
symptoms

-----------------------------------------------------------------------------
a. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
section above?
[ ] Yes [X] No

b. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs and/or symptoms related to any
conditions
listed in the Diagnosis section above?
[ ] Yes [X] No

5. Diagnostic testing
---------------------
a. Has a sleep study been performed?
[X] Yes [ ] No

If yes, does the Veteran have documented sleep disorder breathing?
[X] Yes [ ] No

Date of sleep study: February 15, 2005

Facility where sleep study performed, if known: John Cochran
pulmonary sleep lab, John Cochran VA Medical Center, St. Louis,
Missouri.

Results:
Unspecified sleep apnea. Prescribed CPAP. Veteran has been using
CPAP for the past 9 years

b. Are there any other significant diagnostic test findings and/or results?
[ ] Yes [X] No


6. Functional impact
--------------------
Does the Veteran's sleep apnea impact his or her ability to work?
[X] Yes [ ] No

If yes, describe impact of the Veteran's sleep apnea, providing one or
more examples:
The veteran works for XXX. Because of PTSD
issues the veteran works from home via computer. The veteran states
that he has difficulty concentrating and fall asleep easily when
working.

7. Remarks, if any:
-------------------
Please see medical opinion worksheet.



****************************************************************************


Medical Opinion
Disability Benefits Questionnaire

Name of patient/Veteran: XXX

Indicate method used to obtain medical information to complete this
document:

[ ] Review of available records (without in-person or video telehealth
examination) using the Acceptable Clinical Evidence (ACE) process
because
the existing medical evidence provided sufficient information on which
to
prepare the DBQ and such an examination will likely provide no
additional
relevant evidence.
[ ] Review of available records in conjunction with a telephone interview
with the Veteran (without in-person or telehealth examination) using the
ACE process because the existing medical evidence supplemented with a
telephone interview provided sufficient information on which to prepare
the DBQ and such an examination would likely provide no additional
relevant evidence.
[ ] Examination via approved video telehealth
[X] In-person examination

Evidence review
---------------
a. Was the Veteran's VA claims file reviewed? Yes

If yes, list any reco
rds that were reviewed but were not included in the
Veteran's VA claims file:
VA electronic medical records (CPRS) reviewed.
VBMS reviewed.

MEDICAL OPINION SUMMARY
-----------------------
RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: Is the veteran's sleep condition at least
as
likely as not related to his PTSD or the results of military service?

b. Indicate type of exam for which opinion has been requested: DBQ Sleep
Apnea

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE
CONNECTION ]

a. The condition claimed was at least as likely as not (50% or greater
probability) incurred in or caused by the claimed in-service injury, event
or
illness.

c. Rationale: It is examiner's opinion that the veteran's "sleep apnea" is
an
undiagnosed illness secondary to service in Southwest Asia. According to
the
Gulf War General Medical Examination DBQ, an undiagnosed illness is
established when findings are present that cannot be attributed to a known,
clearly defined diagnosis after all likely possibilities for such
abnormalities have been ruled out. The veteran's sleep study at John
Cochran
VA Medical Center pulmonary lab did not conclusively diagnose obstructive
sleep apnea but the veteran has been treated with success using CPAP machine
as if he were diagnosed with obstructive sleep apnea. His diagnosis is
listed as "other and unspecified sleep apnea" in his VA problem list.

The veteran further claims that his sleep condition is secondary to, but
separate from, PTSD. Supporting this contention are studies done by Brooke
Army Hospital and Walter Reed Army Hospital. In the Brooke Army Hospital
report, entitled Sleep Disordered Breathing in Combat Veterans with PTSD,
researchers concluded that "data show that more than 70% of those
active-duty
members who carry a diagnosis of PTSD are at risk for the diagnosis of
obstructive sleep apnea".
In the Walter Reed Hospital report, entitled Prevalence of Sleep Disorders
among Soldiers with Combat Related Posttraumatic Stress Disorder,
researchers
concluded that "sleep complaints were almost universal among soldiers with
PTSD. The majority were diagnosed with insomnia and/or obstructive sleep
apnea".

In a BVA decision involving the Hartford, Connecticut VA regional office
(Docket#10-25 465) entitlement to service connection for obstructive sleep
apnea as secondary to PTSD was granted with 'Reasons and Bases for Findings
and Conclusions' based upon the studies cited above.

Therefore, it is at least as likely as not that the veteran's sleep
condition
listed as "Other and Unspecified Sleep Apnea ICD-9 Code 780.57" is due to
were the result of military service.

[Whirly Bird]

Well, the claim is closed. My new combined rating is 90%. Still don't know how things were rated because the claim included PTSD and sleep disorder. Will have to wait and see how it all shook out after I receive my decision in the mail. I'm guessing I got 50% for PTSD and 50% for Sleep Apnea. That combined with my original 70% rating would equal out to 90%. Gotta love VA math....

[Whirly Bird]

The big brown envelope showed up today! I was rated 50% for the sleep disorder. The decision doesn't state anything about being secondary to PTSD or attributed to the Gulf War presumptives, just says: "Service connection for sleep disorder has been established as directly related to military service. We have assigned a 50% evaluation based on the fact that you require the use of a CPAP machine".

Also received 50% for PTSD in the same claim decision. These two 50% ratings, combined with my previous 70% rating, bumps me up to 90%.... 94% actually......so close, yet so far away.................I'll probably file for an increase on some of my other conditions down the road, but for now I'm just gonna take a deep breath and relax for a bit......

Thanks for all the help with this guys, it's appreciated.

[john999]

I would love to get my OSA SC'ed. I have great private pulmonologist but I don't know if he would say my OSA is related to service 40 odd years ago.

[thomasc]

Wow, that was some excellent information. I always get shot down when I ask my doctors to fill out DBQ or told C&P will cover it. My OSA claim was denied without even giving me a C&P, but I am putting your articles to work in my Notice of disagreement.

Edited February 8, 2014 by thomasc

[carlie]

Wow, that was some excellent information. I always get shot down when I ask my doctors to fill out DBQ or told C&P will cover it. My OSA claim was denied without even giving me a C&P, but I am putting your articles to work in my apply.

The doc's that refuse to fill out the DBQ's just are not doing their damned jobs !

They surely can complete MOST of the DBQ's available and IMO they are just being

lazy - when they could actually help be a part of knocking down the claims backlog.

http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp

DBQ Info:

Who fills them out?

For VA exams, a VA clinician will fill out the DBQ. If being seen by a private provider, have them complete the DBQ and submit it to us either by Regional Office Fax Numbers or mail.

and

http://www1.va.gov/v...asp?pub_ID=1790

d. Medical Statements to Support VA Benefits Claims.

When honoring requests for medical statements by veterans for VA claims adjudication,

care must be taken to avoid conflict of interest or ambiguity.

(1) Determination of causality and disability ratings for VA benefits is exclusively a function of the Veterans Benefits Administration (VBA). VHA providers often do not have access to military medical records, and may not be familiar with all the health issues specific to military service, such as environmental exposure.

As a result, they may not feel comfortable in stating causality of a current condition.

However, this does not preclude VHA providers from recording any observations on the current medical status of the veteran found in the medical record,including their current functional status.

All pertinent medical records must be available for review by VBA.

NOTE: VHA continues to provide compensation and pension (C&P) examinations and reports as requested by VBA, as part of any new disability claims or review process.

(2) Requests by a veteran for assistance in completing a VA disability claim are to be referred to VBA through official channels; however, the clinician, if requested by the veteran, must place a descriptive statement in the veteran’s medical record regarding the current status of the veteran’s existing medical condition, disease, or injury, including prognosis and degree of function.

This may then be requested by VBA for the purposes of making a claim determination.

[Navy04]

Carlie,

You are on the money. I VA Mental Clinic Doc filled out the DBQ with no problem. When I asked my PCP at VA to fill out Physical DBQ, her Nurse said that was not their job and we yelled back and forth. I live 2 hours away, so when I got home my PCP called me and said that she was sorry and she would fill it out and she emailed it to me that afternoon. My Crohn's Dr at the VA would not even fill one out, WTH. I can not believe that I have 6 C&Ps next week for FDC Increase, even though all my care is at the VA. The DRs should do their darn job, and read our medical files on their VA systems, and stop dragging us to those stupid C&Ps.