New On Forum, Need Help With Sleep Apnea Claim

[abhusal]

I know it is lot of information to read. Sorry for it. Having all these info should I file a claim? Do I need anything else? Your inputs and suggestions will be highly appreciated.

SERVICE RECORDS (09/22/2005 – 09/21/2008)

1. On 04/23/2007 during deployment to Iraq, went to sick call and reported: Feeling weak, tiring easily, not feel rested after sleep, and snoring.
2. On 09/10/2007 went to sick call and reported: Foggy memory and lack of energy
3. On 29/11/2007 appointment with Gastroenterology and talked to Doctor about: Fatigue, memory loss, and foggy feeling
4. On 31/12/2007 appointment with Nurse and talked to Nurse about: Experiencing fatigue prevented from completing course.
5. On 01/08/2008 appointment with Nurse reported: Fatigue
6. On 02/25/2008 went to sick call and reported:Feeling tired
7. On 06/17/2008 went to sick call and reported: Fatigue
8. Post-deployment health assessment dated 06/09/2007 indicated : I still feel tired after sleeping, difficulty remembering.
9. Pre-Separation health assessment dated 06/09/2008 indicated:

• Frequent or severe headache,
• Loss of memory or amnesia, or neurological symptoms,
• Frequent trouble sleeping

VA HOSPITAL RECODS (05/01/2009-Present)

1. On 05/01/2009, appointment with MENTAL HEALTH OUTPATIENT PSYCHOLOGICAL ASSESSMENT and reported:

• Memory issues, irritability, distraction and sleep disturbances to include nightmares.

1. On 05/05/2009, appointment with BEHAVIORAL HEALTH and reported:

• Trouble Sleeping: Nearly every day
• Tired, low energy: Nearly every day

1. On 05/19/2009, went to EMERGENCY CARE SERVICES and reported:

• Feel extreme fatigue

1. On 06/03/2009, appointment with MENTAL HEALTH OUTPATIENT PSYCHOLOGICAL ASSESSMENT and reported:

• Memory deficits and fatigue
• Trouble Falling or staying asleep or sleeping too much: More than half the days
• Feeling tired or having little energy: Nearly every day

1. On 07/09/2009, appointment with PRIMARY CARE OUTPATIENT and reported:

• Feel tired a lot, make a lot of noise during night, and forget everything

1. On 07/29/2009, appointment with TBI and reported:

• Poor concentration, cannot pay attention: Moderate
• Forgetfulness, cannot remember things: Moderate
• Difficulty making Decision: Severe
• Slowed thinking, difficulty getting organized, cannot finish things: Severe
• Fatigue, loss of energy, getting tired easily: Severe
• Difficulty falling or staying asleep: Moderate

1. On 11/25/2009, appointment with TRAUMA RECOVERY and reported:

• Very tired during the day

1. On 12/29/2009, went to EMERGENCY CARE SERVICES and reported:

• Insomnia at night

1. On 01/15/2010, appointment with PRIMARY CARE OUTPATIENT and reported:

• Feel tired a lot

1. On 02/17/2010, went to EMERGENCY CARE SERVICES and reported:

• Feeling tired and achy all the time

1. On 02/21/2010, went to EMERGENCY CARE SERVICES and reported:

• Increased fatigue, problem sleeping

1. On 02/26/2010, appointment with GASTROENTEROLOGY and reported:

• Joints pains and fatigue

1. On 07/20/2010, appointment with PRIMARY CARE OUTPATIENT and reported:

• Feel tired all the time

1. On 08/11/2010, appointment with MENTAL HEALTH OUTPATIENT PSYCHOLOGICAL ASSESSMENT and reported:

• Feel not motivated and tired often
• Sleep 5-6 hrs. and sometimes naps up to 4 hrs. during the day
• Not rested when wakes up

1. On 11/12/2010, appointment with PRIMARY CARE OUTPATIENT and reported:

• Chronic fatigue – always tired

Assessment/plan:

FATIGUE – SLEEP CONSULT TO R/O SLEEP APNEA IN PT. WITH RISK FACTORS

1. On 01/04/2011, appointment with MENTAL HEALTH OUTPATIENT PSYCHOLOGICAL ASSESSMENT and reported:

• Not sleeping well but naps freq during the day

1. On 04/21/2011, appointment with MENTAL HEALTH OUTPATIENT PSYCHOLOGICAL ASSESSMENT and reported:

• Sleeping about 6 hours per night with nightmares 2 to 3 times per week
• Often awakens and can’t go back to sleep

1. On 05/20/2011, appointment with TRAUMA RECOVERY PROGRAM and reported:

• Having difficulty falling asleep and has nightmares twice per week
• Feeling tired during the day due to lack of sleep
• Sleep about 4-6 hours per night but frequently is awake until 2 or 3 am
• Awakens frequently and can’t get back to sleep

1. On 03/05/2012, telephone appointment with PRIMARY CARE OUTPATIENT and reported:

• Main c/o is continued daytime fatigue - does admit to snoring @ hs
• Missed last apt with sleep clinic – will re-consult

1. On 04/05/2012, appointment with TRAUMA RECOVERY PROGRAM and reported:

• Frequent sleep disruption and dyssomnia
• Sleep 5 hours per night having vivid dreams frequently
• Excessive daytime somnolence

1. On 06/01/2012, appointment with PRIMARY CARE URGENT VIGIT and reported:

• Feeling tired

1. On 01/18/2013, appointment with at TRAUMA RECOVERY PROGRAM and reported:

• Difficulty with focus and attention at work and performance has been questioned at work
• Sleep 5 hours per night

1. On 02/14/2013, phone appointment with TRAUMA RECOVERY PROGRAM and reported:

• Complain of dyssomnia qhs and sleepy at work

1. On 03/04/2013, appointment with TRAUMA RECOVERY PROGRAM and reported:

• Excessive day time sleepiness continues with current dosage of amphetamine/dextroamphtamine 20mg bid and sleepiness is affecting work performance
• Difficulty with focus and attention at work and performance has been questioned
• Sleep 5-6 hours per night but still feel tired throughout the day

1. On 03/25/2013, phone appointment with TRAUMA RECOVERY PROGRAM and reported:

• Improved sleep but still complains about daytime sleepiness at work

1. On 03/29/2013, appointment with TRAUMA RECOVERY PROGRAM and reported:

• Excessive day time sleepiness continues particularly in the morning with current dosage of amphetamine/dextroamphtamine 20mg bid and sleepiness is affecting work performance

1. On 04/26/2013, appointment with TRAUMA RECOVERY PROGRAM and reported:

• Complain of low energy in the daytime at times

1. On 01/03/2014, appointment with SLEEP MEDICINE CONSULT and reported:

• Excessive daytime somnolence, Heavy snoring, Non-refreshing sleep, Movement Disorder during sleep
• Severe fatigue and somnolence during daytime despite apparent good sleep at night
• Sleepiness during the day, Epiworth score: 21
• Difficulty maintaining sleep, early awakening, Neuropathic pain
• Snoring History: Loud snoring
• Apneic episodes: Nasal Congestion
• Talking and crying in sleep

1. On 01/04/2014 I had SLEEP STUDY at SLEEP MEDICINE CONSULT.

• DIAGNOSIS: Mild Obstructive Sleep Apnea, Severe Sleep Fragmentation
• RECOMMENDATION: CPAP titration with consideration of auto –titrating CPAP at home is recommended.

1. On 04/18/2014, appointment with SLEEP MEDICINE CONSULT and reported:

• With hx of OSA CPAP fatigue symptoms and tiredness, memory issue.
• Can breathe with the CPAP better but the symptoms with CPAP is the same and wake up 2 times and is not refreshed.
• Sleepy in the morning and has memory issues.

• Violent dreams and he moves arm and hits wife at times.

1. On 04/25/2014, appointment with PRIMARY CARE OUTPATIENT and reported:

• His main concern is he cannot get his weight down- tried to eat carefully but still gains wt.
• He also states his 'mental health' is not improving- he feels 'mental fog'- no 'clarity in the head', forgets things easily, and tired all the time.
• He sleeps 10 hrs. at nite- he is using cpap and tolerates it well but still very tired.
• He states his job told him he is 'poorly performing' and is at risk of losing job. No hx TBI or Head injury per pt. He does feel depressed with anhedonia and feels isolated
• Fatigue/depression-neuropsych eval

1. On 06/20/2014, appointment with SLEEP MEDICINE CONSULT and following is the Dr. notes:

CC: OSA, insomnia, RLS

Interval change in medications: Has tried modafinil 100mg qam with minimal improvement in sleepiness

Current status: Pt here for f/u. He is on CPAP for mild OSA and continues to have significant EDS. He reports EDS causes performance problems at work, worsens mood, worsens anxiety and leads to high frustration levels. He is using CPAP nightly for most of the night and per March PAP compliance reports this is effective in treating his OSA with residual AHI of 1.3.

He does have severe RLS symptoms. He does also report that often wakes up at around3-4 am due to severe nightmares, violent in nature and is unable to go back to sleep, also described hyper vigilance symptoms. Depression present no SI/HI reported today. Complains of anxiety. He also report sinus congestion often leading to difficulty at times using CPAP. He has been prescribed modafinil 100mg for EDS and reports it was only "somewhat effective" has also per pt report been on adderall and ritalin in past with minimal improvement in EDS and increase in anxiety. Some significant issues with sleep hygiene noted.

Impression and plan:

1. Obstructive sleep apnea- well treated with CPAP but still sleepy likely due to nightmares, RLS/PLMD. Continue CPAP use and pt will send in his PAP compliance card for review of most recent Data.
2. RLS and PLMD 10.5- lab work for RLS/PLMD revealed Vit D def 24.3. Will order Vit D sup 2000units daily for 2 months and recheck vit D level. RLS and PLMD may be leading to further sleep fragmentation and insomnia. If Vit D levels normalize and RLS/PLMD persist will consider treatment for RLS with primepexole
3. Obesity- BMI 32.3- may be contributing to the sleepiness pt encouraged to lose weight
4. EDS-if persists despite treatment of OSA/RLS/PLMD and nightmares and use of CBT for insomnia will consider increasing modafinil dose to 200mg q day.
5. For nightmares as appear to be major contributor to short sleep time, sleep fragmentation will trial prazosin 2-4mg qhs.
6. Also prescribed pseudophed 30mg daily to help with nasal congestion and allergic rhinitis as may be making it more difficult for pt to use his CPAP due to nasal congestion. Advised pt to avoid taking it past 6 pm as may worsen insomnia.

SERVICE CONNECTION (SINCE 10/01/2008)

1. Depressive disorder with anxiety disorder not otherwise specified (also claimed as short term memory loss and sleeping disorder)
2. Irritable Bowel Syndrome with gastro esophageal disease (also claimed as chronic constipation and dyspepsia)
3. Tension Headache, Stress relates (also claimed as chronic headache)
4. Vasomotor Rhinitis
5. Chronic Sinusitis of the Frontal and Maxillary Sinus Cavities

OTHERS:

Deviated Septum – Diagnosed by VA ENT Dr. on 01/15/2010

Problem: Obesity (ICD-9-CM 278.00) Date/Time Entered: 20 Jul 2010 @ 1200

Problem: Hypersomnia (ICD-9-CM 780.54) Date/Time Entered: 25 Apr 2014 @ 1200

Problem: Sleep apnea (ICD-9-CM 780.57) Date/Time Entered: 25 Apr 2014 @ 1200

PRESCRIBED MEDICATIONS FOR STOMACH:

1. PANTOPRAZOLE 40MG TAB (PROTONIX)
2. LINACLOTIDE 290MCG CAP
3. SENNOSIDES 8.6MG TAB
4. PSYLLIUM & DEXTROSE POWDER (gram)
5. DOCUSATE SODIUM 100MG CAP
6. SUCRALFATE 1G TAB
7. OMEGA 3 ACID ETHYL ESTERS 1000MG CAPS

PRESCRIBED MEDICATION FOR ANXIETY, DEPRESSION AND SLEEP APNEA:

1. SERTRALINE 200MG TAB (ZOLOFT)
2. ARIPIPRAZOLE 2MG TAB
3. PRAZOSIN 2MG CAP
4. ALPRAZOLAM 0.25MG TAB
5. MODAFINIL 200MG TAB (PROVIGIL)
6. VITAMIN D 1000 UNITS TAB

PRESCRIBED MEDICATIONS FOR RHINITIS/SINUS/ URI:

1. FLUNISOLIDE NASAL SOLN 0.025% (200)
2. LORATADINE 10MG TAB (CLARITIN 24HR)
3. PSEUDOEPHEDRINE 60MG TAB
4. IBUPROFEN 800MG TAB

I thank you very much for taking your time and reading this long post.

[Navy04]

Welcome aboard and good luck

[Philip Rogers]

File the claim.

pr

[abhusal]

Any insight on my above post please Carlie, Navywife, Berta

[georgiapapa]

If you are having trouble with CPAP there are other options (oral appliance, surgery, etc.). Reach out to John 999 for more specific information.

As far as your claim, If your VA sleep doctor has not reviewed your MMR showing symptoms of sleep apnea, provide a copy to the doctor for his/her review. Afterwards, ask the doctor for an IMO including a nexus statement expressing their opinion that "it is at least as likely as not" that you had "sleep apnea" during your military service. If your VA sleep doctor will not provide an IMO, ask the VA doctor to complete a DBQ for sleep apnea. Even if the VA doctor will provide a DBQ but will not provide an IMO, go to a private pulmonary physician who specializes in sleep medicine, provide the private specialist with all of your relevant medical records (MMR & VA), request an IME followed by an IMO. Any out of pocket costs you incur for the private doctor will be a smart investment when you receive an additional 50% disability compensation award for sleep apnea with CPAP. Just my opinion.

Good luck to you.

[BlastDaddy]

You may also research Chronic Fatigue Syndrome. Seems you may meet several overlapping conditions.

[Fat]

I would speak with your treating physician and let him know your service connected issues.

He might offer a professional opinion linking the sleep apnea.

I like the detailed medical summary. You are headed in the right direction.

Good Luck.................