Sleep Apnea Claims Experience With Minimal Service Treatment

[K_C]

Hi All,

I have a question for those of you rated or fighting for sleep apnea. Admittedly, I'm putting the cart before the horse a bit here because I am not currently diagnosed with sleep apnea. However, I am lined up to see a private pulmonary doctor and finally get a sleep study. I'm fairly certain I have some degree of sleep apnea based on my wife's observations, and my history of waking up with severe headaches, waking while I'm actually suffocating, and the worst part, constant sleepiness I've dealt with for almost fifteen years now.

In any case, I'm looking for any experiences, success/ongoing-battle stories with sleep apnea claims and service connection. Unfortunately, like almost all of my conditions that occurred while active duty, I didn't seek much of any medical attention for them, and I feel the nexus is going to be a big fight. Here's my in-a-nutshell in-service treatment

1. Aug-2004 (19 y/o): Saw doc at first duty station, complained of hard time establishing sleep pattern and uncontrolled passing out, daytime somnolence, and bad quality of sleep. His assessment was insomnia and he prescribed ambien. However, the caveat here is I related this to having a new baby, so it may only be seen as acute and directly related to the circumstance.
2. Oct-04: Reported taking sleeping pills on a routine dental exam history questionnaire. I don't believe this would even be considered as evidence, but it's there in my records.
3. Jan-2007: Saw doc for trouble sleeping and insomnia--but again related it to the circumstance of working nightshift. Doctor prescribed Rozerem for insomnia.

So, in 7 years of service I was seen twice for sleeping problems, both excused with circumstance, and never pursued as the chronic issue it was. After discharge, I was even worse about seeking treatment. My general feeling about western medicine is that it rarely has any answers to my problems, and therefore I tend to just "save myself the time" and treat myself with the collective wisdom of the Internet.

If/when I am diagnosed with sleep apnea, I will file a claim. I don't have anything to lose by filing. I'm wondering if there are any pitfalls or strategies to be aware of before I file. So, anyone have a similar in-service history with a claim experience? I welcome any experiences or advice. Thanks in advance.

Edited September 21, 2014 by whalenkcj (see edit history)

[john999]

I think those incidences where you consulted military medical about sleep problems with be the main thing to hang you hat on unless you suffered some facial injury while in service You have to find something to tie your current OSA to service. I have OSA and I did complain about insomnia in service. I would bet $100 bucks I could not win an OSA claim. I have not even bothered to file. If you win then maybe I will file. If you had buddies who heard you snoring or wife who heard you snoring during service years that could be buddy statement that would be proof you had some sleep problem in service. OSA is the current generations version of PTSD and Agent Orange problems for Vietnam vets.

[K_C]

Hi John999,

Thanks for the insight. I'm curious--how is a facial injury connected to apnea? Would it have to do with damage to the nose/septum or jaw? I'm not sure if it could be related, but I was in an auto accident in service in which I was knocked unconscious. Thing is, I had these problems before that, though if it could contribute I do have plenty of medical evidence of that event.

My wife did observe me snoring while in service and my roommate (also military) at my first duty station also heard it. I could get buddy letters from both, but I don't think anyone else would have observed it. I used to pass out in the "bread van" that we would all pile into and get shuttled around to aircraft for launching. I still have contact with some of those guys who saw that. Some of them even physically assaulted me to wake me up.

[john999]

Hey, I think you may have struck paydirt. An injury to the nose/septum or jaw might very well impact your sleep. If your wife and buddies heard you snoring that is also evidence. You need an medical opinion from a sleep doctor or ENT saying that auto accident injuries may as likely as not caused your OSA. I have injury to my nose but it did not happen in service or at least I can't prove it.

John

[georgiapapa]

It may be an uphill battle but you have nothing to lose and everything to gain. Show your private pulmonary doctor your SMR with the sleep apnea symptom references. Perhaps you can convince him to provide you with an IME report and an IMO after he completes the sleep study. At a minimum, he will need to state in the IMO that it "is at least as likely as not" that your sleep apnea started during your military service and justify his opinion with reasonable medical rationale.

Also, get buddy statements from some of your old military buddies and a statement in support of claim from your spouse stating you had sleep apnea symptoms while in the military. The statements should be as specific as possible.

Just a side note regarding obstructive sleep apnea. The most often prescribed treatment for OSA is CPAP. If you have problems adjusting to the CPAP, you might want to consider alternatives to the CPAP including oral devices and surgery. Hadit member,

John 999 recently had surgery for OSA and can give you info on the surgery alternative.

You also mentioned in your post that you had "uncontrolled passing out." I recently had the same problem which was corrected with a pacemaker. I currently have IHD (Coronary Artery Disease) with 3 stents. My cardiologist sent me for a Tilt Table Test and I was diagnosed with Sick Sinus Syndrome. Sick Sinus Syndrome is a heart condition where your heart rate suddenly drops and you pass out. If you are still having episodes of passing out, please get checked by a cardiologist. JMO

Good luck to you and thank you for your service.

[john999]

Hmmmmm......you know narcolepsey goes along with sleep apnea. I take pills to stay awake. Natrurally, the VA would not supply the pills and I had to pay for them via my medical insurance. The real danger of OSA is that your brain and heart are oxygen starved and you have heart attack or stroke. This and sudden passing out are danger signals to me.

[lcurle]

Any connection to the burn pits regarding this?

[VetlawUS]

The simple formula that I use in my client's sleep apnea claims (and that I teach in my book) is this:

A: Understand the full scope of the Diagnosis

B: Select multiple paths to service connection

C: Load the file with lay evidence of symptoms and limitations from service to diagnosis.

D: Tie it all together with the right kind of medical evidence - for both nexus and rating.

It's not easy, but it's a pretty simple approach that works almost every time. Why? Because I believe that Sleep Apnea is the big medical issue that Veterans will face for the next 30 years.

For those of you that don't know, I am the author of the one and only Comprehensive Guide to VA Sleep Apnea Claims...it's only available as an eBook right now...but it's a monster. 165 pages....spent 9 months researching and writing it...talked to hundreds of Vets, read thousands of cases/denials, spoke to a dozen or more doctors, and put it all together into one comprehensive guide. I'm not here to pitch my book, but if you're interested, read a little more about it here.

1) The thing that DRIVES your Sleep Apnea claim is the diagnosis. Why? There are 3 (arguably 4) different types of Sleep Apnea, and each of them have VERY different causes. If you have Central Sleep Apnea, and try to argue that it was caused by a deviated septum or nasal injury in-service, you will likely not win. Why? This is like arguing that the power in your house is off because you didn't pay the water bill.

2) Once you know the specific type of Sleep Apnea that you are diagnosed with, you have multiple points of attack in a Sleep Apnea claim - there are 39 medical conditions (that are frequent among Veterans) which are known to cause, be caused by, or aggravate, sleep apnea. That's 3 different paths to service-connection right there.

3) You do NOT need a sleep study in service, or a diagnosis in service, to service-connect sleep apnea. What you need is lay and medical evidence tying together the past and present symptoms, limitations and diagnosis.

Hope that helps.

Chris Attig

www.VeteransLawBlog.org

[broncovet]

Chris seems to have a good grip on this. It may be worth his book.

However, you probably need to wait to see if a CPAP is prescribed. None of this will matter if a CPAP is not needed as determined by your sleep study. Why? Because sleep apnea is only compensable if a CPAP is needed.

Dont overlook Sleep apnea as a secondary condition. Meds, weight gain, can all be due to military service and so can your sleep apnea.

[K_C]

Thanks VetlawUS and broncovet. Very good advice.

I had my first appointment with a sleep doctor yesterday. I'm now awaiting authorization through Tricare for an in-home sleep study. She (the doctor) seems pretty confident based on my symptoms, history, and explanations that I have some degree of sleep apnea. I self diagnosed myself years ago just based on self research, but... we'll see.

[Gastone]

K_C: I was DX CAD 06, MSA 2010. SC SA 2011 Secondary to CAD. My private SA Neurologist opined that my SA more likely than not, caused by my CAD. On BiPap, 50% SC. If you have the means, good idea to see a private SA Medical specialist. You probably want to wait till you see what VA Sleep Dr says, spend the $ if he goes against you. Don't wait for you next SA appointment, pull your VA SA Results and your Dr's clinician notes. You might want to send the Dr a Secure Message on your MHVet site, requesting his opinion regarding etiology of you SA. Quite often VA Dr's are somewhat reluctant to discuss etiology unless you pin them down.

Semper Fi

Gastone

[K_C]

K_C: I was DX CAD 06, MSA 2010. SC SA 2011 Secondary to CAD. My private SA Neurologist opined that my SA more likely than not, caused by my CAD. On BiPap, 50% SC. If you have the means, good idea to see a private SA Medical specialist. You probably want to wait till you see what VA Sleep Dr says, spend the $ if he goes against you. Don't wait for you next SA appointment, pull your VA SA Results and your Dr's clinician notes. You might want to send the Dr a Secure Message on your MHVet site, requesting his opinion regarding etiology of you SA. Quite often VA Dr's are somewhat reluctant to discuss etiology unless you pin them down.

Semper Fi

Gastone

Gastone,

I decided to give the VMA (Bay Pines, FL) another try this year. The primary care doc I was assigned made a horrible impression on me. Nonetheless, I followed up with the labs--gave about twenty vials of blood, had a knee xray, and a scrotal ultrasound. No calls back with results on any of them or for any other reason. The last straw for me was that the ultrasound report. The tech found nothing, probably because she was too busy talking about local urology gossip and how she worked under all the best urologists. I had a private ultrasound maybe a month before that which found a 1cm epididymal cyst with calcification and varicoceles. Not only that, but I never had the chance to even see a urologist on the VA side, whereas I had several positive visits on the private side with one who made a good impression upon me. The VA ultrasound hurt my claim for epididymitis, which has made me reluctant to even go to them for the things they might put in my records (I also saw very inaccurate notes from my visit with my PC as well).

I'm lucky enough to have Tricare because of my wife. I couldn't at this point trust the VA to provide accurate care nor accurate reporting in my records, so I've gone back to private and will stay there for the foreseeable future. Pretty much all of my experiences on the private side have been good. I have been considering seeing the VA docs at the same time, but I very much didn't like my PC, so if I did go back I would have to request a new one first and I'd also have to emphasize to each person I see that they please accurately document the visit in my records, then go back and check, then repudiate each inaccuracy.

In any case, my sleep doctor is a private one and she seems great. I'd also add that I've encountered some very friendly, compassionate workers at the VMA, so it's not a broad condemnation--just had enough bad experiences to give it up for now.

When you say SA neurologist, is that different than a sleep doctor?

[Gastone]

K_C: Sorry to hear about your VA Clinician experience, just remember you don't have to put up with it, especially today with the VA under heavy scrutiny. If you don't complin in a gentlemanly manner you loose. So don't get so pissed off that you step on your J---son. Take a deep breath, walk away, then go back and explain your reason for being upset. Go see the VAH patients ombudsman if you can't get your problem resolved. Continue to use your outside Drs, but don't pass up the VAH Drs.

As to the MD Vs Neurologist. I think all VA Sleep Drs are either MD or DO. An MD or DO, private or VA that has also been credentialed in Neurology would be a plus, when it comes to your DBQ. SA's often have a Neurological component, who better to address this issue. The main thing is to discuss in great detail the Dr's opinion as to your SA etiology before he completes your DBQ.

Semper Fi

Gastone

[georgiapapa]

K_C

You will also find pulmonary doctors and ENTs who specialize in sleep disorders such as sleep apnea. I currently use a pulmonary doctor whose practice is totally dedicated to sleep disorders. I was referred to my sleep disorder specialist by my cardiologist.

Good luck.

[K_C]

Gastone: Thanks. Have had no problems keeping my cool with them so far, and will keep it that way. I have used the patient advocacy office once already regarding my C&P, and it proved to be a good move.

georgiapapa: Looks like the sleep doctor I'm with is a pulmonologist. When I asked, she said she has been practicing sleep treatment for over fifteen years.

Thanks for the encouragement. I will keep pushing forward.

KC

[georgiapapa]

K_C,

Take care of yourself.