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Obstructive Sleep Apnea Secondary To Sinusitis


calgon

Question

Hello Vets and Vet supporters, I have the subjected claim currently in the final stages of completion.

I received an increase for my sinusitis and allergic rhinitis service connections recently and the C and P examiner opinned:

"Veteran also suffers from Obstructive Sleep Apnea. His Service Connected Allergic Rhinitis /Chronic Sinusitis probably contributes or aggravates this.

My question to the group is whether you feel that statement can be considered a Nexus for a connection between the two? I had an ACE C and P for the subjected claim but the examiner did not provide an opinion. I am confused as to why an opinion was not provided. With that being said, do you think that opinion from a previous C and P exam will hold enough weight to justify granting secondary service connection for OSA?

Everyone have a safe 4th of July holiday weekend!

Chuck

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  • HadIt.com Elder

Make sure the Doc from your pervious exam is qualified to render his opinion , he needs to be a specialist in that field of medicine,

be aware the VA don't use the same evidence if its already been decided for your first claim of sinusitis & allergic rhinitis but it helps that its already in your records.

I think it would be better to get an IMO from a specialist for S.A & not From a Nurse Practitioner or PA they don't have much clout with raters.

you need new & material evidence.

I could be wrong but that's my opinion.

........................Buck

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Thanks Buck. The doctor was a qualified M.D. specializing in internal medicine. I am so hoping his opinion holds some value because the ACE C and P examiner never even mentioned the word sinusitis or rhinitis in his review. I hate those ACE reviews with a passion.

CHUCK

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Calgon,

Good advice provided by Buck. I think you will need much more for your OSA claim to be successful. Even if he did provide an opinion, it would have to be supported by reasonable medicale rationale. Just curious, was this one of those C & P exams where the doctor conducted the exam by telephone? In my opinion, absent evidence in your SMRs supporting your OSA claim, you would need a strong IME and IMO from an ENT specialist who specializes in sleep disorders in order to have a chance of winning your OSA claim.

GP

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GP, the ACE exam was a C and P where the doc reviewed my records and filled out a DBQ. I did not receive a phone call. The C and P for my sinuses increase was an in-person review.

Chuck

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I am looking for any help for filing my appeal for my OSA. In 1997 while on AD, the military conducted a sleep study on me and said that I did not have OSA ..... BS!!, they referred me to get a uvelectomy to stop the snoring, had that done but guess what ..... I STILL SNORE (18 years later). I got out of AD and went into the reserves in 2004. In 2008 my wife kept bugging me to go back and see the doctor again reference to it. In 2008 I had another sleep study done and guess what ... YES, OSA!! The VA denied my claim for the Sleep Apnea (amongst other things which I am appealing) for not occurring during military service.

I really do not have the $$ to pay someone $1500 to get an IME done. Unless someone knows someone cheaper.

Thanks in advance for any and all advice!!

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  • Content Curator/HadIt.com Elder

Hello Vets and Vet supporters, I have the subjected claim currently in the final stages of completion.

I received an increase for my sinusitis and allergic rhinitis service connections recently and the C and P examiner opinned:

"Veteran also suffers from Obstructive Sleep Apnea. His Service Connected Allergic Rhinitis /Chronic Sinusitis probably contributes or aggravates this.

My question to the group is whether you feel that statement can be considered a Nexus for a connection between the two? I had an ACE C and P for the subjected claim but the examiner did not provide an opinion. I am confused as to why an opinion was not provided. With that being said, do you think that opinion from a previous C and P exam will hold enough weight to justify granting secondary service connection for OSA?

Everyone have a safe 4th of July holiday weekend!

Chuck

The word "probably" is not strong enough. Despite the dictionary definition, the VA does not equate it to the 50%/50% or "least as likely as not" threshold. Good advice from other responders here.

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Calgon,

I just got back from an appointment with an independent neurologist and they said that allergic rhinitis does not contribute to sleep apnea. I don't think that this is completely true based on what I've read online. I have SC for allergic rhinitis and OSA, but OSA is not SC at this point. The VA said that I didn't have any symptoms while in the military. Best of luck.

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bolt,

Did you ever mention any sleep issues while at the med clinic? I know I have it in my SMR that I have problems sleeping and usually take a shot or two to fall asleep. Not sure how that will play out for me, since I ony just begun my trip down the yellow brick road of MH.

Semper Fi.

Andy

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What's interesting Vets is that when I went on the C and P for my sinuses increase, the doc said that he noticed in my records that I had sleep apnea. I currently have OSA on appeal secondary to PTSD and was not thinking much about it that day.

He told me that my sinus problems most likely contribute to my problems. He said that he would put a note in the system but was unsure what the VA would do.

Well based on his probably note, I filed for secondary service connection. The claim is in the PFD phase so I have my fingers crossed but somewhat expecting a denial. I have well documented sleeping problems throughout my SMRs and currently rated 30% for Sinusitis and 10% for Allergic Rh.

I had the ACE C and P with a different doctor but he failed to provide an opinion? He justed basically reviewed the records and filled out the DBQ but did not give an opinion? Wouldn't the VA ask him to do so? What's the point in completing that C and P and not providing an opinion whether or not they think it is likely or least likely that my SC sinus problems contribute to or aggravate my OSA? If an opinion was provided I don't see it in the Dr's notes.

It is my hope that the "probably" note holds some weight because it's the only medical opinion, (as weak as it may be) by a qualified person on the subject.

I was hoping the VA would go back to the doc that said probably and ask him to elaborate but from what I can see, that was not done.

In a wait and see approach like many of you. Will keep you guys informed.

I am currently rated at 70% with 100% total in disabilities. The OSA would help me to reach 90%. Holding out hope.

calgon

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Calgon,

I'm pulling for you! I have SA, diagnosed by my private dr. I had problems sleeping, while in, which I compensated for by drinking. I have and use daily, CPAP. I'm interested in your situation, so I may learn some little bit of useful info to help me with my own situation.

Andy

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Calgon,

I did not mention any sleep problems while in the service because I thought it was normal. To be honest I didn't even know what sleep apnea was until a few years ago. I currently have a doctor reviewing all of my records in hopes that he will write a nexus letter for me. This is really the only chance I have to get it SC.

Best of luck,

Matt

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Calgon,

I did not mention any sleep problems while in the service because I thought it was normal. To be honest I didn't even know what sleep apnea was until a few years ago. I currently have a doctor reviewing all of my records in hopes that he will write a nexus letter for me. This is really the only chance I have to get it SC.

Best of luck,

Matt

bolt_vet23,

I, too, am like you. I never gave much thought to sleep issues, while in. I did mention it once or twice, while at the medical clinic, I know, since I have seen it in my SMR. I mentioned problems sleeping and drinking to help sleep.

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  • Content Curator/HadIt.com Elder

Sleep apnea occurs when the airway in the back of the tongue becomes closed. Having closed sinuses is no fun at all, but the lower airway is what matters for SA. The logic of this could be related to your physician's opinion against SC. The CPAP machine helps keep the lower airway open, as long as I don't end up removing it at when I am asleep.

However, if it is in your service treatment records or within a year after you got out, it should hopefully be sufficient. It might be worth looking up some case studies to find a relationship between sinus issues and SA. Not sure if it will help, but it could help convince your doc to opine 50/50.

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I have been dealing with constant sinus infections for years. I know I have several treatment records in my SMR for sinus infections. Between the aircraft exhaust and sleep issues it's no wonder that I ever really slept at all.

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Some good news on the sleep apnea front. I have an independent doctor writing a nexus letter for me and the VA neurologist also agreed to write a nexus letter for me linking OSA to allergic rhinitis. My issue now is that I was denied in 2005 without ever being tested for OSA by the VA and again in 2013 based on the previous denial in 2005. Fingers crossed that the two nexus letters will do the trick and get me the award, but is there anything that I can do about the date being retroactive to 2005? I really feel like the VA dropped the ball on C&P since I claimed it, but was never tested. Appreciate the assistance.

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  • Content Curator/HadIt.com Elder

Congratulations on geting the nexus letters!

Not sure about retro, but it is worth a shot!

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  • Content Curator/HadIt.com Elder

As long as you kept your claim alive, you may be in good shape. However, it never hurts to send them a separate request detailing the potential effective dates. It would help ensure that it does not get overlooked. Even if they do overlook it, you can still go back and request it. In my opinion, it is better to get everything handled sooner than later.

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