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PTSD "TO INCLUDE SLEEP DISTURBANCE" Help

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USMC_VET

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Post Traumatic Stress Disorder To Include Sleep Disturbance        12/03/2015        INC            View Pending Claim

 

So i just filed for Sleep Apnea but under the Sleep Disturbance secondary to PTSD route.  This is what is showing.

 

What is "INC" and i am claiming SECONDARY TO and not INLCUDING, i am guess the INC is "Including" however if they consider it INCLUDING they wont rate it seperately and just put the PTSD and OSA symptoms together for one rating.  I think they are trying to avoid the 50% given for CPAP and just include it in PTSD but keep the rating level the same.

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OK, I may be the one referred to as previously posting about filing PTSD and OSA together and then OSA as secondary.

History:

9/2009 PTSD awarded SC.  OSA denied

4/2012 OSA awarded SC. 

IMO cited some refs and also tied claim with some documented issues- PTSD/Gerd/sinus/etc. Sleep Apnea was not in my health records and I had copies of all 36 years worth

From the IMO:

Sleep Apnea

Pt has PTSD and sleep study proven sleep apnea with CPAP.

Pt also has sinus problems during service and has snored for many years as per spouse statements. Plus he has GERD and pulmonary fibrosis secondary to service.

The literature support as association between sleep apnea and combat related PTSD, sinus, GERD and pulmonary fibrosis secondary to service and this pt has all of these.  (See below):

It is my opinion1 considering every possible sound medical etiology/principle, to at least the 90% level of probability that his current sleep apnea is due to his PTSD/snoring and sinus problems that the patient had during military service for the following reasons.

  1. He entered the service fit for duty without any doctor-diagnosed illnesses of PTSD/snoring or sinus, GERD and pulmonary fibrosis disease but the pt developed all of these in service as per his medical records and attached lay statements.

  2. Some of these (PTSD, snoring and sinus diseases) are know to be associated with sleep apnea as per the literature below;

     

PTSD:

Prevalence of Sleep Disorders Among Soldiers With Combat-Related Posttraumatic Stress Disorder Free To View

Nick Orr, MD; Kevin Carter, DO; Jacob F. Collen, MD; Monica Hoffman, MD; Aaron B. Holley, MD; Christopher J. Lettieri, MD

Walter Reed Army Medical Center, Washington, DC

CHEST. October 2010;138(4_MeetingAbstracts):704A-704A. doi:10.1378/chest.10975

Abstract

PURPOSE: Poor sleep quality, insomnia and daytime somnolence are common among recently deployed Soldiers and those with Post Traumatic Stress Disorder. We sought to determine the prevalence of sleep complaints and sleep disorders among recently deployed Soldiers with PTSD.

METHODS: We analyzed the records of 80 consecutive Soldiers returning from combat and diagnosed with PTSD. We determined the rate of sleep complaints and prevalence of insomnia and obstructive sleep apnea. We compared demographic data, psychoactive medication use, psychiatric disorders and concomitant traumatic brain injury (TBI) to determine if any variables correlated with increased sleep complaints or disorders.

RESULTS: 80 consecutive patients were included. 89.6% were men (mean age 37.7±0.3 years, mean BMI 29.0±0.3 Kg/m2). 76.1% had depression and 30.1% had anxiety. 91% were taking psychoactive medications (average 3.9 Rx/patient). 92.5% reported sleep complaints (46.8% difficulty falling asleep, 35.8% nocturnal awakenings). Insomnia was diagnosed in 52.8%. Mean ESS was 10.5±0.5. 72% underwent polysomnography (mean sleep latency 17.8±6.6 minutes, mean sleep efficiency 84.5±9.2%). Sleep fragmentation was common (mean arousal index 27.7±2.6 events/hour). 61% were diagnosed with OSA (mean AHI 21.8±3.3 events/hour). Those with OSA had less use of narcotics and benzodiazepines and a lower prevalence of TBI than those without OSA.TBI occurred in 50.7%, equally divided among blast and blunt mechanism. TBI was associated with more sleep fragmentation and insomnia, but less OSA, sleepiness and depression than those without TBI. Blast injuries were more significantly associated with insomnia, sleep fragmentation and anxiety, while blunt trauma led to more somnolence and OSA.

 

Interestingly when OSA was approved decision was not specific to being secondary to anything, just SC even though claim and IMO pushed it as secondary and as I said nothing in med records talked to OSA or snoring

 

REASONS FOR DECISION

1. Service connection for obstructive sleep apnea.

Service connection for obstructive sleep apnea has been established as directly related to military service.

An evaluation of 50 percent is assigned from April 18, 2012, effective the date we received your claim for benefits.

We have assigned a 50 percent evaluation for your sleep apnea based on:

  • Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine.

 

Putting it all together what does it mean: 1 ) there are studies and BVA cases relating OSA as secondary to PTSD; 2) it's a crap shoot with the VA; or 3) VA raters are full of crap.

in my case it paid to spend the $ for an IMO

 

Edited by Slick
typo
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  • HadIt.com Elder

Great Post Slick!

Thanks for posting it

 

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

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UPDATE:

I uploaded a letter to ebennies and also certified/return receipt to claims intake center stating I AM NOT SEEKING AN INCREASE FOR MY PTSD I AM SEEKING A SECONDARY CLAIM.  Well they did it now.  it no longer is listed as an increase.

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1 hour ago, USMC_VET said:
 

UPDATE:

I uploaded a letter to ebennies and also certified/return receipt to claims intake center stating I AM NOT SEEKING AN INCREASE FOR MY PTSD I AM SEEKING A SECONDARY CLAIM.  Well they did it now.  it no longer is listed as an increase.

Let them do what they want.  Remember it is a game, give them room to hang themselves.  As long as you have a medical opinion with sound medical rationale and the evidence to support those conclusions a claimant will be in good shape. Remember you are not the doctor.  I feel you clarified what you were claiming and made the distinction on the basis of the claim, you don't need to be a doctor on the rest.  Let your IMO/IME do that for you.

It looks like you're going to be in good shape.  Gotta wait for their response and move now. JMO

Good luck folks.

 

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