hypertension Sleep Apnea

[Palma114]

I've been searching the bva decision, but I have not found anything, claim or case as worse as mind. (sleep apnea)  lol

I have a DRO hearing in about 3 weeks, I appealed and the BVA remanded my case to AOJ in 2014, they wanted to know more about my CKD/Hypertension, and the bva judge wants the RO to find out whether I have sleep apnea or not and is it service-connected, because in 2013 during the BVA hearing, I explained to her my sleep problems and symptoms and that all of this began before I left the military in 1994. So she ask me, have you ever had a sleep study done, and I said no, and I really had no idea what a sleep study or sleep apnea were at that time, because I were claiming sleep disorder.

So in 2014 my pcp at VA finally sent me for a sleep study, 2 wks later diagnosed Obstructive sleep apnea with REM supine position and Severe Oxygen desaturation.

For this DRO hearing coming up in 3 wks, the RO still have not sent me for a C & P exam (sleep apnea)

This is what the judge wrote on the remand docket in 2014 to RO:   When there is an approximately balance of positive and negative regarding any issue material to the determine of a matter, The Secretary shall give the benefit of the doubt to claimant. 30 U.S.C.A. 5107; 38 CFR 3102; See Gilbert V. Derwinski, 1 Vet. App. 49, 53 (1990)

With the about criteria in mind, the relevant facts and contentions will be summarized. A report of medical history completed in July 1993 shortly before service separation noted that the Veteran had "frequent trouble sleeping". After service VA psychiatric treatment reports since as early as August 2004 reflect the Veterans complaints of trouble sleeping associated with nightmares of his combat service in Perisan Gulf War. Reports from an August 1998 VA psychiatric examination-which resulted in the diagnosis of PTSD found to be sufficient for the grant of service connection for this disability in a September 1998 rating decision-showed the Veteran reporting a state of being of 'high tense', and only being able to sleep for three or four hours a night.  (that completes what the judge had to say)

I complained over 22 times, beginning 1994 a few months before I left the Army(twice) and at the VAMC'S(21 times) all the way up until 2014, I guess the only thing is, they did document all of my sleep complaints and symptoms, beginning in the Army, hypertension, headaches, tired/fatigue, can only sleep 3-4 hrs a night. I continuously complained to the VAMC for years, but they would never mention sleep study or sleep apnea to me, and at the time, I did not know anything about it. But I do now, I have been reading and studying everything that I can get my hands on that pertains to sleep apnea. I found something that may be of very importance, The VA Health Services Research and Development Service (www.hsrd.research.va.gov) Medical Director, Sleep Disorder Laboratory, Montgomery VA Medical Center, dated Feb 25, 2014, Dr. Tamanna-transcript of cyberseminar.

Is there any opinions or helpful information.

Edited January 5, 2016 by Palma114

[Vync]

Pete,
That's a really good point. The VA really needs to send out a Fast Letter directing any sleep disorder claims to undergo a sleep study to differentiate between sleep disturbance disorder and sleep apnea. Will the VA do this? Probably not, but we can hope!

[Palma114]

1 hour ago, pete992 said:

The crazy one here, ok for what it is worth I will lend my 2 cents.  There is a major difference between a sleep disturbance disorder and sleep apnea.  Sleep disturbance disorder is a mental health disorder but sleep apnea is a respiratory disorder.  The VA hospital has been treating your condition as a mental health disorder.  The real problem is that you filed a claim for  depression/PTSD and sleep disorder and VA did not consider your sleep disorder to be sleep apnea.  You will need a medical opinion with a good medical rationale that relates/connect your sleep apnea to your PTSD. VA loves to play these little word games and keep veterans claims tied up for years and veterans give up and lose out.  It appears that the VLJ is trying to steer the RO in the right direction but if they continue to deny get an attorney and file an appeal to CAVC.  I had a VLJ remanded a claim twice trying to get the RO to do right but when they refused and denied my claim the VLJ decided WTH and he denied it to and I got a law dawg and we went to CAVC and I won my service connection. Ain't  that a ******    It is not pyramiding if VA consider your sleep apnea secondary to your PTSD.  According to 38 CFR 3.310(a) which states:

3.310   Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

(a) General. Except as provided in §3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.

 

 

Pete992,

oh, I'm not giving up here, I am prepared to take it as far as need be, what's a dam shame is, the bva recognize the sleep apnea symptoms from my military medical records and my VAMC records, and it appears they are saying, how did this individual complain this many times (22) and you all fail to send him to the sleep clinic, when he keeps complaining of sleep problems, and all sleep apnea symptoms.

Edited January 6, 2016 by Palma114

[Palma114]

40 minutes ago, Vync said:

Pete,
That's a really good point. The VA really needs to send out a Fast Letter directing any sleep disorder claims to undergo a sleep study to differentiate between sleep disturbance disorder and sleep apnea. Will the VA do this? Probably not, but we can hope!

Hey Vync,

I thought at any medical facility, including VA, if an individual came in complaining of a medical problem, and if they could not figure it out or medically fix the problem, shouldn't they send you or give a consult to a clinic or somebody that specialize in sleep. 

your thoughts

[Vync]

Hey Palma,
When you initially filed your claims, what was the exact text used to identify your claim? (if you still have copies). Did you file for "sleep problems", "sleep disturbance", "tiredness", etc... or did you just file for PTSD? This question ties back to what Pete posted. If you only filed for PTSD and they considered your sleep disturbances to be a symptom of PTSD, then that would explain why they never considered it as an SA claim. However, you are not an MD, so you should only need to file your claim in layman's terms, like "sleep problems".

Your 2013 C&P exam should have raised the flags steering this towards a possible inferred SA claim: "C & P Exam 04/2013, Mental Disorders, by VA PSYD(EXAMINER), she stated that Veteran indicated that his wife has informed him that he stops breathing at night while sleeping. It should also be noted that he has not been evaluated for sleep apnea".

Regardless, the VA is not supposed to simply drop the ball. Under the "Duty to Assist", they are supposed to maximize the claims. Here are some CAVC references that you might consider researching and familiarizing yourself with before your DRO visit. Please note that the rulings only apply from their specific date forward. You would assume that the VA was supposed to develop your claim to the maximum extent, but they are human and make errors.

Finally, the Board notes that the Court has recently noted that VA has a "well-established" duty to maximize a claimant's benefits.  See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); AB v. Brown, 6 Vet. App. 35, 39 (1993) (a veteran is presumed to be seeking the greatest possible benefit unless he specifically indicates otherwise), see also Bradley v. Peake, 22 Vet. App. 280 (2008).

 

[Palma114]

49 minutes ago, Vync said:

Hey Palma,
When you initially filed your claims, what was the exact text used to identify your claim? (if you still have copies). Did you file for "sleep problems", "sleep disturbance", "tiredness", etc... or did you just file for PTSD? This question ties back to what Pete posted. If you only filed for PTSD and they considered your sleep disturbances to be a symptom of PTSD, then that would explain why they never considered it as an SA claim. However, you are not an MD, so you should only need to file your claim in layman's terms, like "sleep problems".

Your 2013 C&P exam should have raised the flags steering this towards a possible inferred SA claim: "C & P Exam 04/2013, Mental Disorders, by VA PSYD(EXAMINER), she stated that Veteran indicated that his wife has informed him that he stops breathing at night while sleeping. It should also be noted that he has not been evaluated for sleep apnea".

Regardless, the VA is not supposed to simply drop the ball. Under the "Duty to Assist", they are supposed to maximize the claims. Here are some CAVC references that you might consider researching and familiarizing yourself with before your DRO visit. Please note that the rulings only apply from their specific date forward. You would assume that the VA was supposed to develop your claim to the maximum extent, but they are human and make errors.

Finally, the Board notes that the Court has recently noted that VA has a "well-established" duty to maximize a claimant's benefits.  See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); AB v. Brown, 6 Vet. App. 35, 39 (1993) (a veteran is presumed to be seeking the greatest possible benefit unless he specifically indicates otherwise), see also Bradley v. Peake, 22 Vet. App. 280 (2008).

 

Hey, Thanks Vync,

I will research the CAVC references, that you gave.

[Palma114]

3 hours ago, Palma114 said:

 I filed sleep disorder, my PTSD claim was in 1998.