ptsd Filing S.A. claim to secondary Meds from PTSD

[Buck52]

How does  (If he will?)  the VA Dr's ''word an  opinion   to ask him if he would write a letter to state in his opinion this veteran Sleep Apnea aka OSA ....> in my opinion from the medications since taking medications for PTSD he is currently SC  at 70%  .....so the veteran don't have to prove SA from prior military service.

In other words Medications from the SC PTSD is secondary to the S.A.?

Do you ask the Dr to give his opinion on this? or is this a strong evidence for Secondary caused by SC PTSD? Diagnosed by the VA Also S.A. is Diagnosed by the VA & given the VETERAN a CPAP Machine to use.

is this the correct way to go about it?

 

Anybody?

Thanks for your replys & suggestions

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

Edited April 5, 2016 by Buck52

[flores97]

Buck, why not ask the doc if there is a good chance the meds are causing/aggravating the obstructive sa. If the doc says yes, ask him/her if willing to fill out dbq for sa, or at least put that statement, it is at least as likely as not that the vets obstructive sa is being caused/aggravated by the meds he takes for sc ptsd. Or by ptsd itself. If the doc says no, you would probably need a good IMO. Good Luck, Buck!!

[flores97]

Buck I apologize I didn't finish the sentence, (in earlier post), if the doc refuses to do dbq but affirms the PTSD or meds could be causing/aggravating the sa, ask if the doc would be willing to put the statement"it is my opinion the vets obstructive sa is caused/aggravated by the meds the vet takes for his sc ptsd(or ptsd itself), in your myhealthevet notes. 

[broncovet]

Buck...

   The science of the link between PTSD and sleep apnea is strong and established.  

   Back in 2007, when I was first diagnosed with sleep apnea, the VA doc wrote that the OSA was "the result of" MDD.  

   A few months ago, when I went with my wife to the sleep doc to get her cpap, I asked the private doc., 

"Do you think sleep apnea is related to depression (or PTSD)?"  

    He responded, "Yes.  MDD/PTSD have almost the same symptoms as sleep apnea."

   After he said that, I remembered.  One of the ways they diagnose depression is sleep problems.  You know nightmares, can't fall asleep, etc.  

    I also know that "not enough oxygen"  to your heart at night causes problems.  News Flash!  Not enough Oxygen is very serious, and life threatening.  It also causes changes in your brain, especially when it happens every night.  Chemical changes.  Depression.  

Here is a BVA "case in point:

Citation Nr: 0102100 
Decision Date: 01/25/01 Archive Date: 01/31/01

DOCKET NO. 99-22 315 ) DATE 

On appeal from the 
Department of Veterans Affairs Regional Office in St. Louis, 
Missouri

THE ISSUE

Entitlement to service connection for sleep apnea as 
secondary to service-connected post-traumatic stress disorder 
(PTSD).

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Richard A. Cohn, Associate Counsel

INTRODUCTION

The veteran served on active duty from April 1970 to December 
1971.

This matter comes before the Board of Veterans' Appeals 
(Board) on appeal from an August 1999 rating decision of the 
Department of Veterans Affairs (VA) Regional Office in St. 
Louis, Missouri (RO) which denied service connection for 
sleep apnea as secondary to service-connected PTSD.

FINDINGS OF FACT

1. The record includes all evidence necessary for the 
equitable disposition of this appeal.

2. There is competent medical evidence linking current sleep 
apnea to the veteran's service-connected PTSD.

CONCLUSION OF LAW

The veteran's sleep apnea was aggravated by his service- 
connected PTSD. Veterans Claims Assistance Act of 2000, Pub. 
L. No. 106-475, 114 Stat. 2096 (2000); 38 U.S.C.A. § 5107, 
38 C.F.R. § 3.310(a) (2000).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran attributes sleep apnea to his service-connected 
PTSD. The veteran does not contend that he incurred or 
aggravated sleep apnea during service and there is no 
evidence of sleep apnea or other sleep disorder in the 
veteran's service medical records SMRs.

Procedurally, this appeal is developed fully and ready for 
Board adjudication. The RO has verified the veteran's period 
of service; there is no issue as to the substantial 
completeness of the veteran's application for VA benefits; 
the veteran has undergone VA examination pursuant to the 
application; the RO has requested and associated with the 
claims file all available service and postservice medical 
records pertinent to this appeal; VA is unaware of other 
unrequested records pertinent to this appeal, and; the 
evidence is sufficient to permit the Board to proceed with 
appellate review. See Veterans Claims Assistance Act of 
2000, Pub. L. No. 106-475, 114 Stat. 2096, (2000).

A veteran may be entitled to service connection for a 
disability under either a direct or secondary analysis. 
Direct service connection is warranted for disability 
resulting from disease or injury incurred or aggravated in 
service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 
3.303 (2000). Secondary service connection is warranted both 
for a disability caused by a service-connected disorder and 
for a disability aggravated by a service-connected disorder. 
38 C.F.R. § 3.310(a) (2000). In the latter case, 
compensation is limited to the extent to which the service- 
connected disorder increased the severity of the secondary 
disorder. Allen v. Brown, 7 Vet. App. 439, 448 (1995); Jones 
(Wayne) v. Brown, 7 Vet. App. 134, 136-37 (1994). A service- 
connected secondary disorder becomes part of the original 
disorder. 38 C.F.R. § 3.310(a).

The veteran is a decorated former Army combat soldier whose 
PTSD has been service-connected since July 1995. SMRs 
include no evidence of a sleep disorder in service and the 
veteran claims none.

VA medical records confirm that the veteran underwent sleep 
studies in February and October 1998 from which he was 
diagnosed with sleep apnea. A VA psychiatric progress note 
from February 1999 briefly reviewed the studies' findings and 
applicable research and concluded that PTSD and its treatment 
"in all probability has aggravated the obstructive sleep 
apnea." The note further states that "it is certainly as 
likely as not that this veteran's sleep apnea is directly 
related to his PTSD." The VA physician who examined the 
veteran in July 1999 identified two likely causes of his 
sleep apnea: enlarged tonsillar tissue and obesity. The 
physician found no etiological connection between PTSD and 
enlarged tonsillar tissue. However, he acknowledged that 
"an argument could be made" linking the veteran's obesity 
with PTSD although the veteran's medical records did not 
include another medical opinion to that effect.

In the Board's judgment the record presents adequate evidence 
upon which to base a finding that the veteran's PTSD 
aggravated his sleep apnea. The opinion expressed in the 
February 1999 progress note is neither ambiguous nor 
equivocal on that point. The July 1999 examination report is 
more tentative -- finding only a medical possibility of 
attenuated causality under a different rationale. 
Nevertheless, the July 1999 opinion does not refute the 
February 1999 opinion, and it is well established that VA 
itself may not refute expert medical conclusions in the 
record with its own unsubstantiated medical conclusions. 
Colvin v. Derwinski, 1 Vet. App. 171, 175. (1991). 
Therefore, absent medical evidence actually denying a causal 
linkage between PTSD and sleep apnea in this case, the Board 
reads the two opinions together as providing, at minimum, 
evidentiary equipoise which must be resolved in the veteran's 
favor. See 38 U.S.C.A. § 5107(b). Accordingly, the Board is 
constrained to find that service connection for sleep apnea 
is warranted here under a secondary analysis. See 38 C.F.R. 
§ 3.310.

ORDER

Service connection for sleep apnea is granted secondary to 
service-connected PTSD.

 

[broncovet]

In this board opinion, take note of the reference to Colvin:

".... is well established that VA 
itself may not refute expert medical conclusions in the 
record with its own unsubstantiated medical conclusions. 
Colvin v. Derwinski, 1 Vet. App. 171, 175. (1991). "  

This is instructive.  To carry this one step further:

If there are conflicting medical opinions, the board can rely more heavily on the unfavorable opinion  BUT, it must give a reasons and bases for favoring one opinion over another.

In other words, if "Doc A" says, your sleep apnea is at least as likely as not related to service"   but Doc B says,

"Your sleep apnea is unrelated to service"...the Board must explain why they rejected the more favorable opinion.  

Now, the Board could give a great reason.  For example, perhaps Doc A did not read your records, but Doc B, reviewed all your records and documented it, then that denial could stick.  

The Board could also favor one opinion over another if the exam was more thorough, such as including medical tests (sleep studies, blood tests, O2 levels, etc) while the other exam had no such tests.  

Finally, the BOard has a right to "weigh" the opinions.  For example, if Doc B, was a Board certified sleep specialist, while Doc A had a PHd in baskeweaving, then its likely the BOard could give these reasons why it rejected one opinion.  

However, if both docs were board certified sleep specialists, and both had done sleep studies...then the board may have to give an opinion as to why this did not meet the "equipose" criteria which would warrant the Veteran to receive the benefit of the doubt and receive and award.  

Remember, VA benefits are "For" Veterans, its not supposed to be something VA does "TO" Veterans.