Criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed

[Tbird]

The Veterans Law Blog just got word today that the criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed, effective April 18, 2016. http://www.veteranslawblog.org/va-sleep-apnea-ratings-rules-changing/

[broncovet]

Another Vet, on hadit had mentioned a concern about something very similar...on a Total knee replacement.

He was concerned that this was "elective" surgury and he would not get temp 100% convalescent rating.  

In a similar way, the VA apparently doesnt want to connect the dots between a "prescription" for a CPAP and a "medical necessity".  

In regards to the CPAP, is the doc going to write a prescription for a (unneeded) medical device, have the VA pay for the device, and then suggest the Veteran is going AMA (Against Medical Advice) by not using a device that he does not need?  

Its more than common sense..its medical malpractice for the doc to either perform unnecessary surgury, or to prescrible an unneeded medical device.   I can see it now:

"Yep, soldier, I know that leg of yours is great with 0 issues, but I want you to try a wooden leg anyway, so Im gonna scedule you for an amputation.  It wont matter if we cut off the wrong leg, because both of yours are fine.  The maker of the wooden legs contacted me and offered me a bonus if I install x more wooden legs.   Im tired of the medical profession, and so when a lawyer finds out I prescibed an unnecessary medical device, I will lose my license to practice medicine.  Now there is a great reason for me to prescribe this device."  

...Apparently, the VA thinks this is how doctors prescribe CPAPS, TKR's, and prosthetic legs..for benefit purposes.  

Im personally seeking SC for OSA (I have been on a CPAP since 2007, and I definantely would not use this device if it were not a necessity).  

I also will likely have to have twin TKR's due to severe degenerative arthritis, but plan on putting this off as long as possible.  

I can not even imagine a world where people talk docs into cutting off perfectly good knees in order to get compensation for a TKR or prescribe CPAP's to patients who dont need them.     Surely, the doctors would not do such a thing, even if a Vet was crazy enough to sacrafice his limbs for 20% or even 30%.    Yes, I know some people are desperate for money, but its absolutely ALWAYS a bad idea to trade any amount of money for your health.  If your health is gone, how would you be able to spend your money???  

To use a CPAP if you dont need one is just plain CRAZY.  The device is rather invasive, and there is an increased risk of lung problems unless you faithfully clean the tubes.  The tubes serve as "growth media" for germs unless you take rather meticilous care of them.  Each breathe you breathe out deposits cells into this tube which soon grow bacteria, if allowed to accumulate.  Using an unnecessary CPAp would be almost like passing your plate of food around, and having each person in the resteraunt cough in it, then pass it back to you, you cough on it and then eat it.  The CPAP gathers air from the room, along with cells from you and others in the home, puts these cells in a moist environment to grow bacteria, and filter your air through it.  I would never use a CPAP unless I had to.  

Reggie White died of sleep apnea, and raised awareness.  Its a lifesaver if you need it, but totally not only a waste of resources, but a health hazard if you dont need it, as I explained, above.  

  

Edited April 20, 2016 by broncovet

[jbasser]

If you are service connected for a lung condition the rules have also changed. OSA is now lumped into the lung ratings. 

Just another way to rip off a vet by the creative thinkers who have nothing better to do than the VA trying to cut vets out of their benefits.

But alas, Help is on the way. 

 

J

[Joe Hillbilly]

I have "hypniptic jerks" really bad and am service connected for PTSD that has (hypniptic jerks) included in parenthesis with the PTSD rating.  I was recommended a C-PaP to try to help with these and then they sent me for the 2nd sleep study that said I had "mild SA".  The VA has taken the SA as a non service connected condition and attached the CPAP to that instead of for the treatment of the Hypniptic jerks that I'm service connected for.

What would you guys do here?  My medical record seems plain to me that the CPAP was prescribed for the PTSD "hypniptic jerks" but is clouded by the SA diagnosis.  We are talking about something here that destroys your quality of life.  You can't sleep with your wife or nothing due to this issue.  Well, frankly you can't sleep when you need too.  Has absolutely destroyed my life.

 

I probably should have started a new thread.  Didn't mean to hijack.

Edited April 20, 2016 by Joe Hillbilly

[Andyman73]

I know mine is medically necessary by virtue that my insurance never questioned the DX or asked for 1 cent in payment.  They actually in paid  full for my unit, not leasing it like I've heard some do.  Now I have to schedule to get re-evaluated to see if my prescription needs to be adjusted.  I'm sure going to be asking them if they can/will assist me with my claim with a nexus letter.

[brokensoldier244th]

Hypnic jerks are not just a symptom of sleep apnea, though they can be. Hypnic jerks are electrical jolts to the brain by the nervous system on the edge of sleep. A CPAP is only going to keep someone from stopping breathing during sleep. Your doc may have already dx'd you with sleep apnea of one kind or another (there are a few variants). You might want to check to see what the rationale was for the CPAP- they aren't usually prescribed for hypnic jerks unless there is also breath stoppage from OSA or CSA. 

 

 

[Vync]

21 hours ago, jbasser said:

If you are service connected for a lung condition the rules have also changed. OSA is now lumped into the lung ratings. 

Just another way to rip off a vet by the creative thinkers who have nothing better to do than the VA trying to cut vets out of their benefits.

But alas, Help is on the way. 

 

J

Absolutely. It's amazing how the lungs are factored in where the airway collapse occurs in the throat/due to neurological depression. That's right up there with how the VA considers IBS and dysphagia ratings as pyramiding (opposite ends of the plumbing).