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Sleep Apnea Filing secondary to a SC Disability!


Buck52

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This maybe helpful to some of you  wanting to File a secondary claim from a SC DISABILITY THAT YOU MAY HAVE  FOR A SLEEP APNEA CLAIM.

Even though this case is an old one   some of you may want to read up on this case that are thinking about filing a Claim of Sleep Apnea secondary to a SC disability that you may have.

you can get pull up these CFR'S That you need to read up on and do what you need to do for your claim..and submit your evidence accordingly.

 

Please read this   it sure could help you with your claim.

 

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.

 


WARREN W. RICE, JR.

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Wow, that sounded like a stretch to me at first, but after reading it a couple times, I see that it met the requirements for a "nexus", between the PTSD and SA.  Good news for this Veteran.

What it says to me is the PTSD plays a part in this Veterans SA, and it does not matter if it a 1% or 99% part of the SA.  Interesting.

Good info to put in the bank,

Thanks Buck,

Hamslice

Might need to get my OCD denial reconcidered..

 

 

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Hey Buck,

            I've also done a little research and i'm going to give this info to my Psychiatrist on my next visit and hope with a little coaxing i can get him to write me a nexis.  

Sleep Apnea

Citation Nr: 1452083      

Decision Date: 11/24/14    Archive Date: 12/02/14

DOCKET NO.  06-06 848 

 The Veteran has been diagnosed with sleep apnea by a sleep study.  A March 2008 private medical opinion from Dr. C. D. concludes, "I believe that the obstructive sleep apnea is most likely due to a sedentary lifestyle and excessive weight gain around his throat due to the effects of his [DDD]."  Dr. C. D.'s opinion and rationale provide highly probative weight in support of service connection on a secondary basis under 38 C.F.R. § 3.310 (2013).  The August 2007, October 2007, and October 2011 VA examinations do not provide adequate rationales and are therefore not probative.  Affording the Veteran the benefit of the doubt, secondary service connection is established because Dr. C. D. provided probative evidence that the Veteran's sleep apnea was caused by his DDD and there is no probative evidence to the contrary.  38 C.F.R. § 3.310 (2013).

 

Citation Nr: 1546065      

Decision Date: 10/29/15    Archive Date: 11/10/15

DOCKET NO.  08-37 439  )             

The June 2015 report of VA sleep apnea examination reflects a diagnosis of obstructive sleep apnea. On examination the examiner opined that it was less likely as not that the Veteran's sleep disorder had its onset or was otherwise related to service. However, the examiner concluded that the Veteran's sleep disorder was more likely caused by or aggravated by his psychiatric disorder. The examiner explained that the Veteran's sleep issues were symptoms of sleep apnea commonly found in PTSD and depression. Thus, the examiner concluded that the Veteran's current sleep apnea was a significant part of his ongoing psychiatric disorder.

Similarly, the most probative evidence that directly addresses the Veteran's contention that his sleep disorder onset due to event or incident of his period of service or as a result of service-connected disability does, in fact, find that the Veteran's sleep disorder was more likely caused by or aggravated by his psychiatric disorder. Given that the Board, herein, finds that service connection for an acquired psychiatric disorder is warranted, service connection for sleep apnea is warranted.

 

Citation Nr: 1507915      

Decision Date: 02/24/15    Archive Date: 02/26/15

DOCKET NO.  12-13 310  )             

3.  Entitlement to service connection for sleep apnea.

Service Connection for Sleep Apnea

 

Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a) (2014).  Generally, service connection for a disability requires evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service.  See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

In this case, the Veteran has been diagnosed with sleep apnea, which is not listed as a "chronic disease" under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions based on "chronic" symptoms in service and "continuous" symptoms since service at 38 C.F.R. § 3.303(b) do not apply. 

The Veteran essentially contends that the currently diagnosed sleep apnea first manifested during service and that symptoms of daytime sleepiness, snoring, and cessation of breathing attributable to sleep apnea have continued since service separation.  See July 2014 written statement, October 2014 Board hearing transcript.

First, the evidence demonstrates that the Veteran has current diagnosed obstructive sleep apnea.  See December 2009 VA treatment record.

After a review of all the lay and medical evidence, the Board finds that the weight of the evidence is at least in equipoise as to whether the Veteran's currently diagnosed sleep apnea was incurred in active service.  There is both unfavorable and favorable evidence regarding this question.

The unfavorable evidence includes the silence in the service treatment records with regard to complaints, symptoms, diagnosis, or treatment for sleep apnea.  However, the absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). 

In a November 2014 written statement, the Veteran's mother contended that she observed that the Veteran had snoring, coughing, and breathing difficulty throughout active service and that she often feared for his life when he slept.  The Board finds this statement to be competent and credible evidence that the Veteran's sleep apnea began during active service.  As noted above, the Veteran has also provided credible testimony about the onset of sleep apnea symptoms during service, including snoring and daytime tiredness.

The Veteran has made credible statements that symptoms of sleep apneas had their onset in service.  The finding of in-service onset is also supported by the other evidence of record, specifically, the November 2014 statement by the Veteran's mother.  See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent to report in-service and post-service symptoms such as dizziness, loss of balance, hearing trouble, stumbling and falling, and tinnitus that were later diagnosed as Meniere's disease).  As such, resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's sleep apnea was incurred in active service; thus, the criteria for service connection for sleep apnea have been met.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102.

 

Iowa Sleep Blog

Central Iowa A.W.A.K.E. Group

The link between obstructive sleep apnea and depression

Brandon Butters - Monday, October 05, 2015

During Iowa’s colder months or periods during of stressful events in our lives, it’s natural to occasionally feel sad or “down in the dumps.” However, when that feeling seems to linger for longer periods of time, it could be a sign of depression. How does this relate to sleep? Well, individuals who experience depression are also more likely to have symptoms of obstructive sleep apnea. OSA occurs when muscles in the back of the mouth and throat relax during sleep, causing soft tissue to collapse and block the upper airway.

The symptoms of sleep apnea can be closely associated with depression, regardless of other OSA contributors such as weight, age, gender or race. The relationship between the two can be complex, as sleep problems may contribute to depressive disorders and depression may cause you to develop sleep problems. Here are some of the most common connections between obstructive sleep apnea and depression:

Men with a sleep apnea are more likely to suffer from depression

Research and recent studies have shown that men who have OSA are more likely to be clinically depressed. Men that experience both OSA and excessive daytime sleepiness were four to five times more likely to have depression than men without either condition.

Sleepers with depression are more likely to suffer from sleep-disordered breathing

In a study of almost 19,000 people in Europe by the Journal of Clinical Psychiatry, doctors found that individuals experiencing depression were more than five times more likely to also suffer from sleep disordered breathing, such as snorting, gasping and sudden pauses in breathing. These are all signs of a sleep apnea.

Sleep apnea treatments can reduce depression symptoms

Researchers have found that patients who used a continuous positive airway pressure (CPAP) showed reduced signs of their depression symptoms. The CPAP machine is worn during sleep to keep the airways open to promote better sleep, lessening the effect loss of sleep can have on depression.

The specific ways depression and sleep apnea are connected are not completely understood by doctors in this fields, but research is on-going. If you know someone who could benefit from learning more about CPAP treatments for OSA, check out some of the other pages on Iowa Sleep’s website, or send our doctors a question through this form to receive more information.

 See more at: http://www.iowasleep.com/blog/the-link-between-obstructive-sleep-apnea-and-depression#sthash.XEWv8ryu.dpuf

 

CDC Study Shows Association Between Depression and Sleep Apnea

 

Obstructive sleep apnea and other symptoms of OSA are associated with probable major depression, regardless of factors like weight, age, sex or race, according to a new study from the Centers for Disease Control and Prevention. There was no link between depression and snoring.

“Snorting, gasping or stopping breathing while asleep was associated with nearly all depression symptoms, including feeling hopeless and feeling like a failure,” said Anne G. Wheaton, PhD, lead author of the study. “We expected persons with sleep-disordered breathing to report trouble sleeping or sleeping too much, or feeling tired and having little energy, but not the other symptoms.”

The study, appearing in the April issue of the journal SLEEP, is the first nationally representative sampling to examine this relationship, surveying 9,714 American adults. Previous studies have focused on smaller samples of specific populations, such as people suffering from obstructive sleep apnea (OSA), depression or other health conditions.

Wheaton, an epidemiologist with CDC, said the likelihood of depression increased with the reported frequency of snorting and/or instances when breathing stopped in the study. She suggested screening for these disorders in the presence of the other could help address the high prevalence and underdiagnosis of sleep apnea and depression, especially if sleepiness is a chief complaint.

Snorting, gasping and pauses in breathing during sleep are all signs of OSA, a common form of sleep-disordered breathing. Six percent of men and 3 percent of women in the study reported having physician-diagnosed sleep apnea. OSA occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.

 

National Sleep Foundation

Feeling sad every now and then is a fundamental part of the human experience, especially during difficult or trying times. In contrast, persistent feelings of sadness, anxiety, hopelessness and disinterest in things that were once enjoyed are symptoms of depression, an illness that affects at least 20 million Americans. Depression is not something that a person can ignore or simply will away. Rather, it is a serious disorder that affects the way a person eats, sleeps, feels and thinks. The cause of depression is not known, but it can be effectively controlled with treatment.

The relationship between sleep and depressive illness is complex – depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders. For some people, symptoms of depression occur before the onset of sleep problems. For others, sleep problems appear first. Sleep problems and depression may also share risk factors and biological features and the two conditions may respond to some of the same treatment strategies. Sleep problems are also associated with more severe depressive illness.

Insomnia is very common among depressed patients.  Evidence suggests that people with insomnia have a ten-fold risk of developing depression compared with those who sleep well. Depressed individuals may suffer from a range of insomnia symptoms, including difficulty falling asleep (sleep onset insomnia), difficulty staying asleep (sleep maintenance insomnia), unrefreshing sleep, and daytime sleepiness. However,  research suggests that the risk of developing depression is highest among people with both sleep onset and sleep maintenance insomnia.

Obstructive sleep apnea (OSA) is also linked with depression. In a studyof 18,980 people in Europe conducted by Stanford researcher Maurice Ohayon, MD, PhD , people with depression were found to be five times more likely to suffer from sleep-disordered breathing (OSA is the most common form of sleep disordered breathing). The good news is that treating OSA with continuous positive airway pressure (CPAP) may improve depression; a 2007 study of OSA patients who used CPAP for one year showed that improvements in symptoms of depression were significant and lasting.

 

Citation Nr: 1512100      

Decision Date: 03/20/15    Archive Date: 04/01/15

DOCKET NO.  09-30 225  )

THE ISSUE

Entitlement to service connection for sleep apnea.

ATTORNEY FOR THE BOARD

T. Azizi-Barcelo, Counsel

INTRODUCTION

The Veteran had active service from September 1981 to September 1983 and from October 1984 to February 1998.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

The issue was remanded by the Board in March 2012 and August 2012 for additional development.  In June 2013 the Board denied the claim of entitlement  to service connection for sleep apnea.  The Veteran appealed the Board's June 2013 decision to the U.S. Court of Appeals for Veterans Claims (Court).  In a  June 2014 Memorandum Decision, the Court set aside the Board's decision       and remanded the case to the Board for further adjudication consistent with its Memorandum Decision.

The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ).  VA will notify the appellant if further action is required.

REMAND

In the June 2014 Memorandum Decision, the Court noted that the evidence of record raised a new theory of entitlement for service connection for sleep apnea as secondary to his service-connected major depressive disorder, and by failing to discuss whether the claimed disability was proximately due to or the result of his service-connected major depressive disorder, the Board failed to provide an adequate statement of reasons or bases. 

In this regard it was noted that the service treatment records showed the Veteran complained of sleep difficulties during service related to his depression and marital stress.  After service, a VA examiner in October 2004 noted that Veteran was prescribed an antidepressant to help with pain and associated sleep problems.  Additionally, the March 2012 and the April 2013 VA medical specialists determined that sleep complaints described in service were related to depression.  As such, the Court found that the evidence suggested a relationship between the Veteran's service-connected major depressive disorder and the sleep apnea.

Service connection may be established for disability that is proximately due to or the result of a service-connected disability.  38 C.F.R. § 3.310(a) (2014).  Further,   a disability that is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown.  38 C.F.R. § 3.310 (2014); Allen v. Brown, 7 Vet. App. 439 (1995).  However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury.  38 C.F.R. § 3.310(2014).

While VA obtained a medical opinion addressing whether sleep apnea was secondary to the Veteran's service-connected orthopedic disabilities, there is no competent medical evidence with respect to the question of service connection for sleep apnea as secondary the service-connected major depressive disorder.  Thus, a VA medical opinion must be obtained.

 

This may shed some light on what's out there to tie SA with PTSD or MDD like i have.

 

 

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yes good information silverdollar  & knowing a service connected disability can be aggravated to cause a secondary disability  such as sleep apnea .

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

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I think its best  to be honest and if you never had S.A.  or any sleep disturbance while in military its best to let them know  and have a specialist to state that your S.A. ''is likely as not caused from your Service Connected Disability  such has PTSD.

This is what I am trying to get a nexus for.  just ain't found my Dr yet, 

I been thinking bout hiring Dr Elis from Oklahoma  he does this for veterans but I'm not sure if he will do it without examining you  or just do things via email?

jmo

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

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What if you had SA but didn't know it until you heard about this illness when you got out. While I was in the service my wife and other in my tent always told me I needed to see a doc about my snoring or breathing issues.  I was ask once while in service did I snore when I took a physical, and I said no. Never thought about being sleep and not able to hear myself snore, especially when people around me said I did. It just didn't register. Now it's a uphill battle. No worries, VA has excepted and diagnosed me with OSD non-service connected. I get the treatment without the compensation it's just now they call it insomnia. Should I claim insomnia? 

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I recently found out sleep apnea was compensable. When I retired in Sep 94 and applied later to VA for benefits it was in my records from a VA Hospital in Cal  that I had sleep apnea. Diagnosed at VA Hospital in March 94 that I had sleep apnea. Have all paperwork from that time at VA. Later got my cpap and also had the UPPP surgery (which I don't recommend) in 2007. I have copies of 2 sleep studies showing my apnea. I never mentioned the apnea to VA in Houston and they never said anything about it in my records. Question is Iam about to apply. This is May 2016. Would I be eligible for retroactive back pay? I think I can qualify for the monthly compensation regardless of back pay. Thanks.

Edited by Jerry Harris
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