ptsd Sleep Apnea Filing secondary to a SC Disability!

[Buck52]

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.

[Palma114]

On 5/14/2016 at 5:15 PM, Buck52 said:

This will help you guys coming from a Phy Doc Some great information here

Anyman and Sync7 &Silverdollar.

I'll ask Ms T bird to Archive it  or make it a stickey.

''a 'secondary' disorder, which is a “…disability which is proximately due to or the result of a service-connected disease or injury…” (38 C.F.R § 3.310).

In terms of evidence, I would definitely talk with a Veterans Service Officer about it. There are a couple of options:

1. You could file a claim for OSA (Obstructive Sleep Apnea) secondary to PTSD, and then go to the C&P exam and see what happens. --> If this is not successful, you could then try the next option and ask for a reconsideration.
2. You could pay for an Independent Medical Examination (IME) and then file the claim. --> Downside here is that you might be successful with the first option, and you would not have needed to spend the money on an IME.
3. You could ask your sleep medicine doctor and/or psychiatrist for a 'nexus letter'. --> Unless the doctor knows what's involved and how to write it (which takes a lot of time, btw), this is not likely to succeed.

I know that many veterans have received SC for sleep apnea secondary to PTSD. However, there is not any scientific evidence at this time that shows a causal link (nexus) between PTSD and OSA. Vets usually get SC because the C&P examiner does not read the scientific literature and they simply give an opinion. The VBA must accept such opinions as valid unless there is some obvious error. 

If you do file a claim, be sure to request not only SC based on OSA being "proximately due to or the result of" PTSD, but also SC based on OSA beingaggravated by PTSD. I wrote about this point in a blog post regarding secondary mental disorder claims, although the same principle applies to a PTSD-->OSA claim. There is not yet any definitive research regarding PTSD exacerbating OSA, but it seems to be a more plausible connection than direct causation. 

All the Best,

Mark

P.S. Central Sleep Apnea is a different animal--I am referring only to OSA. I would never give an opinion regarding PTSD-->CSA secondary claim because there is so little known about the possible relationship, but some physicians, e.g., neurologists, psychiatrists, and others, are more comfortable with such claims because they have more knowledge about possible physiological processes that could theoretically lead a person with PTSD to develop CSA (or PTSD aggravating CSA). Thus, the couple of times I was scheduled for a C&P exam regarding a PTSD-->CSA claim, I would have the exam transferred to an MD.

P.P.S. I highly recommend working with a Veterans Service Officer for a PTSD-->OSA claim.''

Edited 5 hours ago by Mark D Worthen PsyD 

This Dr posted this on one of my post about filing Sleep Apnea Secondary  and also would it be pyermding filing secondary to my 70%PTSD Claim I jus got awarded for this year.

he said no its not pyramiding.

 

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

 

 

 

Buck

 

 

OSA with REM Sleep, is effected or aggravated by PTSD. So make sure you check your complete diagnosis, if you have OSA. For example, my diagnosis is:  OSA with REM Sleep and severe oxygen desaturation, if any of that is effected by a service-connected condition, you can claim it as secondary with the OSA, because all of the symptoms are apart of your OSA.

[Andyman73]

Funny thing, I asked my Sleep specialist, when I saw her the other day, how does pain effect sleep, and can it lead to sleep apnea?  She basically said that she doesn't believe chronic pain can cause or lead to sleep apnea.  Yet it sure does interrupt my sleep!

[Buck52]

  Chronic Pain my not be the cause of S.A. but it certainly aggervates it...I would think..but Dr needs to say it.

I apologize Andyman

Some how I figured you were service connected for MDD?

I thought you had won that a few months back?

 

Edited May 18, 2016 by Buck52

[syne7]

While studies are useful.  Unless its specific to you or Veterans.  It really takes a Dr's opinion.  I know that getting Nexus letters is a challenge.  However, it's work seeking out Dr's you deal with to write them or finding a professional IME/IMO Dr. who does that for a living.  In the end it's mostly the Dr's opinion (C&P Examiner or IMO/IME/treating physician) that counts. 

The nice thing is that opinions can differ.  Go find a Doctor that understands your position and can support it (if possible).  I think it worth putting the effort into getting the paperwork (official Dr stuff) to support you claim rather than statements and arguements on your own.  These can help but the impact of dr's statements are so much more impactful in my opinion.

Of course one should do everything one can.

[Andyman73]

8 hours ago, Buck52 said:

  Chronic Pain my not be the cause of S.A. but it certainly aggervates it...I would think..but Dr needs to say it.

I apologize Andyman

Some how I figured you were service connected for MDD?

I thought you had won that a few months back?

 

Yeah, Buck, was denied because examiner ignored all of my physical evidence, SMR and VMR treatment entries for ongoing pain issues with my injuries.

  If my neuro exam results aren't in my favor....does it even matter anymore? 

[Buck52]

Andyman

you can request another C&P & state your reason but first, if you can go see a private Dr and get an IME and let the Dr know what the examiner put in his report and ask him to write his impression of your nero exam and how bad your disability trully is  with the chronic Pain