Sleep Apnea Claim

[EODCMC]

Hi, I am a 30 year retired vet. I retired 13 years ago. I as recently diagnosed with "very severe" obstructive sleep apnea. The machine they gave me is preset on the highest output flow. My episode exceed 35 times an hour with some lasting more than 30 seconds. 

I was diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record. In fact, they wanted to operate on my uvula. There lies the rub. The operation could have ended my career so I didn't persue. Additionally, while on active duty I developed severe chronic sinusitis and allergic rhinitis and this also is documented in my service health record. I have been living with this and chalking it down to getting old.

Fast forward...I recently got a machine that they say I have to wear for the remainder of my life. I just learned that Tricare Prime does not pay for it all. So, I researched online and submitted a claim the E-benefits and it has been received and was under review until today when they changed this to "gathering of evidence" Development Letter Sent.

Does anyone know what this means? What do I have to look forward to concerning the process. I watch the news. It doesn't look good, right?

thanks in advance.

[cooter]

When you did your sleep study the Dr would of recommended oxygen therapy if your O2 levels were dangerously low enough to to constitute CRF. CRF is really dangerous. People that has it are usually the ones you see walking around with an oxygen tank, depending how severe it is. The reason for this is we need enough oxygen to get rid of the carbon dioxide from our body. CRF comes into the picture when our O2 saturation isn't high enough to get rid of it.

By reading your sleep study I noticed the Dr didn't comment on using oxygen so if you think there's a good possibility that you do have CRF there is a test for that as well. It's the one where they insert a needle in your wrist to check for O2 gas levels. OUCH

 

   Coot

[Gastone]

Have you had an appointment with your VMC Sleep Dept, for a review of your current SA DX and to discuss your concerns regarding your Sleep P02 Sat levels? Seeing a VA Sleep Clinician would be of great assistance.

A BVA Appeal Decision held that the RX'd use of 02 in conjunction with Cpap or Bipap constituted CRF, even though the Supplemental 02 was not needed for daytime use. Been a few yrs since I read the BVA Decision, it pushed me to file for my SA increase in 2013, finally Awarded 100% SA Scheduler, 12/2015.

I get all my SA equipment from my VMC (since 2010), the 02 Concentrator plugs into the line just before the mask. I'm not aware of any current Cpap or Bipap machines have P02 Sat recording capabilities. I do a yearly overnight P02 Sat study using a small finger-tip Recording Device supplied by the VMC Respiratory Dept, while off Bipap, and provide the Po2 Sat report to my non VA Sleep Neurologist, at my yearly appointment. My 02 RX (1 Liter) hsn't changed since 2010.

If you don't have a combined SC of 30%, you can expect to pay Deductibles for your 02 Concentrator, provided by the VA. The service is great. Let them know in advance of a Trip, a local 02 Provider, will have a machine delivered to where ever your staying.

Semper Fi

[EODCMC]

Cooter and Gastone, thanks for your responses. I tend to agree with you both. The problem is that since mentioning Some symptoms with my new Tricare Prime primary care physician during a physical, I have not spoken with a Physician since. She referred me for a sleep study and based on that, I was given a CPAP by a technician. The DX came in the mail.

I've been on it for a couple of months now and I'm assuming that they will follow up with me after receiving some data. I know that some data reaches them via magic, but I'm not sure if it gathers as much info as the sleep study did. I think it just measures usage and apnaic events. 

Tricare Prime covers most of the expenses, but I thought it should be fully covered since I was also DXd on active duty for the same thing, although not as severe. That is why I applied for compensation initially. I'm sure the CPAP is doing its work. I'm probably just overthinking this. I never thought it was such a big deal before. 

Thanks to everyone for your help. I'll just wait until the dust clears and take it from there.

[cooter]

Just curious, were you ever dx with any heart or respiratory problems excluding SA? Was you ever a smoker?

 

   <Coot> 

[EODCMC]

Cooter, no I have not. However, shortness of breath is a symptom I gave to my PCM and still experience (to a lesser degree) since going on CPAP. I smoked for 17 years but I quit the day my first child was born 30 years ago.

[Gastone]

17 years of smoking, be on the look-out for COPD. One of the primary symptoms of early onset COPD, is shortness of breath, with poor P02 Sats (less than 90%) day and night.

What brings on the shortness of breath symptom? What Lung Tests have been ordered for a VA Pulmonary referral? The Lung function tests are used to rule out the usual suspects, that can cause the shortness of Breath. You would need a Heart Echo to determine if Pulmonary Hypertension is the culprit. SA can lead to PH Development.

If you ever get the SA SC, a DX of PH could be a Secondary Claim linked to your SA.

Semper Fi