Am I interpreting this VA letter correctly? (sleep apnea)

[100Bound]

First bullet says, "We have assigned a 50% evaluation for your sleep apnea..."

But here's where it's interesting. The second bullet says, "A higher evaluation of 100 percent is not warranted for sleep apnea syndromes unless the evidence shows:Carbon dioxide retention; or Chronic respiratory failure; or Corpulmondale; or, Tracheostomy required." (underlining is mine)

I thought it had to be chronic respiratory failure AND carbon dioxide retention? So, if I'm reading this correctly, according to this letter, all I would have to prove is carbon dioxide retention and I'd be rated at 100%?

[Gastone]

A very good question. What do your 02 overnight Sats look like? Constantly mid to lower 80's, without supplemental 02?

The need for Supplemental 02 while on Bipap or Cpap based on a confirmed DX, is evidence of Chronic Respiratory Failure. As you rightfully point out, CRF is 1 of the (3) "ORs" that can get you a SA 100% Rating.

What to do, what to do? NOD with a DRO Review or Hearing Request could take up to 2+ Yrs. 1st you need to determine if the Medical Evidence regarding Low 02 overnight Sats and the Requirement of supplemental 02 while on Cpap is actually in your VMC Med Records. Can you post redacted copies from your VMC MHV link?

Is there any indication or discussion regarding taking your low 02 Sats and need for nighttime supplemental 02 into consideration, in the Evidence Viewed section of your Award Letter?

If your only 1 or 2 months since the Award Letter issue date and the above evidence was in your VMC Records, you could ask your VSO-Rep to do an Official Review for CUE Request. If it doesn't get you anywhere, you still have the remainder of the 12 month NOD window  to file asking for a DRO Hearing. You'll at least give the RO Rating Dept management a heads up to something that may have been missed.  Might even cause the Rating Dept "Phantom" Quality Control Specialist to take a hard look at your Award.

Keep in mind, with the DRO Program, you MUST supply New & Material Evidence that was not available to the original Rater.

Semper Fi

[100Bound]

28 minutes ago, Gastone said:

A very good question. What do your 02 overnight Sats look like? Constantly mid to lower 80's, without supplemental 02?

The need for Supplemental 02 while on Bipap or Cpap based on a confirmed DX, is evidence of Chronic Respiratory Failure. As you rightfully point out, CRF is 1 of the (3) "ORs" that can get you a SA 100% Rating.

What to do, what to do? NOD with a DRO Review or Hearing Request could take up to 2+ Yrs. 1st you need to determine if the Medical Evidence regarding Low 02 overnight Sats and the Requirement of supplemental 02 while on Cpap is actually in your VMC Med Records. Can you post redacted copies from your VMC MHV link?

Is there any indication or discussion regarding taking your low 02 Sats and need for nighttime supplemental 02 into consideration, in the Evidence Viewed section of your Award Letter?

If your only 1 or 2 months since the Award Letter issue date and the above evidence was in your VMC Records, you could ask your VSO-Rep to do an Official Review for CUE Request. If it doesn't get you anywhere, you still have the remainder of the 12 month NOD window  to file asking for a DRO Hearing. You'll at least give the RO Rating Dept management a heads up to something that may have been missed.  Might even cause the Rating Dept "Phantom" Quality Control Specialist to take a hard look at your Award.

Keep in mind, with the DRO Program, you MUST supply New & Material Evidence that was not available to the original Rater.

Semper Fi

I've never had my CO2 levels checked, so there is nothing in my record. Should I go to a blood doctor to get the Arterial Blood Gases (ABG) test done?

[Gastone]

I've had the ABG done for a PH Exam, very painful and doesn't really address your nighttime CO2 retention or P02 levels dropping below 90% while off Cpap or Bipap.

You can ask your VA Sleep Dept, via MHV Secure Message, for an overnight P02 Study. Respiratory will provide the recording equipment, the results of which, will be the basis for a CRF DX. You need this before you do anything else.

Did I miss what causes you to think you have CRF? Your not currently on Supplemental 02 with your Cpap? Usually, low P02 Sats are picked up during the SA overnight Sleep Studies.

Semper Fi

 

 

[100Bound]

2 hours ago, Gastone said:

I've had the ABG done for a PH Exam, very painful and doesn't really address your nighttime CO2 retention or P02 levels dropping below 90% while off Cpap or Bipap.

You can ask your VA Sleep Dept, via MHV Secure Message, for an overnight P02 Study. Respiratory will provide the recording equipment, the results of which, will be the basis for a CRF DX. You need this before you do anything else.

Did I miss what causes you to think you have CRF? Your not currently on Supplemental 02 with your Cpap? Usually, low P02 Sats are picked up during the SA overnight Sleep Studies.

Semper Fi

 

 

I had my sleep study done 12 years ago. I don't know if they even tested for that back then.

[Gastone]

You know how it works with the VA, you need the DX for it to be SC'd as Direct or Secondary.

No DX of Low P02 Sats (less than 90%), your not on supplemental 02 at night in conjunction with your C/Bipap = No possibility of 100% SA Bump.

Semper Fi

[EODCMC]

Gastone, in another thread I posted my sleep study while on active duty and one recently. The active duty one diagnosed me with mild OSA but no low O2. Recommended CPAP. The recent one diagnosed very severe OSA with low O2; however, they prescribed CPAP, but no O2. After reading some recent posts, including yours, I think I should be asking why not. 

For all, I wish I had been using the machine all along. I have most symptoms associated with SA but for the last 14 years, since retirement, I have attributed them to "getting old". NOT SO! In the 2 months since forcing myself to wearing a full face mask, most symptoms have nearly disappeared. I'm not groggy all day needing a nap and never feeling completely rested. My mind is clearer and I'm less irritable. I really am refreshed. My wife no longer wakes me in a panic out of fear from my unforced breath holds and I no longer snore at all. My growing short term memory loss is still a problem; perhaps the damage is permanent or a result of something else...old age.

Use your machine if you truly need one. I found it easier to find a seal and be more comfortable when I put it on about 15 min. before sleep while watching tv.

Pardon my verbosity and I'm off my soap box.