Sleep Apnea claim with only a diagnosis from active duty?

[afvetwife2000]

I'm new here so I hope I am doing this right. I am actually the wife of the vet that is filing a claim. In April of 2011, 2 weeks before being placed on TDRL for a heart condition, my husband had a sleep study done at a VA sleep center. The result was sleep apnea and recommendation was a CPAP machine. Because he was on TDRL he did not pursue VA benefits. He also did not receive (didn't ask either) for a CPAP machine. We didn't realize that was recommended until recently when we requested the diagnostic paperwork. My husband has been completely separated from the Air Force since October of 2015 (no longer on TDRL).  In Nov 2016 he filed a claim that included sleep apnea. The sleep apnea was denied in May of 2016 as it said it was not service connected. That's when we called the sleep center and requested the diagnosis to be printed. We assumed the VA would have access to this because they said they did not need him to send any medical records, they could filter through them on their own. Once we got it printed from the sleep center he "reopened" the case (didn't know he should have just appealed) and included the diagnoses paper. As far as any other history related to sleep problems while he was enlisted.. it is documented a couple of times that he visited the military hospital post deployment for sleep issues and was told to take Benadryl.  He never thought of going to the doctor because he snores a lot.. we always assumed he had sleep apnea but honestly didn't realize how dangerous it could be so he never went to the doctor about it while active duty. He just went for the study before being put on TDRL because like I said, we knew by his symptoms he had it and he wanted it documented. We are in the process of waiting to see if he will get denied again. I'm including the diagnosis information we have. Based on what you guys usually see.. do you think he has a chance of getting benefits? He was rated at 0% for his heart so no benefits currently

*Overall sleep architecture was consistent with sleep disordered breathing. The patient demonstrated a severe degree of sleep fragmentation (arousal index 82.6/hr). The majority of these arousals were secondary to sleep disordered breathing(SDB). The patient slept 114.4 of 282.0 minutes in the supine position. The lowest oxygen saturation was 86%. The patient had a periodic limb movement of sleep (PLMS) index of 0.9/hr and a PLMS arousal index of 2.77/hr. The EKG revealed no abnormalities. EEG no abnormalities.

IMPRESSION: Obstructive Sleep Apnea

RECOMMEDATIONS:

1. Discuss with patient treatment options considering CPAP or surgical evaluation

the rest is just about if patient was CPAP what to do.

 

 

[afvetwife2000]

2 hours ago, broncovet said:

Whoa, hoss!  

Two things:

1.  IN order to get any (serious) compensation, he needs to be prescribed AND USING a cpap.  That is 50% if its service connected.   If he refuses the CPAP, then the compensation will be no more than 10%.  

2.  HOwever, the "rating" is the cart before the horse.  To get the OSA service connected, he needs the Caluza big 3:

      A.  Current diagnosis of sleep apnea.

     B.  In service event or agravation.

     C.   Nexus between A and B above.  

would B. in service event or aggravation qualify as the sleep study? It shows that he obviously was having an "event" while in service since it was while he was still active duty. As far as current diagnosis.. the dr may order a new sleep study they said. If he doesn't, he'll go ahead and set him up for a CPAP.  As far as a nexus.. that's new to us.. would the DBQ suffice seeing as though it ask if it the apnea is connected to time in service?

Edited August 11, 2016 by afvetwife2000
clarifying

[afvetwife2000]

I appreciate the responses, they have really helped me understand this better and know what I needed to look more into. Obviously, I am very new to this (as is my husband). After more digging into some past posts on this site and utilizing google.. I think I understand that my husband is "good" as far as proving his sleep apnea is service connected. I think what we missed was keeping that diagnosis up to day to prove it's still ongoing. I am in contact with our VA sleep lab and more than likely they are going to schedule another sleep study. I'm certain it will confirm he still has OSA. I have been writing my spouse statement this morning and then will need the "nexus".  I think he's going to be denied this go around but feeling more confident in the next time. 

[EODCMC]

AFVW2, I look at it this way. I have seen positive results posted on this site from claims that didn't have a direct service DX like your husband has. I would keep your chin up and feel cautiously optimistic, if not positively entitled. 

Yea, the VA makes some head scratching mistakes. Cross that bridge when it comes. There is plenty of great help here for that too.

[afvetwife2000]

2 hours ago, EODCMC said:

AFVW2, I look at it this way. I have seen positive results posted on this site from claims that didn't have a direct service DX like your husband has. I would keep your chin up and feel cautiously optimistic, if not positively entitled. 

Yea, the VA makes some head scratching mistakes. Cross that bridge when it comes. There is plenty of great help here for that too.

Thank you for the encouraging words. I was delightfully surprised that our VA sleep lab got in contact with us and scheduled his sleep study for next week. I thought it would have been a little further out. My husband said they told him they are going to hook him up to the machine to get the settings correct while he's sleeping. He is horrible about not asking questions or remembering details of a conversation so that was his summary of the call. I assume they meant the CPAP machine since they know he needs it. 

I'm new to what a "nexus" is..  Can he ask the doctor at the sleep lab to write him one next week?

We also found out that he should be getting the claim decision next week even though Ebenefits is still in review of evidence.

[gs106]

If he isn't using a CPAP I suggest that he go to VA and request one based on the previous sleep study.  VA will issue a CPAP based on a non VA sleep study. If they won't issue one he should request another sleep study.  Since he had the diagnosis while on active duty he shouldn't have any problem getting service connected.  A current sleep study should also be sufficient since I believe you said he has been out for less than a year.  I was just service connected for OSA 11 years after retirement and the diagnosis/sleep study was 7 years after retirement.  I had a nexus letter from my non VA doctor stating that it was more likely than not that I had OSA while still on active duty.  That, and surgery for a deviated septum while on AD was cited in the decision letter.

[afvetwife2000]

On ‎8‎/‎15‎/‎2016 at 7:15 AM, gs106 said:

If he isn't using a CPAP I suggest that he go to VA and request one based on the previous sleep study.  VA will issue a CPAP based on a non VA sleep study. If they won't issue one he should request another sleep study.  Since he had the diagnosis while on active duty he shouldn't have any problem getting service connected.  A current sleep study should also be sufficient since I believe you said he has been out for less than a year.  I was just service connected for OSA 11 years after retirement and the diagnosis/sleep study was 7 years after retirement.  I had a nexus letter from my non VA doctor stating that it was more likely than not that I had OSA while still on active duty.  That, and surgery for a deviated septum while on AD was cited in the decision letter.

He actually had his sleep study with the VA sleep lab last night. They wanted an updated study since his last was in 2011. He said they had him wear the CPAP stuff so they could get settings correct (that's what he gathered from what they told him).  It will take about a week for the dr to review over the results to see what he needs. His claim is actually past the date of estimated closure but we are hoping they haven't made the final decision (although on phone they told him it was in decision pending or something like that) so we can add the updated info next week.