Comp & Pen Sleep Apnea & Hypersomnia

[Alex Googe]

I was wondering if anyone can let me know what my most recent comp & pen results mean.

 

 

=========================================================================

Date/Time:               12 Jan 2017 @ 1430

Note Title:              C&P EXAM

Location:                VA CONNECTICUT HEALTH CARE SYS

 

Date/Time Signed:        13 Jan 2017 @ 1308

-------------------------------------------------------------------------

 

 LOCAL TITLE: C&P EXAM                                          

STANDARD TITLE: C & P EXAMINATION NOTE                         

DATE OF NOTE: JAN 12, 2017@14:30     ENTRY DATE: JAN 13, 2017@13:08:24     

                              

     URGENCY:                            STATUS: COMPLETED                     

 

 

                                   Sleep Apnea

                        Disability Benefits Questionnaire

 

   

   

    Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

    Request?

    [X] Yes   [ ] No

   

 

    ACE and Evidence Review

    -----------------------

    Indicate method used to obtain medical information to complete this

document:

   

    [X] Review of available records (without in-person or video telehealth

        examination) using the Acceptable Clinical Evidence (ACE) process

because

        the existing medical evidence provided sufficient information on which

to

        prepare the DBQ and such an examination will likely provide no

additional

        relevant evidence.

 

    Evidence Review

    ---------------

    Evidence reviewed (check all that apply):

   

    [X] VA e-folder (VBMS or Virtual VA)

    [X] CPRS

 

 

    1. Diagnosis

    ------------

    Does the Veteran have or has he/she ever had sleep apnea?

    [X] Yes   [ ] No

   

       [X] Obstructive

              ICD code:  g47.33              Date of diagnosis: 2012

 

    2. Medical history

    ------------------

    a. Describe the history (including onset and course) of the Veteran's sleep

       disorder condition (brief summary):

         Veteran served 7/82-5/86.

 

 

         VBMS does not document the diagnosis of sleep apnea during service, and

         the diagnosis of OSA occurred years post-discharge. Given that there is

         no objective documentation for the diagnosis of, or treatment for, OSA

         in service or within 1 year of discharge, this examiner does not find

         evidence of OSA directly due to service.

 

         Obstructive sleep apnea (OSA) is the result of obstruction of the upper

         airway,with symptoms including unexplained daytime fatigue, loud

         snoring, and periods of apneas ("pauses" in breathing). Risk factors

         include male sex, increasing age,obesity, and large neck circumference.

         OSA is associated with anatomical upper airways changes, including

         decreased muscle tone, increased soft tissue around the airway, and

         structural features that give rise to a narrowed airway.

 

         Depression is not an established risk factor for the development of

OSA.

         As such his current OSA is less likely as not (50 percent or greater

         probability) proximately due to or the result of major depression

        

    b. Is continuous medication required for control of a sleep disorder

       condition?

       [ ] Yes   [X] No

      

    c. Does the Veteran require the use of a breathing assistance device?

       [ ] Yes   [X] No

      

    d. Does the Veteran require the use of a continuous positive airway pressure

       (CPAP) machine?

       [X] Yes   [ ] No

      

    3. Findings, signs and symptoms

    -------------------------------

    Does the Veteran currently have any findings, signs or symptoms attributable

    to sleep apnea?

    [ ] Yes   [X] No

   

 

    4. Other pertinent physical findings, complications, conditions, signs,

       symptoms and scars

    -----------------------------------------------------------------------

    a. Does the Veteran have any other pertinent physical findings,

       complications, conditions, signs or symptoms related to any conditions

       listed in the Diagnosis Section above?

       [ ] Yes   [X] No

      

    b. Does the Veteran have any scars (surgical or otherwise) related to any

       conditions or to the treatment of any conditions listed in the Diagnosis

       Section above?

       [ ] Yes   [X] No

      

    c. Comments, if any:

       No response provided.

      

    5. Diagnostic testing

    ---------------------

    a. Has a sleep study been performed?

       [X] Yes   [ ] No

      

           If yes, does the Veteran have documented sleep disorder breathing?

           [X] Yes   [ ] No

          

           Date of sleep study:  12/2012

          

           Facility where sleep study performed, if known:  Gaylord

          

           Results:

             severe OSA with AHI 122

            

    b. Are there any other significant diagnostic test findings and/or results?

       [ ] Yes   [X] No

      

        

    6. Functional impact

    --------------------

    Does the Veteran's sleep apnea impact his or her ability to work?

    [ ] Yes   [X] No

   

          .

 

    7. Remarks, if any:

    -------------------

       No remarks provided.

 

LOCAL TITLE: C&P MENTAL DISORDERS                              

STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT        

DATE OF NOTE: JAN 19, 2017@11:07:56  ENTRY DATE: JAN 19, 2017@11:07:56     

      AUTHOR:                  EXP COSIGNER:                           

     URGENCY:                            STATUS: COMPLETED                    

 

COMPENSATION AND PENSION EXAMINATION REPORT (FREE TEXT)

=======================================================

 

 

MEDICAL OPINION REQUEST

 

TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection.

 

OPINION REQUESTED: Secondary Service Connection.

 

The Veteran is claiming service-connection for hypersomnia as secondary to his service-connected major depression associated with left ankle, residuals of left medial malleolus fracture. The Veteran's current treatment records now show he has hypersomnia.

 

There is a recent mental exam conducted on 10-27-16 in file, however, if another examination is warranted, please pursue exam for diagnosis and to

assess current severity.

 

Is the Veteran's hypersomnia at least as likely as not (50 percent or greater probability) proximately due to or the result of his service-connected major depression associated with left ankle, residuals of left medial malleolus fracture?

 

Rationale must be provided in the appropriate section.

 

POTENTIALLY RELEVANT EVIDENCE:

 

TAB A: DBQ Mental Disorders exam dated 10-27-16

 

Tab B: VAMC treatment records showing Veteran has hypersomnia

 

RESPONSE:

Veteran's hypersomnia is at least as likely as not (50 percent or greater probability) proximately due to or the result of his service-connected major depression associated with left ankle, residuals of left medial malleolus fracture. It appears that as his depressive symptoms increased,in part related to the incident at work described in his most recent C&P exam.There is evidence based on the timing of the change in sleep and ADLs, as well As the known symptoms of major depression, that provide evidence for this secondary

service connection.

 

Edited January 23, 2017 by Alex Googe
Adding another section

[Buck52]

I am not sure they will rate you but they may S.C. You to S.A.

The examiner checked NO in all the boxes that would help you get a Rating

usually a 50% rating for required use of c-pap machine  with this box check yes  that may be what gets you the S.C.

or they may deny your claim altogether?

but I could be wrong   others will chime in

Edited January 17, 2017 by Buck52

[toddt]

"less likely than not" usually sews it up.  You will need a nexus preferably from a sleep specialist  connecting your depression  as the cause of your OSA.   Also, you need to connect your depression to your military service.

[Gastone]

No SA SC Rating for you, sorry to say.  Your Service Med records don't document any Sleep problems and it was DX'd many years after discharge, not within the 1st year after separation.

I've done a significant amount of OSA, CSA & MSA research since 2010. Really can't say I ever came across any Medical Sleep Journals or articles linking SA to Depression. PTSD yes but it is still difficult.

When you have the time, research BVA Decisions for 14,15 & 16. Use "Sleep Apnea Secondary to Depression," as you key search term. I doubt you'll see any Direct Nexus Awards to Depression, but you never know.

Semper Fi

[Alex Googe]

Thanks every one I'm service connected for depression but jus got awarded 100% for PTSD, I'm also service connected for left ankle @ 30%, service connected for scars @ 30% and service connected for left foot @ 10%

Edited January 17, 2017 by Alex Googe
add service connection for depression @ 50%

[Alex Googe]

Thanks again everyone for your feed back I'm service connected for depression @ 50% but I just awarded service connection for PTSD @ 100% so this will wipe out the service connection for Depression, service connected for left ankle @ 30%, service connected for scars @ 30% and service connected for left foot @ 10%

[Buck52]

if your S.C. 100% For PTSD   They may service connect your S.A. with a good Nexus Letter from a qualified sleep specialist  but as for as getting a compensation rating I doubt you will being 100% PTSD.

Now if you get a 100% rating for sleep Apnea  that will open up some doors for sure with SMC SPECIAL MONTHLY COMPENSATION....if you do get a 100% rating for S.A. they should boost your compensation pay up to what the criteria is for that rating its mandatory they do that.  so watch it.

just going by your C&P exam I doubt you will get a 100% rating for S.A.

But hey that's just my unprofessional opinion....anything is possible