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Comp & Pen Sleep Apnea & Hypersomnia

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Alex Googe

Question

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 by Alex Googe
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On ‎1‎/‎17‎/‎2017 at 5:52 PM, Gastone said:

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

Here is an article... Not sure if it helps, but Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort.  Here is the link:  http://www.journalsleep.org/Articles/281111.pdf

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Hello all,  I am new to this site and I pretty much have the same story.  I retired in 2005 and rated 60%.  for Panic Attacks, back surgery, left shoulder surgery (collar) surgery and scars.  I was never questioned about sleep apnea.  hell to be honest I really didn't ever know what it was.  Until recently, my VA primary questioned me about my sleeping pattern, due to me complaining about being tired all the time.  I took a sleep study at the VA and diagnosed with sleep apnea and issued a CPAC.  Now my question:  I have already submitted my claim and already had my C & P exam on 28 Feb 2017 (I haven't seen the results).  I have no private doctor info I submitted my personal statement.  Is there anyway that the sleep apnea could be link to one of my current "service connected" disabilities?  I know I should of done my research prior to submitting my claim, but I went with what I had at the time.  Personally I expect to get denied, hence I click on the button on e-benefits for a decision (as I had no other evidence to submit).  I think that that if/when I get the denial that I may look into getting an attorney to assist, perhaps they would recommend that I go to a private doctor etc. etc.. Thoughts? 

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Tazz, that Sleep Journal article is from 2005 and refers to 2000 study of SA Vets using DSM IV as the guidelines. The referenced "Means" study showed a "reduction in Depressive Symptoms of SA Vets using Cpap." Other statements in the article like "Causality cannot be determined" hurt attempts to Nexus SA as Secondary to an earlier Depression DX. 

I'll have to look at DSM V, DSM IV determined that Depression was Secondary a General Medical Condition, OSA. Vets have recently been successful in getting SA Secondary to PTSD DX's, I just haven't seen any Secondary to straight Depression Awards or discussions.

Semper Fi

 

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Tazz, I looked at the DSM V and the DBQ's for Depression & SA, not good for an SA Secondary to Depression claim.

You should give the DSM Va read, see what you think. As to the current DBQ's, the Depression DBQ requests a discussion of "Any comorbid Sleep issues" whereas the SA DBQ doesn't mention anything regarding a Depression DX.

I think the Depression DX is currently viewed by the Medical Community as being either caused by SA or exacerbated by SA, not as a causative agent for the development of the comorbid SA DX.

Semper Fi

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On 3/17/2017 at 10:12 AM, Gastone said:

Tazz, I looked at the DSM V and the DBQ's for Depression & SA, not good for an SA Secondary to Depression claim.

You should give the DSM Va read, see what you think. As to the current DBQ's, the Depression DBQ requests a discussion of "Any comorbid Sleep issues" whereas the SA DBQ doesn't mention anything regarding a Depression DX.

I think the Depression DX is currently viewed by the Medical Community as being either caused by SA or exacerbated by SA, not as a causative agent for the development of the comorbid SA DX.

Semper Fi

I am 100% SC for MDD and Anxiety and have a 50% rating for SA as a secondary condition.  It was a long hard fight after several denials, and it took getting a C&P examiner that cares and knows the VA game.   The studies the C&P examiner referenced are:

Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008 - PubMed (nih.gov)

and

Depression as a Manifestation of Obstructive Sleep Apnea - PMC (nih.gov)

Hope this helps someone else.

Edited by Lavish
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