Thoughts about OSA Claim

[Cessnabc]

I am SC for Chronic Sinusitis, Allergic Rhinitis with Nasal Polyps Benign, Mild Obstructive Pulmonary Disease.

 

My ENT surgeon (Navy Capt, retired; (Septoplasty)) wrote in his operation report - preoperative diagnosis was (1.) Obstructive Sleep Apnea and (2.) Deviated Nasal Septum; Postoperative Diagnosis was the same. 

The original claim was denied and the VA stated that “service treatment records do not contain complaints, treatment, or diagnosis for this condition” (Sleep Disturbance (Sleep Apnea)) and that “there was no actual diagnosis of sleep apnea in service, only snoring was the outcome of the study”.  They did not find a link between my medical condition and military service.

I filed a NOD with the highlighting the following points.  (All of this information was submitted with the original claim)

I had a sleep study done in Sept 2007 which showed 2 Obstructive Apneas, two hypopneas, loud snoring, and a total AHI of 0.5 events per hour with 1.6 events per hour in REM.  Oxygen saturation nadir was 89%.  (Polysomnogram report states under history: "referred for he evaluation of SNORING, EDS.  The current Epworth Sleepiness Scale was 14."

According to the Journal of Clinical Sleep Medicine, (Vol. 5, Nos. 2009) "OSA is defined by occurrence of daytime sleepiness, loud snoring, witnessed breathing interruptions, or awakenings due to gasping or choking in the present of a least 5 obstructive respiratory events per hour of sleep. 

I had another sleep study done in 2014 that showed an apnea-hypopnea index of 19 events per hour with oxygen desaturation nadir of 83%.  CPAP was prescribed at that time for mild to moderate OSA.

 

 

I contacted my surgeon and he wrote a NEXUS letter that stated "it is my opinion that it is more likely than not that the veteran's current condition of OSA represents a progression of disease that occurred while he was on active military service". 

 

The VA denied it.  I appealed it to the Board of Veteran's Appeals.

 

After I filed the Form 9, I also received another NEXUS letter. (I had requested previously but did not receive it, so I filed without the second letter) My pulmonologist, who monitors my CPAP usage, stated "Sleep apnea tends to worsen with time and weight gain and his moderate OSA which was diagnosed in 2014 is more likely than not a progression of his symptoms that originated while he was on active military service". 

 

Thoughts?

[rhoe]

If that's all your surgeon's letter said, it's not legally sufficient, as it contains no medical rationale to support its opinion. I also have no idea what the "disease" he/she is referring to is based on the information you've provided.

Several things do not add up here - you said you had a sleep study in 2007 that indicated obstructive apnea, but then later you also said that your sleep apnea was diagnosed in 2014. Which is it, and when did you discharge? This is the important sticking point. 

 

[Cessnabc]

He is talking about the progression of Sleep Apnea.

Based on the results of the initial sleep study, there were not enough events to be diagnosed with OSA.  The official diagnosis did not come until 2014.  At that time, I was put on CPAP.

I discharged in 2008.

[john999]

If you have service connected DMII, CAD and neuropathy can there be any doubt that OSA is going to aggravate those conditions.   I would like to know if depression, anxiety ,  DMII, CAD and neuropathy could lead to OSA and hypertension.  DMII does lead to weight gain and weight gain leads to OSA, but getting a doctor to say that is hard.   It is as if OSA just popped out of the sky.  I was DX-ed with OSA and hypertension after my DMII DX.  I know there are interconnections between all these problems.  I want to file for OSA and HB but is there any basis or any doctor who can make such a case for them to be secondary to DMII?  Have disease, money and will travel of IMO.

 

 

                        John

[john999]

My basic question is what are conditions that cause OSA.  The OSA is having drastic effects on my service connected conditions and there is probably a feedback loop to the NSC conditions as well.  How can you untangle all these conditions and say one is SC and one is not SC?  All this on top of my chronic pain  that is service connected and I don't  know how I have lasted this long.  I am thinking for another avenue for connecting OSA to service is as a secondary condition to a accepted SC condition because way too much time has passed since I got out in 1971 and for me to find those lost records of sleep problems.  I don't mean to step on your post but there are more than one way to skin a cat.  My OSA was so bad at one time I was having 50 events an hour.  I was like the living dead.

 

 

 John

[Buck52]

Its good to have a C-PAP if you been diagnose for OSA/Sleep Apnea &  hopefully help you sleep better and possibly save your life.....>  OSA/Sleep Apnea is a Deadly Killer.

Just because you have a OSA/Sleep Apnea Diagnose and  a prescribe C-PAP Machine does not mean the VA Will give you S.C. & Rating.....but they will diagnose you for it and prescribe you a C-PAP.....They diagnose me for Mild to Severe S.A. and prescribe me a C-PAP...But I never filed a Claim for it...I never had it while in the military as for as I know?  but I am very Thankful  I got  the C-PAP Machine to use.

besides I have most of my in service injury's/disease  claimed  from (Vietnam)  with 2 SMC''s  awards  & have  for over 15 years now, well over the 100% rating. (but still considered at 100%) & the SMC's increases the 100% rate insubstantially. 

However getting OSA/Sleep Apnea  S.C. and a Rating  is hard to do if you never had it or had signs of it while in the military,(No Records or treatment) but its not impossible to get it S.C.

  Usually/Normally if the veteran has a service connected disease or injury that could be  secondary problem with OSA/or cause the OSA.Sleep Apnea......>he/she could file a secondary claim to that disease,  this will need Qualfied Dr : sleep specialist to state in his opinion that the medications Mr Veteran takes for his S.C. disease.(well say PTSD Medications) and'' name them ,it is '' 50% greater & it is at least likely as not '' the reason Mr Veteran has OSA/Sleep Apnea.

when you have a 50/50 shot  or chance  usually that will favor the Veteran ( in my opinion.) And from my experience in veterans having did this.

   He needs to examine you and read your medical records and treatment records before he gives his opinion and give HIS/HER specialty expertise Credentials

This will let the raters know why you have OSA & that  its likely as not caused from your S.C. PTDS Meds, they use a rating manual to see what your rating should be.

JMO

Edited February 4, 2017 by Buck52

[Buck52]

To find a Dr that will give you his.her opinion as to rather or not your S.C. disease you have now, you will need to get on the phone call around until you find a Dr that will help you  just be up front and honest with the Dr or Receptionst 

Let them know your filing a claim with the VA for OSA/Sleep Apnea and you need a rational statement/opinion from the Dr that  your DX of OSA is likey as not caused from your S.C. Disease that you been Service Connected for by the VA , take the Dr your medica records that pertaint to the disease/Medications you been S.C. For and simply ask him to examine you and read your medical records.

give his/her opinion....the cost is not that bad,but can get expensive use your own judgment on that,  you know your finances better than anyone else  but well worth it ,they simply check you and then later on talk into a machine and the Dr send it to a transcriber  and the DR will either send it to you in the mail or just email it or fax it to you.

Its hard to find a Qualified Dr (SPECIALIST) but they are Dr's out there willing to help us Veterans.