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]

10 hours ago, Cessnabc said:

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.

This makes much more sense, thank you - I would ask your surgeon to write you a slightly different statement, indicating whether the apneas shown on your in-service (2007) sleep study were "the first manifestation" of your later diagnosed sleep apnea. I understand that that's basically what he's already said, but "progression" implies an already diagnosed condition that became worse, whereas "first manifestation" indicates a first symptom of a later diagnosed condition.

He'll still need to provide some sort of medical rationale to explain this opinion, likely something along the lines of "the obstructive/hypoapneas shown on the 2007 study are consistent with early sleep apnea, which continues to the present day" or something similar. 

[john999]

If you complain to the VA that your meds are causing or making your OSA worse they will just tell you to stop taking those meds.  No doubt opiates and drugs like Clonazepam make it worse so if you take those drugs the VA will give you fits if you have DX of OSA.    This has already been a big problem for me with my various doctors fighting about which drugs I should or should not take.  I would say just from my own experience the fatter you get the worse your OSA will get.  Now if you are disabled and cannot get around much you  are liable to put on weight.  This will make your OSA worse.  If you have DMII you will probably put on weight.  Just having OSA causes weight gain which in turn makes the OSA worse.   So it is all a feedback loop ending in our extinction.   I remember going nuts because I could not sleep in Vietnam and that is in my records.  There were not sleep studies in 1970 as far as I know.  I have long history of sleep problems but only found out about OSA about 4 years ago long after I had been DX'ed with DMII and CAD due to AO exposure.   We all need to find doctors who will write reports that are acceptable to the VA and provide medical rationale to connect OSA and any other non-presumptive disease to our service.  My current pulmonologist will not do that since he believes it does not matter what caused it only what will fix it.  The C-Pap failed and Inspire has failed to a substantial degree.   I guess I need one of our "hired gun" doctors.   Hey,  the VA has an army of hired guns that are ready to deny your claims until you are rotting in the ground.   Anyone know of decent and vet friendly docs who will help a vet?

 

                      As far as the vet who actually had a sleep study done in the service I think there is a natural progression theory from your first in-service sleep study to current study that says OSA.  Once upon a time I had a small army of shrinks that I could call on for help with the VA.  They are mostly retired now since I am 67 and they were all older than me when I got P&T.  If OSA is going to kill me I want the VA to take responsibility in part.  I have certainly gained weight with age and with the peripheral neuropathy which is secondary to DMII (A0) because I just can't walk two blocks without pain and I cannot even do other exercise due to the neuropathies in my hands as well.   It seems obvious that the SC conditions are caused by or made worse by the few non-SC conditions I have.   98% of doctors neither understand or want to understand VA rules and regs.  in order to write up an IMO/IME.   They shrink from making a medical opinion because they believe their future credibility or liability will be called into question.   They want to keep their petticoats clean while raking in money for bogus treatments and pushing new expensive drugs from the companies that visit them and always buy lunch.

 

 

             John