Been Dx for OSA

[chilo209]

Good Gents,

 

  After a longtime of wonder why i always was so tired during military service and then getting out. I come to find out I have OSA and have to use a CPAP machine. Never thought of it in service of an issue due to who get 8 hrs of sleep in service.Only time was on exit exam where i reported issue of cough blood when waking up, headache in the morning, itchy throat at night with cough, sensitive to light. Exit exam put me down for vascular head aches. During my initial visit to the VA when i got out, they me down with Unspecified sleep disturbance and insomnia. Also let the VA now of the sleep issue and problems in the morning. This has been going on for a while now until i was refer by Menlo Park - MTRP to conduct a Sleep test.

I had to do a sleep at a clinic due to initial test with a machine they send me home came back inconclusive. The sleep test at a the clinic came back with 60+ incident of apnea in an hour with low oxygen of 80%. The Sleep Dr would not do the VA questionnaire because he wants the VA to do that. He just gave me

all the document in regards to my study. Should i collect buddy letter and try to SC to in service or do i go the route of secondary to PTSD. I now i can do some more work on working out and lower weight which would be helpful, but this has been an issue even when i was down in weight. Thank you all.

[broncovet]

Sleep apnea is difficult to service connect.  

First, its unclear whether or not you were prescribed a CPAP or not.  If you are, then you can get up to 50 percent if you use a Cpap.  

As always, you need all 3 Caluza elements for service connection:

1.  Current diagnosis of sleep apnea.

2.  In service event or aggravation. Your post which stated you had an "unspecified sleep disturbance and insomnia" may provide some documentation, but, as you said, buddy letters may help.  Did you have an incident in service that you allege led to your apnea?  For example were you hit in the face and your nose broken?  

3.  Nexus or medical link between your diagnosis and the event or aggravation in service.  

    As always, check your service cfile and see if you have all 3, dont leave home without your caluza elements and your American Express card.  (lol).  

[chilo209]

I was just prescribed a CPAP machine this year after various trouble and complain to VA about lack of sleep or being tired after long hour of sleep, drowsy when driving in the morning with head aches. One big thing that VA uses against me is upon return from combat deployment, started hitting the bottle

hard and was involved in a vehicle accident on base, which led to TBI and being in ICU for couple days. The other only probably head injury are from being airborne but who goes to sick call when you hit the ground hard, lol.

for 3 caluza:

1. diagnosed with sleep apnea and have been prescribed a CPAP machine thru the VA

2. Only thing i have for this for in service is on exit exam with complain of head ache in the morning with, itchy throat when sleeping/coughing, and buddy letter from deployment about my sleep. Also comaplain to VA about this in the first year that i was out of service.

3. The nexus or link is the part that will be hard as to how to go about it. I have the paper work for diagnoses but how to tie them is the hardest part without them just denying it.

[broncovet]

Yes, the nexus is often the most difficult.  The worst part is when Vets put in their claim WITHOUT a nexus, and their VSO neglects to tell them they needed a Nexus.  A Honda  is just not the same.  (I cant be serious all the time).  

Here is how you get a nexus statement.

1.  Ask your doctor if he or she thinks this is related to your "sleep disorder" diagnosed in service.  If he/she says yes, then ask them to please document same in your file.  

2.  If your doc says, "no", then dont ask them to document that, you dont need any more negative evidence.  Instead, you have 3 possible choices:

    a) Do nothing and you will get denied, and appeals wont help until/unless you get a nexus.  

    b) Ask ANOTHER VA doc the same question, (number 1, above).  

    c)  Get an IMO/IME from a private doc who YOU pay for not the VA.  

Edited October 26, 2017 by broncovet

[chilo209]

Now as for asking a Dr. should i go first with my VA PMC Dr or go with my ENT Dr, that recommended me to get this

1. Now if i need to go thru a IMO/IME, which type of Dr would those be. Would that be something i would go thru that is paid my my employers insurance type of Dr. ?

[Gastone]

What's your PTSD SC Rating and Effective Date? Are you positive that there are SMRs discussing treatment or complaints of sleep issues while on active duty? Do you have the Clinician Treatment Notes for your Sleep Issues, addressed in the 1st year after Discharge?

Direct SC or Secondary to PTSD? Why not address both in a 21-4138?

VMC Sleep Specialists are very reluctant to give a conclusive supportive DBQ or Clinician Note as to a PTSD Nexus. Then again you might Luck Out. Based on my personal experience, you would be wise to see a Private MD, Board Certified Neurologist Sleep Specialist. No DBQ necessary, strictly his initial exam consult Treatment Notes could seal the deal.

You indicate your Sleep Study had your P02's dropping to low 80's. In addition to the CPAP RX, are you also on supplemental 02? If not, you should address this immediately with your VA SA Clinician and/or a Private Sleep Dr. A very dangerous situation. Periodic overnight P02 readings should be scheduled.

 

[chilo209]

What's your PTSD SC Rating and Effective Date? Are you positive that there are SMRs discussing treatment or complaints of sleep issues while on active duty? Do you have the Clinician Treatment Notes for your Sleep Issues, addressed in the 1st year after Discharge?

PTSD is @ 70% with an effective date of 10/2015, thats when it was increase with a cue due to initial assessment was only granted 30% which was with effective date of march-2013 same month i was separated from active duty. The PTSD was a long battle with VA due to initial claim was denied. As for notes for  complaint for sleep issue were at exit exam on 2807-1, while in service (that is as much of info from in service) and also I have treatment notes from my initial assessment that the Dr. recommends for sleep study due to suspicion of OSA and probability of headaches coming from OSA.

Direct SC or Secondary to PTSD? Why not address both in a 21-4138? How to go about this. I have asked VSO about

and which way to go about it. VSO wants nexus. They want me to go over this with VA Dr. and the notes from the Sleep clinic to see if i can get the nexus that way. But not sure which route to push this a single SC or to secondary this to PTSD.

VMC Sleep Specialists are very reluctant to give a conclusive supportive DBQ or Clinician Note as to a PTSD Nexus. Then again you might Luck Out. Based on my personal experience, you would be wise to see a Private MD, Board Certified Neurologist Sleep Specialist. No DBQ necessary, strictly his initial exam consult Treatment Notes could seal the deal.

Could i use the assessment from the sleep study that  i had for this and/or will i still need a nexus letter to file for it

You indicate your Sleep Study had your P02's dropping to low 80's. In addition to the CPAP RX, are you also on supplemental 02? If not, you should address this immediately with your VA SA Clinician and/or a Private Sleep Dr. A very dangerous situation. Periodic overnight P02 readings should be scheduled.

on the Polysomnohraphic split night report with CPAP goes as:

first hour of sleep 137.5 minutes of test without CPAP was report with AHl 70.7 and 7.3 minutes of oxygen below 88% with the lowest at 80%

assessment:  OSA(G47.33 )    ,  Sleep related Hypoxemia (G47.34) , hypersomnia 780.54, nightmares, snoring and overweight

Edited October 30, 2017 by chilo209