Questions about upcoming sleep apnea C&P exam.

[Nobby]

Greetings,

Background: I retired from AD in 2007 without a sleep apnea (SA) diagnosis.  However, my AD medical records DO include sleep complaints that were never investigated and several instances of "failure to go", with each instance involving a "no-show" attributed to sleep issues.  I'm also SC for Asthma, Allergic Rhinitis and Hypertension.   After a 2017 sleep study, I was diagnosed with mild complex SA and issued a CPAP device.  I have sworn lay statements from a barracks roommate and my wife of 25 years.  Lastly, in June 2018, I obtained an IME in which the doctor stated:  "It is my medical opinion, it is more likely than not, that the patient's sleep apnea is service connected because of the occurence of symptoms when he was serving on active duty.  The nasal obstruction from allergic rhinitis caused him to snore and the tissue laxity and decreased muscle tone with REM sleep caused airway collapse and desaturation.   Arousal with restoration of the airway resulted in sleep fragmentation leading to hypersomnolence.  The long term implications are hypertension, weight gain, and sexual dysfunction". 

Current situation: I'm scheduled for a SA C&P with VES next week.  I'm reviewing the DBQ and want to ensure I answer the following questions correctly.

1C.  If there are there additional diagnoses that pertain to a diagnosis of sleep apnea, list them.  For this question, should I list SC Asthma and Allergic Rhinitis?  If not, what kind of info are they looking for?

2A. Describe the history.  My answer for this question is 1986 - Sleep-related work issues, 1993 - Sleep complaint during physical exam, 2017 - Diagnosed with complex SA.  Is this what they're looking for? 

4B. Does the veteran have any pertinent physical findings, complications, conditions, signs and or symptoms related to any conditions listed in the diagnosis section?  My response to this question is SC Hypertension, SC Asthma, SC Allergic Rhinitis and weight gain. Is that what they're looking for on this question? 

Let me know your thoughts and recommendations regarding responses or my situation in general.  

Cheers,

Nobby

 

 

Edited October 8, 2018 by Nobby

[doc25]

4 hours ago, Nobby said:

Greetings,

Background: I retired from AD in 2007 without a sleep apnea (SA) diagnosis.  However, my AD medical records DO include sleep complaints that were never investigated and several instances of "failure to go", with each instance involving a "no-show" attributed to sleep issues.  I'm also SC for Asthma, Allergic Rhinitis and Hypertension.   After a 2017 sleep study, I was diagnosed with mild complex SA and issued a CPAP device.  I have sworn lay statements from a barracks roommate and my wife of 25 years.  Lastly, in June 2018, I obtained an IME in which the doctor stated:  "It is my medical opinion, it is more likely than not, that the patient's sleep apnea is service connected because of the occurence of symptoms when he was serving on active duty.  The nasal obstruction from allergic rhinitis caused him to snore and the tissue laxity and decreased muscle tone with REM sleep caused airway collapse and desaturation.   Arousal with restoration of the airway resulted in sleep fragmentation leading to hypersomnolence.  The long term implications are hypertension, weight gain, and sexual dysfunction". 

Current situation: I'm scheduled for a SA C&P with VES next week.  I'm reviewing the DBQ and want to ensure I answer the following questions correctly.

1C.  If there are there additional diagnoses that pertain to a diagnosis of sleep apnea, list them.  For this question, should I list SC Asthma and Allergic Rhinitis?  If not, what kind of info are they looking for?

2A. Describe the history.  My answer for this question is 1986 - Sleep-related work issues, 1993 - Sleep complaint during physical exam, 2017 - Diagnosed with complex SA.  Is this what they're looking for? 

4B. Does the veteran have any pertinent physical findings, complications, conditions, signs and or symptoms related to any conditions listed in the diagnosis section?  My response to this question is SC Hypertension, SC Asthma, SC Allergic Rhinitis and weight gain. Is that what they're looking for on this question? 

Let me know your thoughts and recommendations regarding responses or my situation in general.  

Cheers,

Nobby

 

 

Complaints in service are not enough medical evidence to grant direct service connection.

Although complaints are evidence that there was an event/injury in service related to sleep problems.

According the information you provided it appears you have met all 3 Caluza factors:

1. Injury/event incurred in-service.

2. Current Diagnosis

3. Nexus of opinion.

 In addition, you have a CPAP machine issued.

Tentatively, you should be good to go for 50% granted Sleep Apnea. You never know how the Ratings Schedulers will interperet all pertianing information. Best wishes on your claim.

[Nobby]

Doc25,

Thanks for the info but I was looking for feedback on the three questions I asked in my original post.  Any thoughts?

Nobby

 

[Buck52]

15 hours ago, Nobby said:

Greetings,

Background: I retired from AD in 2007 without a sleep apnea (SA) diagnosis.  However, my AD medical records DO include sleep complaints that were never investigated and several instances of "failure to go", with each instance involving a "no-show" attributed to sleep issues.  I'm also SC for Asthma, Allergic Rhinitis and Hypertension.   After a 2017 sleep study, I was diagnosed with mild complex SA and issued a CPAP device.  I have sworn lay statements from a barracks roommate and my wife of 25 years.  Lastly, in June 2018, I obtained an IME in which the doctor stated:  "It is my medical opinion, it is more likely than not, that the patient's sleep apnea is service connected because of the occurence of symptoms when he was serving on active duty.  The nasal obstruction from allergic rhinitis caused him to snore and the tissue laxity and decreased muscle tone with REM sleep caused airway collapse and desaturation.   Arousal with restoration of the airway resulted in sleep fragmentation leading to hypersomnolence.  The long term implications are hypertension, weight gain, and sexual dysfunction". 

Current situation: I'm scheduled for a SA C&P with VES next week.  I'm reviewing the DBQ and want to ensure I answer the following questions correctly.

1C.  If there are there additional diagnoses that pertain to a diagnosis of sleep apnea, list them.  For this question, should I list SC Asthma and Allergic Rhinitis?  If not, what kind of info are they looking for?

2A. Describe the history.  My answer for this question is 1986 - Sleep-related work issues, 1993 - Sleep complaint during physical exam, 2017 - Diagnosed with complex SA.  Is this what they're looking for? 

4B. Does the veteran have any pertinent physical findings, complications, conditions, signs and or symptoms related to any conditions listed in the diagnosis section?  My response to this question is SC Hypertension, SC Asthma, SC Allergic Rhinitis and weight gain. Is that what they're looking for on this question? 

Let me know your thoughts and recommendations regarding responses or my situation in general.  

Cheers,

Nobby

 

 

You will need a qualified Dr to give his/her opinion on all the above.  

The  VA will not take OUR word for anything. even if we know what were talking about  unless your a Dr yourself.

so its best to take this form  (DBQ)your filling out to a Qualified Dr   

The Dr will need to read your records and examine you  then state his/her pro-opinion on these questions.

VA will not use what we say or write down ....> its only speculative.  

Edited October 9, 2018 by Buck52

[Nobby]

2 hours ago, Buck52 said:

You will need a qualified Dr to give his/her opinion on all the above.  

The  VA will not take OUR word for anything. even if we know what were talking about  unless your a Dr yourself.

so its best to take this form  (DBQ)your filling out to a Qualified Dr   

The Dr will need to read your records and examine you  then state his/her pro-opinion on these questions.

VA will not use what we say or write down ....> its only speculative.  

Thank you...totally understood.  However, since I've already had a sleep study & diagnosis, I expect the C&P to be more of an "interview" than a physical exam.  If the doctor asks questions from the DBQ, I just want to ensure my responses appropriately answer the questions.

[Buck52]

Yes the C&P EXAMINER is a medical professional and reads on the computer what your Dr has gave his opinion to and the C&P Examiner will ask you some questions to see if they are per taint to whats on the computer and what your Dr mention...the examiner is just a go between to read the records on file and to make sure your conditions your claiming are correct...and give his report back to the VA. R.O.

  Unfortunately some examiners don't read all the information  and this usually causes a denial,  so its best to speak up during your C&P Exam if you feel its going south

If you feel the examiner has not mention anything relevant to help substantiate your claim,  speak up and ask this examiner...Sir or Dr, Did you read what Dr smith mention about my Sleep Apnea  or whatever condition is in question  make sure you tell the examiner this Dr is Qualified to render his professional opinion& State his credentials are on record.

Its always good to make sure your C&P Examiner has the correct medical credentials also.  just ask.   you don't want a Heart Dr to give his opinion about your bad feet  ect,,ect,,,

[GeekySquid]

25 minutes ago, Nobby said:

However, since I've already had a sleep study & diagnosis,

@Nobby

I am assuming you have a copy of the Sleep Exam results and diagnosis. Does it have an Epsworth scale rating in it? I can't say how the C&P examiner will react to being "told" things, but gently pointing out /directing them to information in the file is helpful. My Epsworth is 22/24 which basically says I am tired all the time and fall asleep standing up. (not quite but you get it).

The one question I have is does your diagnosis explicitly state that your "cpap/bipap" is a medical necessity or issue? There was a recent change to the SA rating requirements that necessitate that type of wording.

The law firm Perkins and Stoddard shows this change at this link

https://veterans.perkinslawtalk.com/post/bad-secret-change-to-va-sleep-apnea/

this is the important line from the M21 adjudication manual

“When determining whether the 50-percent criteria are met, the key consideration is whether use of a qualifying breathing assistance device is required by the severity of the sleep apnea.”

Good luck, just be honest and complete. If your Caluza Triangle is solid you should get your rating.