Obstructive Sleep Apnea: Mild to Severe in 10 Years

[JoeCab]

Hello group -

I had a sleep study in 2007 while on active duty and got diagnosed with "mild obstructive sleep apnea." There was no treatment provided/necessary. 

I retired from the Navy in 2017 after 25 years of active duty and submitted the sleep study in my claim. Unfortunately, I did not have documented proof of hypersomnolence. In May 2018 I had another sleep study with the result being "severe obstructive sleep apnea," and was prescribed a CPAP which I use currently. This particular evidence was not submitted in my claim package.

I just received my VA decision letter on 10/4/18, the VA assigned a disability rating of 0% for the apnea (as expected), but listed it as "service connected."

My question is this: I have the medical evidence now to prove I have severe apnea and I'm getting ready to submit a NOD. Do I have to also prove "service connectivity?" or has this been sufficiently established and cannot be taken away by the DRO?

Also, do I have to provide evidence that I had hypersomnolence from 2007 to 2018 to prove it's all connected? This will be the tough part for me.

It seems pretty straight forward, but I know nothing is ever a slam dunk in this arena so what am I potentially missing?

Thanks!

Joe

[Buck52]

I agree with broncovet

to answer your question   this is your Service connection date (2007)

''I had a sleep study in 2007 while on active duty and got diagnosed with "mild obstructive sleep apnea."

(use this 2007 letter for evidence)

If you were S.C. for sleep apnea  but at 0% ....> use your new  May 2018 letter from that Dr that stated you have Chronic Severe Sleep Apnea'' Hopefully the Dr mention some thing like this or close to it below (if not check with this Dr ask him to mention this  you need it in writing (documented) use the word chronic severe

''it is Medically Necessary Requirement you use the C-PAP ''(They may try to use this May 2018 date?)

''In May 2018 I had another sleep study with the result being "severe obstructive sleep apnea," and was prescribed a C-PAP which I use currently.''

or you can try to get the EED Back to  2007 your first diagnose while in the military  when it first occurred (adjustments will need to be made but let them figure that all out  from mild OSA 2007 to the severe OSA in 2018 (Point this out in your NOD

Just my opinion here

'You have been diagnosed with ''Severe Obstructive Sleep Apnea.''

that should be a 100% Rating

As for as getting the 2007 date even if it was at 0%  that 2007 date established  your Service connection  for the Mild Sleep Apnea...it just got worse over the years and its now been increase to the ''Severe Sleep Apnea''.

HOW DOES VA RATE SLEEP APNEA?

''Sleep apnea is rated by the VA under 38 C.F.R. § 4.97, Code 6847 as Sleep Apnea Syndromes (Obstructive, Central, Mixed). Veterans are assigned 0%, 30%, 50% and 100% ratings for sleep apnea, depending on the severity of their condition. Below are the criteria listed in VA’s rating schedule for sleep apnea:

100%: “Chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy, or cor pulmonale.” Cor pulmonale is the enlargement or failure of the right side of the heart due to lung disease.''

50%: ''If a veteran “requires use of a breathing assistance device, such as a continuous airway pressure (CPAP) machine.”

30%: ''''The veteran is experiencing “persistent daytime hypersomnolence.” Hypersomnolence is a condition similar to insomnia, characterized by chronic daytime sleepiness that does not improve even with sufficient sleep.''

0%:'' If the veteran’s condition is Asymptomatic but has “documented sleep disorder breathing.” An asymptomatic condition is one that is diagnosed, but may not be producing symptoms.''

''Keep in mind that sleep apnea can be a secondary service-connected disability, or can cause a secondary service-connected disability. For example, a veteran who developed Parkinson’s Disease (PD) after being exposed to Agent Orange may develop sleep apnea as a result of their Parkinson’s. This means VA can rate you for PD, as well as for sleep apnea.''

Source: CCK

 

 

 

 

 

 

Edited October 16, 2018 by Buck52

[broncovet]

Yes.  Once SC for sleep apnea, if you have been prescribed a CPAP, use the CPAP, and if your doctor submits a statement that you have sleep apnea, and a cpap has been prescribed for you out of medical necessity, then you should get 50 perce.  

File a NOD to preserve your effective date. 

[broncovet]

Alex explains the BVA focuses on one question, when deciding many Veterans claims:

Quote

1.  Did the Veteran meet the Caluza critieria of diagnosis, in service event, and nexus?  If he did, it should be service connected.  

You apparently met that criteria and they SC'd you..  Further, the rating critieria is if service connected for OSA and using a cpap, the rating is 50 percent.  The VA did not follow its own critiera and, upon appeal, this should be overturned.  

CAUTION:  New rules of sleep apnea state the doctor MUST state that the CPAP is "medically necessary" to get the 50 percent.  

     As silly as this is, it gives the Va an opportunity to deny more Vets.  You see, is the doctor going to prescribe for you stuff that is unnecessary?  I can see it now:

     Doctor:   "Im prescribing this for you even tho you dont need it, because I get a kickback on every prescription I write."  

     The presumption here is if the doc writes the prescription (for a CPAP), then its necessary for the health and wellness of the Veteran, that is, the VA has hired doctors who act in the interest of their patitents and not exclusively in their own interests.  

      Still, you may have to ask your doctor to state the obvious: 

Quote

YOur cpap is medically necessary.  

Its just ridicilous that the VA is presuming here that the doc wrote your cpap prescription for reasons other than your medical necessity, but, it gives them an "opportunity to deny".  Get your doc to state its medicallly necessary.  

[doc25]

File out your NOD but this time substantiate your claim with these two recommendations below.

Although, you have a Dr. saying it is medically necessary to use a CPAP, it's not VA language. (I know, I know...it's ridiculous.)

Get your Dr. to  fill out the Sleep Apnea Disability Benefits Questionnaire https://www.vba.va.gov/pubs/forms/VBA-21-0960L-2-ARE.pdf  and write a more detailed Nexus of opinion along the lines likes this.

To whom it may concern:

"My name is Dr. so and so. I am board certified in my specialty. I have been practicing for so many number of years. I have been treating this patient (your name) for x-amount of months/years. I have reviewed this veteran's service-medical records and it is in my opinion that it is "at least as likely as not (equal to or greater than 50% probability) the veteran's sleep apnea was incurred in-service and has worsened requiring a medically-necessary CPAP machine.

RATIONALE:

According to sleepapnea.org, 

The Greek word “apnea” literally means “without breath.” Sleep apnea is an involuntary cessation of breathing that occurs while the patient is asleep. There are three types of sleep apnea: obstructive, central, and mixed. Of the three, obstructive sleep apnea, often called OSA for short, is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. In most cases the sleeper is unaware of these breath stoppages because they don’t trigger a full awakening.

Left untreated, sleep apnea can have serious and life-shortening consequences: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments.

Sleep apnea is seen more frequently among men than among women, particularly African-American and Hispanic men. A major symptom is extremely loud snoring, sometimes so loud that bed partners find it intolerable. Other indications that sleep apnea may be present are obesity, persistent daytime sleepiness, bouts of awakening out of breath during the night, and frequently waking in the morning with a dry mouth or a headache. But none of these symptoms is always present. Only a sleep study in a sleep laboratory or a home sleep study can show definitively that sleep apnea is present and how severe it is.

Obstructive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea,  the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed sleep apnea, as the name implies, is a combination of the two. With each apnea event, the brain rouses the sleeper, usually only partially, to signal breathing to resume. As a result, the patient’s sleep is extremely fragmented and of poor quality.

Sleep apnea is very common, as common as type 2 diabetes. It affects more than 18 million Americans, according to the National Sleep Foundation. Risk factors include being male, overweight, and over the age of 40, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and health care professionals, the vast majority of sleep apnea patients remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.

Best wishes on your claim.

 

 

Edited October 17, 2018 by doc25

[Buck52]

I have Mild Diagnose for Sleep apnea And the Dr mention I needed  the use C-PAP  medically for my well being.&prescribe me one...The VA even called some of us up for a C-PAP Class to learn how to use it and clean& care for it.

I use it every night... ..but I am not filing a claim for it...I never had an OSA Problem while in the military  even though I did snore at times from exhaustion from what my fellow soldiers mention to me.

And  now I could file a secondary OSA Claim from the PTSD Meds I have to take...but I am through fighting the VA  I AM 100% with 2 SMC' and that's enough.

why take up another needed veterans time.

[doc25]

On 10/16/2018 at 8:47 AM, Buck52 said:

I have Mild Diagnose for Sleep apnea And the Dr mention I needed  the use C-PAP  medically for my well being.&prescribe me one...The VA even called some of us up for a C-PAP Class to learn how to use it and clean& care for it.

I use it every night... ..but I am not filing a claim for it...I never had an OSA Problem while in the military  even though I did snore at times from exhaustion from what my fellow soldiers mention to me.

And  now I could file a secondary OSA Claim from the PTSD Meds I have to take...but I am through fighting the VA  I AM 100% with 2 SMC' and that's enough.

why take up another needed veterans time.

It's completely your choice to pursue a claim or not. I was just passing on information. I apologize if I came across intrusively.