Sleep apnea- does the DBQ cover the "medically necessary/required" language?

[chibears3531]

Hey everybody! Long time lurker, first time poster.

My question is regarding the sleep apnea language that specifies that a prescription of a breathing assistance device is "medically necessary" for a 50% rating:

Assuming that a vet is already prescribed a CPAP/APAP by the VA, does the sleep apnea DBQ portion under 2B "IS CONTINUOUS MEDICATION REQUIRED FOR CONTROL OF A SLEEP DISORDER CONDITION?" fulfill that language requirement?

Edited December 6, 2018 by chibears3531

[Tbird]

The ratings are subject to the law 38 CFR 4.98 layouts the ratings for sleep apnea see image below

[Gastone]

"C," if you have a possible SA Claim possible, don't be a Lurker, your Start New SA Claim have been started. You have the 12 months to complete for the SA SC 50% after you find a non-VA SA Neurologist that present you any  of your SA attached to whatever caused by CAD or RX'd while you were on active doing,

Which of the about 12 medical problems that you expect to have that can be caused for the SA need of CPAP or BIPAP?

The 6847 SA is relativist reading and understanding the 0%, 30% and 50% Ratings if you passed. However, reading the 100% SC needs a bit of work. I went at 1 VMC  C & P SA DR Denie me while we talked, and (3) VA Raters also Denied my 100% Claim in 07/2016. An SR Rater agreed on me with my claim as I addressed the Legal Status.  Awarded me with the 100% 11/2016 Retro about 8 mos before and also added the SMC S due to the 60% of other SC %.

[broncovet]

Sleep Apnea is one of the most difficult conditions to get SC, so make sure you have all your ducks in a row.  

DO NOT count on the answers in the DBQ to satisfy VA's new recent requirment:  "That the CPAP is medically necessary".  

This is just another VA "con game" to deny Vets.  Think about it:  A CPAP is by prescription only.  Do you hear the doc say, "Naw, this machine isnt medically necessary, I prescribed it because I get a kickback on each machine sold."  

It should be "presumed" that, in the doc's opinion, the device is medically necessary, or else he would not have prescribed it!!!!

When you take meds for diabetes, does the doc prescribe this because its necessary, or because the doc "likes writing prescriptions"??  

Make no mistake, tho.  This new requirement will be strictly enforced.  Unless the doc specifically says this cpap is "medically necessary", expect to get denied.  

The DBQ is unlikely to help you.  The DBQ is designed by VA, not Veterans, and its designed to "gloss over" critical, pertinent information the Vet needs to get SC.  You are unlikely to find a "check box" that this is "at least as likely as not" related to service.  The VA does not want to EVEN suggest to the doc this may be related to service.  Instead, the doc will have to probably write a seperate nexus letter.  The VA does not want to make it easy to get SC.  Alex has pointed out that VSO's sometimes persue an appeal for years not even bothering to notice there is no nexus. Many VSO's think a Nexus is a small car made by Lexus.  They think "Caluza" is element number 13 on the periodic chart, in between Hydrogen and laughing gas.  

You need to be proactive and make sure everything requred for SC is documented in your claim.  Dont depend on a VSO, dont depend on a DBQ, do depend on you reading your file with your own eyes confirming you have all caluza elements, as well as the "medically necessary" documented for OSA.  

[doc25]

7 hours ago, chibears3531 said:

I'm awaiting an IMO by a sleep specialist stating that my service connected TBI "at least as likely as not " caused my SA that the VA prescribed an APAP for.

 

I have an appointment in January with the VA doc that prescribed my APAP.  I'm not sure how to go about asking him for a letter or statement of medical necessity. My plan is to bring him the sleep study to refresh his memory and a bunch of peer reviewed journal articles showing that breathing devices improve PTSD symptomology (which I'm rated for) to make the case that my device is "medically necessary."

 

That's unfortunate, I thought I could kill two birds with one stone. The same doc who's writing the IMO is filling out the DBQ.

Which service-connected disability are you going to use to secondary-service connect your OSA? TBI or PTSD?

You can use TBI or PTSD, but you can't use both; if I'm not mistaken.

Either way, you already meet 2 out of 3 requirements to secondary connect OSA.

1. Must have a service-connected disability

2. Must have a current diagnosis of disability claimed.

3. You're just missing the nexus of opinion. Which it sounds like you'll be able to obtain from the sleep specialist first for the OSA, as secondary to TBI.

If you want to get an, IMO from the VA doc you'll need this article that was done by a VA doctor (see attached files), to give your request some teeth, along with the peer review journals you have to claim OSA, as secondary to PTSD; if you want to go that route. 

Best wishes on your claim.

PTSD and Sleep Apnea article.pdf

[chibears3531]

8 hours ago, Gastone said:

Which of the about 12 medical problems that you expect to have that can be caused for the SA need of CPAP or BIPAP?

I'm awaiting an IMO by a sleep specialist stating that my service connected TBI "at least as likely as not " caused my SA that the VA prescribed an APAP for.

 

6 hours ago, broncovet said:

Sleep Apnea is one of the most difficult conditions to get SC, so make sure you have all your ducks in a row.  

DO NOT count on the answers in the DBQ to satisfy VA's new recent requirment:  "That the CPAP is medically necessary".  

This is just another VA "con game" to deny Vets.  Think about it:  A CPAP is by prescription only.  Do you hear the doc say, "Naw, this machine isnt medically necessary, I prescribed it because I get a kickback on each machine sold."  

It should be "presumed" that, in the doc's opinion, the device is medically necessary, or else he would not have prescribed it!!!!

When you take meds for diabetes, does the doc prescribe this because its necessary, or because the doc "likes writing prescriptions"??  

Make no mistake, tho.  This new requirement will be strictly enforced.  Unless the doc specifically says this cpap is "medically necessary", expect to get denied.  

I have an appointment in January with the VA doc that prescribed my APAP.  I'm not sure how to go about asking him for a letter or statement of medical necessity. My plan is to bring him the sleep study to refresh his memory and a bunch of peer reviewed journal articles showing that breathing devices improve PTSD symptomology (which I'm rated for) to make the case that my device is "medically necessary."

 

6 hours ago, broncovet said:

The DBQ is unlikely to help you.  The DBQ is designed by VA, not Veterans, and its designed to "gloss over" critical, pertinent information the Vet needs to get SC.  You are unlikely to find a "check box" that this is "at least as likely as not" related to service.  The VA does not want to EVEN suggest to the doc this may be related to service.  Instead, the doc will have to probably write a seperate nexus letter.  The VA does not want to make it easy to get SC.  Alex has pointed out that VSO's sometimes persue an appeal for years not even bothering to notice there is no nexus. Many VSO's think a Nexus is a small car made by Lexus.  They think "Caluza" is element number 13 on the periodic chart, in between Hydrogen and laughing gas.  

That's unfortunate, I thought I could kill two birds with one stone. The same doc who's writing the IMO is filling out the DBQ.

[doc25]

17 hours ago, chibears3531 said:

Hey everybody! Long time lurker, first time poster.

My question is regarding the sleep apnea language that specifies that a prescription of a breathing assistance device is "medically necessary" for a 50% rating:

Assuming that a vet is already prescribed a CPAP/APAP by the VA, does the sleep apnea DBQ portion under 2B "IS CONTINUOUS MEDICATION REQUIRED FOR CONTROL OF A SLEEP DISORDER CONDITION?" fulfill that language requirement?

Ok. There's a few questions I have for you.

1. Were you or the veteran diagnosed, in-service with OSA? If so, was a CPAP issued ? Was OSA claimed as a direct-service connection claim?

2. Were you or the veteran diagnosed, after-service with OSA? If so, is there currently a service-connected mental health condition, heart, neurological(brain), or respiratory condition and were issued a CPAP? Was OSA, claimed as secondary to any of those conditions?

But, to answer your question. No, it does not fullfill the language requirement. I didn't have medication to control a sleep disorder, but I required the CPAP to sleep well and keep breathing during sleep, otherwise I'd stop breathing in my sleep. The ratings schedule is specific. To rate OSA at 50% the only requirement is a breathing assistance device such as a CPAP.

 

I think this is a good opportunity to inform you that  if a veteran was diagnosed with OSA after 1-year of discharge and service medical records are absent of complaints for breathing issues during sleep such as: very loud snoring, cessation of breathing during sleep, gasping to breathe. (Obesity does not always cause OSA, there's plenty of veterans and in the general population that are not obese that have  OSA). Also, absent of an in-service sleep study and was never diagnosed with OSA in-service; will make it very difficult to direct-service connect.

Secondary-Service connection is the probably the best route to take to service-connect OSA for an after-service diagnosis. As I previously mentioned, an SC mental-health condition, heart, neurological(brain), or respiratory conditions are known by the medical community to be co-morbid; meaning the simultaneous presence of two chronic diseases or conditions in a patient.

I know this was alot of information, but I do hope it helps you out.