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

[doc25]

14 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.  

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.  

My secondary OSA to PTSD C&P exam was absent of "medically necessary". I'm not suggesting you are wrong, "medically necessary" does provide the nexus of opinion added weight. My sleep study did state in the impression that; Sleep Apnea improved with CPAP.

The DBQ, Nexus of opinion, and rationale met all the requirements for secondary-service connecting OSA.

[chibears3531]

27 minutes ago, doc25 said:

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

I'm claiming OSA as secondary to TBI.

Thank you for the journal article. If anyone is reading this or lurking like I was and is seeking more academic journal articles linking PTSD and OSA, the following are strong sources of evidence in my opinion:

http://jcsm.aasm.org/ViewAbstract.aspx?pid=29881

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201407-299FR

https://www.ncbi.nlm.nih.gov/pubmed/15253098

http://jcsm.aasm.org/viewabstract.aspx?pid=30015

https://journal.chestnet.org/article/S0012-3692(15)00129-4/fulltext

https://www.sciencedirect.com/science/article/pii/S0022399900001471

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443749/

https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201407-299FR

[chibears3531]

15 minutes ago, doc25 said:

My secondary OSA to PTSD C&P exam was absent of "medically necessary". I'm not suggesting you are wrong, "medically necessary" does provide the nexus of opinion added weight. My sleep study did state in the impression that; Sleep Apnea improved with CPAP.

The DBQ, Nexus of opinion, and rationale met all the requirements for secondary-service connecting OSA.

As of April 18, 2016, a 50% rating requires the "medically necessary/required" language. When were you awarded your connection?

[doc25]

22 hours ago, chibears3531 said:

As of April 18, 2016, a 50% rating requires the "medically necessary/required" language. When were you awarded your connection?

You're absolutely correct.Good to know. I was awarded October 23, 2017. I have a pulmonology appointment scheduled in a couple of months. I'll have my pulmonologist document that in my records.

I appreciate the feedback.

I'm also hearing the VBA has made changes to the  PTSD criteria, but I have yet to find any literature on any recent changes. 

Edited December 8, 2018 by doc25

[doc25]

22 hours ago, chibears3531 said:

I'm claiming OSA as secondary to TBI.

Thank you for the journal article. If anyone is reading this or lurking like I was and is seeking more academic journal articles linking PTSD and OSA, the following are strong sources of evidence in my opinion:

http://jcsm.aasm.org/ViewAbstract.aspx?pid=29881

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201407-299FR

https://www.ncbi.nlm.nih.gov/pubmed/15253098

http://jcsm.aasm.org/viewabstract.aspx?pid=30015

https://journal.chestnet.org/article/S0012-3692(15)00129-4/fulltext

https://www.sciencedirect.com/science/article/pii/S0022399900001471

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443749/

https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201407-299FR

Thanks for sharing your info. 

[doc25]

46 minutes ago, doc25 said:

You're absolutely correct.Good to know. I was awarded October 23, 2017. I have a pulmonology appointment scheduled in a couple of months. I'll have my pulmonologist document that in my records.

I appreciate the feedback.

I'm also hearing the VBA has made changes to the  PTSD criteria, but I have yet to find any literature on any recent changes. 

I have to correct myself. In a VA note dated 2-10-16, my pulmonologist documented:

SLEEP LAB REVIEW AND MANAGEMENT NOTE

Subjective: Sleep lab was available for review. Dr. jeffys supplied it.
I have reviewed this sleep study which was performed on 4/27/2009
It was performed at Zerenity Sleep Center, 
Necessity for a cpap was demonstrated. The study demonstrated that 
abnormal respiratory events were abolished by 8 cm h2O pressure.

Assessment: Sleep apnea severe enough to use CPAP