Primary Physician for Sleep Apnea C&P

[JaeNobe]

Hello All, 

I recently submitted a claim for Sleep Apnea secondary to depressive disorder on Friday (1/25). Along with submitting the claim I submitted and IMO from a non-VA doctor.  Today Tuesday 1/29 got a call to schedule my C&P. (World Record to me) Was wondering if anyone else thought this was weird and they also said that my C&P exam was going to be conducted with a Primary Physician not a Sleep Specialist.  I also just thought about it. I didn't submit a DBQ with my initial claim. Could this be the reason? Just seemed off I'm not going to a specialist.

Edited January 29, 2019 by JaeNobe

[Wanderer]

5 hours ago, JaeNobe said:

Thank you so much... that gives me so much hope. I appreciate it!

The hope is incredible, isn't it? My whole life has been turned around through my disability awards.

[doc25]

5 hours ago, Wanderer said:

The hope is incredible, isn't it? My whole life has been turned around through my disability awards.

Indeed it is Wanderer.

In 2014, I was pretty much at the end of my rope. All I had been getting was 20% that didn't start until 2012. I was married with a baby and unemployed(eventually did find work.) I wasn't aware that I could get an increase to the 10% PTSD with MDD I had and I wasn't aware about secondary Sleep Apnea until 2015(initial claim for increase) and 2017(granted sleep apnea), respectively.

In 2016, I was awarded 70% PTSD with Depression, 10% Tinnitus, 0% Hearing loss, and 10% L Knee Patellofemoral Syndrome. My VSO asked me after my award if I had Sleep Apnea by any chance. I said,"Yes. Why?" She said that I could secondary connect Sleep Apnea to PTSD.

So, I submitted the secondary claim, which was DENIED twice. I had the first two parts for secondary connection of OSA:

#1. Must have a SC condition.

#2. Must have a current diagnosis for secondary condition claimed, plus a CPAP and it said "medically necessery" .

#3. NO NEXUS OF OPINION

I was able to re-open my OSA claim with a filled out DBQ from a pulmonologist. Got sent to a C&P exam at another VA and that's where I received the favorable nexus of opinion for secondary OSA.

[JaeNobe]

10 hours ago, doc25 said:

Indeed it is Wanderer.

In 2014, I was pretty much at the end of my rope. All I had been getting was 20% that didn't start until 2012. I was married with a baby and unemployed(eventually did find work.) I wasn't aware that I could get an increase to the 10% PTSD with MDD I had and I wasn't aware about secondary Sleep Apnea until 2015(initial claim for increase) and 2017(granted sleep apnea), respectively.

In 2016, I was awarded 70% PTSD with Depression, 10% Tinnitus, 0% Hearing loss, and 10% L Knee Patellofemoral Syndrome. My VSO asked me after my award if I had Sleep Apnea by any chance. I said,"Yes. Why?" She said that I could secondary connect Sleep Apnea to PTSD.

So, I submitted the secondary claim, which was DENIED twice. I had the first two parts for secondary connection of OSA:

#1. Must have a SC condition.

#2. Must have a current diagnosis for secondary condition claimed, plus a CPAP and it said "medically necessery" .

#3. NO NEXUS OF OPINION

I was able to re-open my OSA claim with a filled out DBQ from a pulmonologist. Got sent to a C&P exam at another VA and that's where I received the favorable nexus of opinion for secondary OSA.

One more question... my Sleep Apnea notes in the VA systems state "Necessity of the CPAP" as a subject line. She then goes on to list education etc... About two paragraphs down she states that "Treatment for your sleep apnea is critical." I'm hoping that will suffice as its "medically necessary" 

My C&P is Tuesday. I'm hoping for the best!

[doc25]

57 minutes ago, JaeNobe said:

One more question... my Sleep Apnea notes in the VA systems state "Necessity of the CPAP" as a subject line. She then goes on to list education etc... About two paragraphs down she states that "Treatment for your sleep apnea is critical." I'm hoping that will suffice as its "medically necessary" 

My C&P is Tuesday. I'm hoping for the best!

Oh yea...that's clear and unmistakable. 

[david dupe]

I was diagnosed with central sleep apnea and given a bipap machine for this, according to the examiners my heart just quits beating, this test and diagnosis was from a va doctor.

i requested a rating for sleep apnea and was disapproved as non service connected. I have a Sc rating of 60% cad, sc rating 10% copd, sc rating 10% hypertension, sc rating 10% anxiety disorder. I have also been diagnosed with thrombosystosis, loss of spleen due to splenic infarction (spleen stroke), heart sttack, heart stent, aortic valve replaced. Would my central sleep apnea be secondary to all of these blood problems that I have experienced???

[doc25]

23 hours ago, david dupe said:

I was diagnosed with central sleep apnea and given a bipap machine for this, according to the examiners my heart just quits beating, this test and diagnosis was from a va doctor.

i requested a rating for sleep apnea and was disapproved as non service connected. I have a Sc rating of 60% cad, sc rating 10% copd, sc rating 10% hypertension, sc rating 10% anxiety disorder. I have also been diagnosed with thrombosystosis, loss of spleen due to splenic infarction (spleen stroke), heart sttack, heart stent, aortic valve replaced. Would my central sleep apnea be secondary to all of these blood problems that I have experienced???

 

There is a bit of a debate from what I was researching between the correlation between CSA and CAD. It seems that the studies done; tip the scale toward CSA causing CAD rather than CAD causing CSA. (I'll research some more.)

Your SC hypertension could be causing your CSA. Review this veteran's case with the BVA word for word. It was granted.

https://www.va.gov/vetapp15/Files4/1534763.txt

Your SC anxiety disorder could also be a culprit to causing your CSA. Review this one also. It too was granted.

https://www.va.gov/vetapp15/Files4/1537135.txt

III.  Sleep Apnea

Initially, the evidence shows that the Veteran has a current diagnosis of sleep apnea.  See, e.g., February 2015 VA Sleep Apnea DBQ.  After review of the evidence of record, the Board concludes that the Veteran's sleep apnea was caused by his service-connected anxiety disorder.  Of record are multiple letters from Dr. J.Z.  A letter dated May 2013 noted that the Veteran was a patient of Dr. J.Z.  This letter stated in part:

[The Veteran] asked me to write him a letter to determine if in fact the depression/anxiety which he had first might have more likely than not contributed to his developing the other major medical conditions and I believe that this is indeed the case.  With his depression/anxiety, he became somewhat despondent and took worse care of himself, causing him to gain a fair amount of weight as he did not participate in exercise and turned to food as his redeemer.  He developed...obstructive sleep apnea because of this...Again, if he had not been depressed and used food to help satisfy his needs where nothing else would and stopped exercising, he would not have developed any of the other medical conditions...All of these conditions can be traced directly back to [the Veteran's] depression and anxiety - maybe not as a direct cause but a definite contributing factor and more than likely partially to blame.

In another letter from Dr. J.Z. dated June 2013, it was stated that "[a]gain, due to the anxiety issues, [the Veteran] gained a fair amount of weight in comfort eating and not exercising which led to his...[obstructive sleep apnea]."  A February 2015 VA opinion provided a negative opinion with respect to whether the Veteran's diabetes mellitus was secondary to his service-connected anxiety disorder.  The rationale provided was that "[a]nxiety or depression does not cause obstructive sleep apnea (OSA).  OSA is caused by mechanical compromise of the upper airways during sleep, usually associated with obesity...The [V]eteran has comorbidities of morbid obesity."  The opinion additionally stated that the Veteran's diagnosis of sleep apnea "coincides with the time period he has become morbidly obese."

Based on the evidence of record, the Board finds that the Veteran's sleep apnea was caused by his service-connected anxiety disorder.  The letters from Dr. J.Z. contained medical opinions indicating that the Veteran's service-connected anxiety disorder resulted in the Veteran's obesity, which resulted in the Veteran's sleep apnea.  The physician's opinion is supported by a cogent rationale and is entitled to probative weight.  The February 2015 VA opinion, while providing a negative opinion as to whether the Veteran's sleep apnea was secondary to his service-connected anxiety disorder, also suggested that the Veteran's sleep apnea was caused by his obesity.  The February 2015 VA opinion, however, did not address the causation of the Veteran's obesity, which the letters from Dr. J.Z. attributed to the Veteran's service-connected anxiety disorder.  As such, the Board concludes that the criteria for entitlement to service connection for sleep apnea as secondary to a service-connected anxiety disorder have been met and the Veteran's claim is therefore granted.  38 U.S.C.A. § 1110 (West 2014); 38 C.F.R. § 3.310 (2015).

Here is how it is rated:

Sleep Apnea
Code 6847: Any sleep apnea syndrome is rated under this code. Sleep apnea is a disorder that occurs while asleep. There is either a pause when breathing that can last up to a few minutes or there is very shallow, low breathing. Central sleep apnea is caused by a decrease in the “action” of breathing—the body doesn’t try as hard to breathe properly. Obstructive sleep apnea is caused by a block in the airways, like a narrowing of the airway passages or an excess of mucus. This causes severe snoring. Mixed sleep apnea is a combination of both central and obstructive.

Sleep apnea can cause a significant impairment of the heart and respiratory system by limiting the amount of air that is taken in during the hours of sleep.

If the condition continues over a long period of time and causes respiratory failure with right heart ventricle failure or with too much carbon dioxide in the blood stream, or if it requires a tracheotomy, it is rated 100%.

If it requires the use of breathing machines like a continuous positive airway pressure (CPAP) machine during sleep, it is rated 50%.

If it causes serious sleepiness during the daytime or not feeling rested after sleeping, it is rated 30%.

If it is diagnosed by a sleep test, but it doesn’t cause any significant symptoms, it is rated 0%.

Edited February 12, 2019 by doc25