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dajoker12

Tips for Sleep Apnea Secondary to PTSD/Mental Disorder Claims

Question

Moderator, you might want to Pin this somewhere, as this seems to be a recurring trend. 

I have given out this information to others, but I will post it here so that others can find it rather than searching through the forum.

First and foremost, claiming and getting sleep apnea secondary to PTSD or Mental disorder is not easy. I have personally seen more lost than won, however, it can be obtained and I myself have personally received it. 

If you had sleep apnea diagnosed while in active duty, it is usually a slam dunk........for the rest of those trying to get it, it could require a lot of work.  I suggest trying to get it both direct and secondary service connected.

It is easier to get sleep apnea as a direct service connection obviously, however, most Veterans do not get it diagnosed while in service. Best way to get that resolved is through buddy statements. I suggest getting 3-4 (I personally had 7-8) or more. Do not have them only say that they saw you snoring.......that is great and all, but that is not a symptom of sleep apnea.......it is incidental. They would need to say that they saw you gasping for air, choking, etc. Preferably roommates. If you were deployed, it would be easy to have many people saying that they saw/heard this as you would have more than likely been in an open bay setting at some point in time. You can also have your spouse write up a statement. This all needs to be during active duty periods of times and dates need to be included.  M21-1 reference III.iii.2.E.2.b "Types of Evidence VA May Use To Supplement or as a Substitute for STRs" allows for buddy statements to act as STRs for medical evidence.........if they are certified "buddy" statements or affidavits.............having them written on VA Form 21-4138 solves this issue as it has the appropriate verbiage written near the bottom. Under M21-1 reference III.iii.1.B.7.a and 38 CFR 3.200, it meets the certification criteria..........problem solved. From my experience, getting all of the buddy statements needed can take longer than you originally anticipate....plan ahead.

Now, for secondary criteria.

Have you ever been diagnosed with alcohol abuse (it is frequently written as "ETOH")? If so, has it been attributed to your mental disorder or did it exist prior to that and is it considered willful? If you have been diagnosed with alcohol abuse, and it is attributable to your mental disorder,  guess what, alcohol consumption is attributable to sleep apnea. 

would suggest that you start doing your own academic research. You might be able to locate peer-reviewed academic journal articles (those are the types of articles that you want to submit) through https://www.researchgate.net/. If not, another alternative is using a college database to search academic journals through. Ah, but you need to be a college student to use the database to search academic journals through. One might make an argument that you could register for classes at a local community college (you can even register online nowadays without even stepping foot on campus) and even register for "late start" classes, and have access to the aforementioned database immediately (hint hint, look in the academic journal Chest); one could easily find within a 60 minute search at least 5 appropriate and recent journal articles clearly establishing a link between specific mental disorders and sleep apnea; there is a clear link between PTSD, anxiety disorders, depression, and especially schizophrenia. One might make an argument that you could simply then disenroll from the classes that you enrolled in by the date specified in order to get a full refund, thereby being charged nothing. Save the academic journal articles as pdf files, and create a work cited page (bibliography) for them in APA format (google is your friend.)

You now have a choice...........

Submit your claim with the buddy statements, mental health notes from a private provider, and evidence that you have and go with either a VA exam or vendor exam (whichever is given) or you can get an IME and IMO from private providers. If go the latter route, I would schedule one with a sleep specialist, why, because sleep apnea is their specialty. Pulmonologists also fall within this scope as well, though I suspect that you will have better luck finding a sleep specialist believing there to be a link between mental disorders and sleep apnea. You will get a Sleep Apnea DBQ and an IMO. Make sure that you have your C - File first as an examiner is required to have access to it and state that they have seen it on the DBQ for it to acceptable proof to the VA.

I would also get one from your psychologists/psychiatrist (Make sure that they are a psychiatrist or a psychologist.....if a psychologist, they need to be PsyD or Ph.D., or under the observation of a Ph.D.). 

Make sure before you solicit those medical opinions, that you acquire "buddy statements" from 3-4 (or even more) people with whom you served. Roommates would be best, or people who slept in close proximity to you.........again, this is only if you believe that sleep apnea developed while you were in Active Duty service. Make sure that they are written on VA Form 21-4138. Make sure they say that they witnessed clear symptoms of sleep apnea i.e. gasping for air, choking sounds, moments where they visibly or auditorily could determine that you ceased breathing etc.

Remember, you will want the sleep specialist and the psych professional to have your academic journal articles and buddy statements.

Once you have all of them, solicit your medical opinions from the two aforementioned providers.

Ideally, you would love for the IMOs to say that they believe that you could be both direct service connected for sleep apnea or secondary due to mental disorder, possibly even say that the mental disorder and sleep apnea aggravate one another (which there is medical evidence to support.)

If you opt to go the route of getting the private IMO and IME, you will obviously submit those with your claim, and all medical records from private providers pertinent to sleep apnea and your mental health treatment, buddy statements, academic journal articles, and a nicely written statement written by yourself on a VA Form 21-4138 talking about the issue at hand and summarizing everything concisely. Mention everything that you are providing that you wont to be considered for the claim, and when the issue first manifested. 

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38 minutes ago, Buck52 said:

I have been diagnose for Mild Sleep Apnea . 

MH Phyischartist put in for me to see the Sleep Clinic and they did a sleep study and dx Mild Sleep Apnea and required to use a C-pap Machine

Since I was diagnosed with chronic PTSD and the medications from it also medications to help me sleep , my spouse notice I stop breathing and cough to wake up  I guess my brain is telling my Body to wake up.

  but I never had that that I know of anyway any sleep disturbance while in military  but I think I did snore.

But now that I am out of military 46/47years ago and since taking the PTSD Medication and was prescribe a C-Pap machine required to use every night 

I have not considered a Sleep Apnea claim Secondary to PTSD  simply to be denied for what ever reason they can come up with.

I am ok with my S.C. Disability's 90% combined rating for TDIU P/T Since 2002  and in 2015 a separate  70%  S.C. Rating for PTSD..and a 100% final degree rating

What  the Rater did was look at the SMC Special rating tables and mention I met the SMC Criteria for SMC S H.B. and Inferred the SMC-S  and SMC K for E.D. Actually I filed a claim for the E.D Due to my PTSD Medications.

However I have not ruled out a secondary claim for Sleep Apnea due to my PTSD Medication's, there's no more compensation for me at this level other than just having the S.A. Service connected. 

but I just really don't know what to do ? if I should or shouldn't file a secondary claim for the Sleep Apnea Secondary to my PTSD Medications????

I  have not seen any claims for sleep apnea secondary to PTSD medications..........it would simply be due to PTSD.......if you want to go with the angle to PTSD medications you can,  however, I have not seen any claims come in like that. I have seen people claim the likes of tinnitus and GERD secondary to NSAID medication (nonsteroidal anti-inflammatory drugs) i.e. ibuprofen, however, the amount that one would have to take to affect those conditions is very very high, especially for tinnitus. 

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3 hours ago, dajoker12 said:

I  have not seen any claims for sleep apnea secondary to PTSD medications..........it would simply be due to PTSD.......if you want to go with the angle to PTSD medications you can,  however, I have not seen any claims come in like that. I have seen people claim the likes of tinnitus and GERD secondary to NSAID medication (nonsteroidal anti-inflammatory drugs) i.e. ibuprofen, however, the amount that one would have to take to affect those conditions is very very high, especially for tinnitus. 

You're correct on the part of secondary connecting OSA to PTSD only. There's been studies over the past 15-20 years that have concluded the correlation between OSA and Mental Health conditions. (Please see attached files at the bottom of this post).

You're also correct on PTSD medications can be used to secondary connect Sleep Apnea on an aggravation-basis. PTSD medications can aggravate Sleep Apnea. 

PTSD alone can also aggravate Sleep Apnea. Here's a BVA case that uses aggravation of OSA due to PTSD without any mention of PTSD meds.

https://www.va.gov/vetapp16/Files6/1648003.txt

SecondarySleepApneaArticle.pdf Sleep apnea, psychopathology, and mental health care.pdf

Edited by doc25

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6 hours ago, doc25 said:

You're correct on the part of secondary connecting OSA to PTSD only. There's been studies over the past 15-20 years that have concluded the correlation between OSA and Mental Health conditions. (Please see attached files at the bottom of this post).

You're also correct on PTSD medications can be used to secondary connect Sleep Apnea on an aggravation-basis. PTSD medications can aggravate Sleep Apnea. 

PTSD alone can also aggravate Sleep Apnea. Here's a BVA case that uses aggravation of OSA due to PTSD without any mention of PTSD meds.

https://www.va.gov/vetapp16/Files6/1648003.txt

SecondarySleepApneaArticle.pdf 644.59 kB · 5 downloads Sleep apnea, psychopathology, and mental health care.pdf 103.61 kB · 7 downloads

I just added a couple more............ one could write up one hell of a compelling medical opinion utilizing all of those resources. I would not use all of them at once..........hold some in your back pocket for the potential of submitting "new and relevant" evidence (formerly material evidence) 

Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort.pdf PTSD depression binge eating.pdf Sleep Disordered Breathing in Patients with Post Traumatic Stress Disorder.pdf Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel.pdf SLeep Disorders in Combat-Related PTSD.pdf Sleep Disorders in US Military Personnel A High Rate of Comorbid Insomnia and Obstructive Sleep Apnea.pdf

Edited by dajoker12

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Roger that dajoker12 and doc25, great information   may help a veteran with S.A.that has been s.c. for PTSD

I am unsure rather to file for S.A. Secondary to PTSD ??

, gotta know before hand all the T's and I's crossed and if the Dr's would help ? all I have is VA Docs  and they are not much help with claims.

Can't afford private Dr's for IMO/IME's

Edited by Buck52

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