Tips for Sleep Apnea Secondary to PTSD/Mental Disorder Claims

[dajoker12]

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. 

[Buck52]

Well the TDIU is basically for veterans that can't work or do the job they were trained for due to their  S.C.90% or below the 100% ratings  but can get the 100% pay to help them and their family's...vs a 100% scheduler rating the advantage for these Veterans they can work and allowed to make so much during the year  as a veteran on TDIU is not supposed to be working.

TDIU is good to get but at a 90% rating or combined rating  if this Veteran can't work...why not just give him a 100% scheduler  rating .......if your 90% disabled  your pretty disabled.... I mean that rating should automatically make the 100% scheduler  rating.

[Wanderer]

I see, Buck52, I would be able to keep more money if I had a true 100% should I return to the workforce. I just had sleep apnea approved secondary to asthma. Would a claim for apnea also secondary to bipolar be a good idea? Is that possible?

[doc25]

2 hours ago, Wanderer said:

I see, Buck52, I would be able to keep more money if I had a true 100% should I return to the workforce. I just had sleep apnea approved secondary t

Would a claim for apnea also secondary to bipolar be a good idea? Is that possible?

No. Only one condition can be claimed.

Now if Sleep Apnea is causing another secondary condition. That condition can be secondary to the Asthma and Sleep Apnea.

Here are some secondary conditions that can be caused by Sleep Apnea.

Sleep apnea may increase your risk of the following disorders:

• Asthma
• Atrial fibrillation
• Cancers, such as pancreatic, renal, and skin cancers
• Chronic kidney disease
• Cognitive and behavioral disorders, such as decreases in attention, vigilance, concentration, motor skills, and verbal and visuospatial memory, as well as dementia in older adults. In children, sleep apnea has been associated with learning disabilities.
• Diseases of the heart and blood vessels, such as atherosclerosis, heart attacks, heart failure, difficult-to-control high blood pressure, and stroke
• Eye disorders, such as glaucoma, dry eye, or keratoconus
• Metabolic disorders, including glucose intolerance and type 2 diabetes
• Pregnancy complications, including gestational diabetes and gestational high blood pressureexternal link, as well as having a baby with low birth weight

Did you know that sleep apnea can cause inflammation and lead to complications?

 

When blood oxygen levels drop due to obstructive sleep apnea, your body and brain trigger the “fight or flight” response. This increases your blood pressure and heart rate and wakes you from sleep so that your upper airway can open. These cycles of decreased and increased blood oxygen levels can cause inflammation that may contribute to atherosclerosis, the buildup of plaque in blood vessels, which can increase the risk of heart attack or stroke. Chronic inflammation can also damage the pancreas and lead to type 2 diabetes

 

[Wanderer]

6 hours ago, Wanderer said:

I see, Buck52, I would be able to keep more money if I had a true 100% should I return to the workforce. I just had sleep apnea approved secondary to asthma. Would a claim for apnea also secondary to bipolar be a good idea? Is that possible?

Actually, though, my TDIU says I'm permanently disabled and also that no reexamination is required. Would that mean  I would lose nothing if I earned high income?

[broncovet]

There are at least 2 kinds of "income":

1.  Earned income.  Wages, salary, tips, etc.  

2.  Unearned income, that is "investment income".  

    A tdiu Vet can get as much "investment income" as he can and keep tdiu.  However, "earned" income would be limited to the poverty level, or you are in danger of having your tdiu removed.  

     The difference between "earned income" and investment income, generally means that you did not work to produce this income, that it was the rusult of investments.  

     Dividends from stock(s), bond payments, gains from the stock market or cryptocurrencies, are investment income and are unrelated to whether or not you "work" or not.  

     TDIU, and other forms of Veterans compensation, are not "needs based".  Pension is needs based, where whether or not you get pension, turns on how much you make.  

Theoretically, you could earn 10,000,000 per year off investments and still keep tdiu.  TDIU does not require your bank statement be zero.  

[Buck52]

12 hours ago, Wanderer said:

I see, Buck52, I would be able to keep more money if I had a true 100% should I return to the workforce. I just had sleep apnea approved secondary to asthma. Would a claim for apnea also secondary to bipolar be a good idea? Is that possible?

You will need a qualified Dr to connect the bipolar to the sleep apnea  as the Dr would need to give his opinion that he read your medical records and also examine  you and it is his opinion that this veterans diagnose of Sleep Apnea (or OSA) is likely as not related to his bipolar  and the medications  prescribe by the VA he takes for his bipolar disorder.

Sleep Apnea is a hard claim to get approved if you never had any reported sleep disorders while in the military...but it can be  a secondary condition to several  service connected conditions.

even if a Dr states it is likely as not osa disorder is related to his bipolar  threes no guarantees that will fly.