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. 

[tk3000]

There is also a nexus between GERD (chronic heartburn, or acid reflux) and sleep apnea. A causal relation of the former with the later. Below, I am attaching an article  from an academic publication regarding this issue.  So, if you have GERD and it is service connected you can add it to the list of secondary conditions that could contribute to the onset of sleep apnea

SLEEP_APNEA_GERD_PAPER.PDF

Edited July 2, 2019 by tk3000

[GBArmy]

tk3000 Did you have any success with it as secondary to OSA? Did you have any additional med papers that you tied it into? Wondering, I might be able to do the same. Thanks.

[tk3000]

GBArmy, it seems since I got 100% TDIU I got too accommodated and somewhat lazy, so I haven't really started process yet. But that is about to change now. I am on the planning phase now doing the research and preparation process.  I plan on retrieving medical records tomorrow, and if I find out more relevant research papers I will share them here (this one that I posted is not all that interesting...). But the mainstay of my claim is going to be set of secondary conditions that I hold, all of each play a role development of sleep apnea: anxiety disorder, major depression, gerd, and obesity  due to the lack of regular physical exercise  (then due my physical disabilities) . I will share the main developments of my claim process and steps here with you guys. It just happens that the VA is too dysfunctional and too slow to be real as we all know so well, so it will probably take longer than what I would wish or what any rudimentary civilized society would expect: I anticipate 50% chances of it going to the BVA. 

[cham1968]

Thanks DaJoker! Great information! 

[courage2]

Can the VA Group OSA to Mental Health Disorder or will this always be secondary to Mental Health? I think the VA is trying to group my Sleep Apnea with my Anxiety, Insomnia, and Somatic Symtpom all as one claim... Thats 4 seperate issues combined..... I go in for a C&P Exam in 2 weeks for another phsyc eval I believe to see if they can tie Sleep apnea to my mental health. 

[swimdad84]

I got PTSD service connected without direct evidence 70%

then i got Sleep Apnea secondary to ptsd service connected without direct medical evidence.

I Had buddys of mine write buddy statements witnessing my sleep apnea (3 of em) Signed/Certified) They witnessed me do these things.  I had all the signs of sleep apnea.

I had a IMO Nexus from Dr. Anaise. (He charged me like 1,000$)

I attached BVA Decisions that were similar to mine (This doesn't really hold much weight but did it anyway)

Also attached the Army Study where sleep apnea is caused or aggravated by ptsd/trauma

 

No one will help you do this but yourself. DAV said i wasnt going to get service connected without records and when i went to the C&P exam the doctor told me she was denying me and said PTSD doesnt cause sleep apnea even though i showed all the studies and decisions...i even said why can people claim "Sleep Apnea Secondary to PTSD" on ebenefits if  it doesnt exist.. its a drop down.  I was raging at this doctor.  Anyway she denied me and Regional VA, Looked at all my information and Gave me Service Connection.  You have to do all the leg work yourself though.  Nobody will care about yourcase more then yourself.  

 

I was literally rejected by the C&P Dr. and Regional Didnt care and still service connected it.. How often does that happen?

Get your ducks in order if you think you rate service connection.