Sleep Apnea Secondary to PTSD

[Jonathan AF]

I recently did a home study from the VA, and my results are as follows (see attached):

 

Min SpO2: 78.0%

Total RDI: 50.2

Findings: Snoring & Obstructive apneas/hypoapneas

Impression: OSA (G47.33) ("severe" is handwritten next to this).

They set me up with a CPAP machine to wear each night.

I am currently 30% rated for PTSD.  Based on this, can anyone tell what my rating would be filing sleep apnea as secondary to PTSD?

Edited July 3, 2019 by Jonathan AF
add attachment

[Jonathan AF]

Well, guys, It got denied.  My C&P said the dreaded "less likely than not".  I am going to appeal, but I'm gonna have to go get an IME.  I had already scheduled one, but they scheduled the C&P the exact same day and time, so I had to reschedule for 8/14.  I'll let you guys know what comes of that.

 

BTW, does anyone have an example NOD I can look at, or any advice on it?

On 7/3/2019 at 9:34 PM, Patton said:

That doesn't surprise me, did he tell you that it is because of your BMI? 

I would take a copy of your SMR with you. Pull out everything to do with PTSD, Sleep Disorders, Respiratory issues, GERD (Acid Reflux) and Medication. Put them in order so that the Doctor doesn't have to search thru your whole file. Ask the Doctor if he could review them (along with your VA records) and if any of these conditions would cause your OSA. If he come back with your BMI, then ask if any of your Medications / Conditions ( I.E. PTSD / Depression / Sleep Disorders all can cause weigh gain) could be the reason for your weigh gain. 

I have attached information from @dajoker12 and @doc25 below. This information is outstanding medical documentation on the subject. Knowledge is key to winning your claim. 

 

Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort.pdf 695.18 kB · 3 downloads PTSD deprssion binge eating.pdf 207.9 kB · 2 downloads Secondary Sleep Apnea Article.pdf 644.59 kB · 8 downloads Sleep apnea psychopathology and mental healthcare.pdf 103.61 kB · 3 downloads Sleep Disordered Breathing in Patients with Post Traumatic Stress Disorder.pdf 542.53 kB · 3 downloads Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel.pdf 815.13 kB · 5 downloads SLeep Disorders in Combat Related PTSD.pdf 242.93 kB · 6 downloads Sleep Disorders in US Military Personnel A High Rate of Comorbid Insomnia and Obstructive Sleep Apnea.pdf 790.5 kB · 2 downloads

Oh, I submitted all these with my claim.  It never showed they even reviewed them, and as soon as the C&P was finished, they denied the claim.

[Patton]

Jonathan,

I have an appointment on 8/16 and it sounds like they are willing to write an IMO. Your post has motivated me to get it done. 

They have requested that I bring all my STR / VA / Private records with me. They also want me to keep a sleep diary for the next 2 weeks. In the diary, they want me to record when I drink coffee / coke / alcohol, take medicine, when I go to bed, when I think I fall a sleep and get up. Also they want to know if I get up during the night. They also included a questionnaire for me to fill out.

I have won a few NOD by including a IMO, and a VA Form 21-4138 (Statement in Support of Claim). In the statement, I gave a brief background on how / when the condition happened and how it affects my daily life. In the denial letter, they should have given a reason for the denial and I ensure that I address every point (it also helps if the doctor address this).

Attached I have include a good example of a Nexus letter. I don't have a good electronic copy of a personal statement, but I believe the most important part is the Nexus Letter (IMO) from the Doctor. 

NEXUS letter for SA.docx

Edited August 2, 2019 by Patton
wording

[Jonathan AF]

On 8/1/2019 at 8:23 PM, Patton said:

Jonathan,

I have an appointment on 8/16 and it sounds like they are willing to write an IMO. Your post has motivated me to get it done. 

They have requested that I bring all my STR / VA / Private records with me. They also want me to keep a sleep diary for the next 2 weeks. In the diary, they want me to record when I drink coffee / coke / alcohol, take medicine, when I go to bed, when I think I fall a sleep and get up. Also they want to know if I get up during the night. They also included a questionnaire for me to fill out.

I have won a few NOD by including a IMO, and a VA Form 21-4138 (Statement in Support of Claim). In the statement, I gave a brief background on how / when the condition happened and how it affects my daily life. In the denial letter, they should have given a reason for the denial and I ensure that I address every point (it also helps if the doctor address this).

Attached I have include a good example of a Nexus letter. I don't have a good electronic copy of a personal statement, but I believe the most important part is the Nexus Letter (IMO) from the Doctor. 

NEXUS letter for SA.docx 33.62 kB · 5 downloads

Awesome!  I hope it gets approved.  I just had an appointment with my sleep dr that diagnosed my OSA.  He said he would write a nexus letter that my ptsd caused insomnia, and that insomnia causes or worsens OSA.  I am also using Law Offices of Carpenter Chartered as my attorney to represent me for my appeal.  

Edited August 14, 2019 by Jonathan AF

[Patton]

12 minutes ago, Jonathan AF said:

Awesome!  I hope it gets approved.  I just had an appointment with my sleep dr that diagnosed my OSA.  He said he would write a nexus letter that my ptsd caused insomnia, and that insomnia causes or worsens OSA.  I am also using Law Offices of Carpenter Chartered as my attorney to represent me for my appeal.  

This year, they added Insomnia to my Depression/ Anxiety (they would not call it PTSD in my case). It did not raise my rating (30%) but now it is SC. I have a feeling that he will look at Upper Respiratory Infection (URI) or GERD as the cause of my OSA. The Depression/ Anxiety/Insomnia is also an option, because the Medication they put you on to lack of motivation which all can cause weight gain. The VA still believes that OSA is caused by being overweight which is not true. So if your BMI is more than 25, use it, as it maybe the golden ticket.

Best of luck and keep me posted on the outcome!

 

[Richard1954]

On 6/20/2019 at 8:36 AM, Jonathan AF said:

I am sure a C&P exam would say "Just as likely as not".

Don't bet on it... the va examiners work for for the VA ... when trying to get a secondary condition service connected you have to do you homework.  Usually, an independent medical opinion will work  but even that is not a guarantee... 

[Buck52]

21 hours ago, Jonathan AF said:

Awesome!  I hope it gets approved.  I just had an appointment with my sleep dr that diagnosed my OSA.  He said he would write a nexus letter that my ptsd caused insomnia, and that insomnia causes or worsens OSA.  I am also using Law Offices of Carpenter Chartered as my attorney to represent me for my appeal.  

This Nexus looks great!  you should be approved for S.A. 

At the least 50%