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Question - how to proceed with sleep apnea denial


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I filed for sleep apnea and it was denied as service connected.  I have all the documents and use a CPAP daily so the issue is secondary to PTSD and service connected. 

I am inclined to just let this go; however, I started my sleep issues in Viet Nam but back in the mid 60's most folks did not look for help because Viet Nam was pretty unpopular with the folks back home.  I have had sleep issues all my life after military.  But in fairness I was just 18 when I went in (4 active USMC).

My question is if it is worth an appeal or a supplemental claim?  I can get my doctor to give me an opinion letter and state how the sleep issues relate to PTSD.  But the big question is if I already screwed up by letting the VA nurse have here say first.  My regular doctor filled out the original DBQ but we did not offer an opinion at that time.

I am 70% for PTSD and don't need more money but I would like to get 100% so I can get the full benefit of what we were originally promised. 

Advice or personal experience with the supplemental claim process - thanks very much.

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Rexlan One way to connect SA or OSA is secondary to PTSD by way of weight gain. If you are overweight or obese, and you take PTSD meds that tend to make you put on weight, you might have a case. Look up the side effects of your prescribed VA meds and see if they do. Look up obesity charts and see if you are classified as over weight or obese based on your height, called BMI.  If this matches up, it may work for you. I assume you never asked medical help on sleep problems while in the service, so direct disability is going to be a tough nut to crack.

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This is a big deal, and no, I would not let it go.  Since your profile says you are at 70 percent, you have a potential of 100 percent plus smc s.  That's a huge raise for you to about 3500 per month, from where you are now.  

I have no opinion on what your doctor "would or would not do", because I have never even met him.  Its simple, tho.  If he wont "connect" your sleep apnea to PTSD (secondary) or to military service (primary), then you need to make it happen with another doctor.  Yes, it may cost you.  Lets say you have to pay a doc 2000 for a nexus.  Now thats a bargain, because, if your sleep apnea gets you to 100 percent plus smc s (and I cant guarantee that), you would pay for your IMO in 1 or 2 months, tops.  

Im assuming here, that you are prescribed and using a CPAP or Bipap.  OSA with a cpap is 50 percent.  

Are you currently working?  If not, then consider filing for an increase in ptsd and tdiu.  Let the VA sort out which applies to you..granting an increase to 100 percent for PTSD or granting tdiu.  

To Proceed:  File a NOD, and my opinion is you should select BVA with evidence submission, in case you need a nexus (additional evidence).  Of course, review your file to see if it is already there, it may be and cost you zero.  You wont know till you review your records.  

 

Edited by broncovet
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GB 

The only thing about weight gain is they can go back years and check a Veteran weight , if you were over weight before filing for sleep apnea  they can and will use that against you to deny s.a../ osa claim...by checking medical records for the past years  or before a MH Condition was approved...like PTSD

I been over weight for years  normally my weight should be around 170 lbs  according to my BMI..But since I had to stop working   because of my s.c. disabilities   I've really put on the weight I am up around 255 lbs  some 85 lbs over weight.

I have sleep apnea and was prescribe a C-pap machine medically necessary to use for my well being  but have not filed a claim for Sleep apnea I might later on  but for now I am ok with what I am rated for  although I do have some complints as to how they rated me back in 2002/2003  different dates on my award letters and the EED but as long as they are called typo errors  I have no defence in getting a better EED, BUT THIS IS COMPLETELY DIFFERENT from the OP Question.

It could work using the obese excuse,  but most of the time  a veteran will need more than that to win the sleep apnea claim.

If a Veteran has been diagnosed for PTSD AND PRESCRIBE medications like to help him sleep and ease of night mares ect,,,ect,,,   this is called sudation to relax...to be able to sleep  with a C-pap machine, the thing is  a veteran will need  a Dr to opine that the meds he takes for his mental health condition to help him sleep  will cause or can be related to his now OSA/Sleep Apnea and can be secondary to his mental health condition (PTSD)

if a spouse wakes up in the middle of the night and notice her hubby not breathing or gasping for air  this needs to be addressed with his MH Clinic, they(normally) in turn will contact the sleep clinic and a sleep study will be order and if the veteran is diagnose for sleep  apnea and prescribe a C-pap Machine  necessary medically to use and the medications he takes for his PTSD/SLEEP /ANXIETY/STRESS   ECT,,,ECT,,,  then he has the tools to use  for his sleep apnea claim medically to file a secondary claim to his PTSD

Actually this is how I got my Sleep apnea and was diagnose for mild to moderate OSA.

I may file a claim for it later...but right now for me is not a good time to be filing anything  were moving and keep running into problems  like the home we were going to buy a few days ago   did not pass inspection and needed way to much things the seller would not fix  like a roof, and havc unit, breaker box in the garage was unsafe with bare hot wires exposed  as a fire hazard, hot water heater was 20 years old, cracks in the walls, and a bunch of other things to many to mention the seller decline to fix or replace any of this  so we backed out   of course it cost us 400.00 bucks for this inspection  but glad to pay that and not invest in this home.

so I am waIting to get settled into my new home address before I file anything with the VA.

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Buck so your saying when he got s-c for PTSD is a key element relative to his weight gain. Hadn't considered that, but it make sense the VA would use that logic to deny. Good point!

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Great discussion.  I am badly overweight but only because I love to cook and eat - I make a LOT of sausage and nothing better than that with some fine pasta - so, that won't fly and the fats on me - literally ... lol..  Also, I do not take meds for PTSD and tossed them in the trash when they were initially given to me.

I filed the sleep apnea claim as secondary to the PTSD but only submitted a simple statement about Viet Nam and a completed DBQ signed by my doctor.  I also submitted the sleep study and it says severe sleep apnea with an AHI of 58.9 and oxygen desaturation as low as 63% - killer stuff.  I was prescribe a CPAP machine as medically necessary and bought one.  I use it every night and do well with it.  I had another post about the battery backup after I lost it 2 nights because of a storm and I could not sleep at all.

The VA, after a lot of fighting, finally gave me a CPAP and I use it and put mine away for a rainy day.

The VA had a nurse practitioner called me and she did an interview, confirmed all my stuff and she concluded that my sleep apnea was LESS likely than not caused by my PTSD.  Not sure how she could conclude that but she did and the VA denied the claim.

 

These are the notes she made with her examination

73 MARINE CORPS VETERAN WHO IS CLAIMING OBSTRUCTIVE SLEEP APNEA
SECONDARY TO PTSD. EXAM CONDUCTED VIA TELEPHONE INTERVIEW.
REPORTS WHILE IN VIET NAM HE WAS TOLD HE SNORED SO LOUD THE ENEMY WOULD FIND THEM. REPORTS HE ALSO HAD FATIGUE AND SLEEP ISSUES OVER THE YEARS.
REPORTS SYMPTOMS WORSENED OVER THE YEARS WITH FALLING ASLEEP DURING DAYTIME. REPORTS HIS WIFE INSISTED HE BE TESTED.
REPORTS HE ALSO HAS COPD. PER DR. HOVEY, MD PULMONOLOGIST NOTES IN VBMS VET WITH STAGE 3 COPD ON CONTINUOUS OXYGEN, DX. ON 1/229/2019 RESPIRATORY FAILURE WITH HYPOXIA -
86% O2 SATURATION ON ROOM AIR.

STARTED ON CPAP 1 YEAR, REPORTS 100% IMPROVEMENT IN AHI. REPORTS HE
STILL FEELS FATIGUED, SNORING HAS STOPPED AND STILL FEELS SLEEPY IN THE DAYTIME. REPORTS HE IS DIAGNOSED WITH NARCOLEPSY.

She concluded this:

b. The OBSTRUCTIVE SLEEP APNEA claimed is less likely than not (less than
50% probability) proximately due to or the result of the Veteran's
service connected POST TRAUMATIC STRESS DISORDER.
RATIONALE: VETERAN DIAGNOSED WITH SEVERE OBSTRUCTIVE SLEEP APNEA 2/11/2019 BY POLYSOMNOGRAPHY. WHILE OBSTRUCTIVE SLEEP APNEA AND PTSD ARE RECOGNIZED AS HAVING AN ASSOCIATION WITH OVERLAPPING SYMPTOMS, THE CURRENT MEDICAL EVIDENCE ESTABLISHES NO CAUSAL RELATIONSHIP BETWEEN OSA AND PTSD (NIH; MAYO CLINIC).
THUS BASED ON THE MEDICAL EVIDENCE:
The OBSTRUCTIVE SLEEP APNEA claimed is less likely than not (less than 50%
probability) proximately due to or the result of the Veteran's service
connected POST TRAUMATIC STRESS DISORDER.

Claim Denied.

 

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