Sleep Apnea Secondary to PTSD

[JonathanAD]

I filed a claim for Sleep Apnea secondary to my PTSD, which is service connected.  I have been diagnosed from the VA as having sleep apnea, and given a CPAP to wear at night.  I used Carpenter Chartered Law Firm to do the claim, but got this denial letter (attached is an excerpt).  In it, it says "In the absence of other major risk factors such as obesity it would be reasonable to attribute OSA to PTSD as this is considered a risk factor for OSA from uptodate.com".

My thought is that if both obesity and PTSD are considered risk factors, shouldn't it be a 50% chance that it could be either obesity or PTSD, and go to the veteran's favor?  And doesn't that mean that attributing OSA to obesity is just as speculative as attributing it to my PTSD?

I had Carpenter Chartered start an appeal, so I am hopeful to get it approved.  

[GBArmy]

JohanathanAD You have an excellent chance at winning an appeal. Carpenter is good at what he does, also. Go with the flow: if they are hanging the reject on obesity, suggest to Carpenter looking at the obesity as an INTERIUM link between PTSD and OSA. PTSD meds cause weight gain. WG causes OSA. I am not a doctor but the argument is that there is doubt as to how much either factor, weight gain/obesity, or your original evidence of the MH condition, but since they are interconnected, they are service-connected. IMHO. As to whether you go HLR ,or go directly to BVA with additional evidence is your choice. 

[Buck52]

Well not to be mean or anything  just because you have a diagnosis for OSA and was giving a C-pap machine  does not cut it with these raters  they will deny 100%of the time  

FILING SECONDARY CLAIM to be connected to your PTSD  for OSA

YOUR GOING TO NEED A SLEEP DR to give his/her medical opinion that your PTSD AND THE MEDICATIONS YOU TAKE FOR IT IS LIKELY AS NOT THAT THIS VETERANS OSA IS CAUSE BY OR RELATED TO HIS PTSD MEDICATIONS  AND HIS PRESCRIBE C-PAP MACHINE IS MEDICALLY REQUIRED TO USE.

THE DR NEEDS TO READ YOUR MEDICAL RECORDS THAT PERTIAN TO THIS CLAIM AND EXAMIN YOU.  AND GIVE A DETAIL EXPLANATION WHY THE MEDICATIONS WILL CAUSE THE OSA.

 

THIS  IS WHAT YOU NEED  TO BE APPROVED FOR OSA/SLEEP APENA.

I agree with GB Army 

Questions  was you denied using the

''Carpenter Chartered Law Firm? its a rare denial if they helped you with your claim?

 If they still REP you ,They should file the NOD for you and get you a medical opinion (IMO) From  the Qualified  Sleep Dr's MEDICAL OPINION .

Edited September 23, 2020 by Buck52

[flow1972]

I agree with GBArmy.  Beat them at their own game...Obesity is linked to PTSD in common Medical Literature.  It's can be due to medication taken for PTSD, Stress Overeating, etc..  That would make the Obesity a symptom/secondary condition of the PTSD which (by VA Legal Language) makes the Obesity a "part of" the SC'd PTSD directly making your OSA secondary to the PTSD.

[Buck52]

I agree with GBArmy.  Beat them at their own game...Obesity is linked to PTSD in common Medical Literature.  (True) 

But

The only thing here is  the VA will not use'' common medical literature'' in making their decision  or any medical literature that we use or copy from another web site.

The Qualified Dr will need to give his professional opinion on the nexus  that it ''is likely as not''  the cause or related to.this Veteran medications he takes for PTSD...ect,,,ect,,,of the above statement.

[USMC_VET]

On 9/23/2020 at 11:32 AM, JonathanAD said:

I filed a claim for Sleep Apnea secondary to my PTSD, which is service connected.  I have been diagnosed from the VA as having sleep apnea, and given a CPAP to wear at night.  I used Carpenter Chartered Law Firm to do the claim, but got this denial letter (attached is an excerpt).  In it, it says "In the absence of other major risk factors such as obesity it would be reasonable to attribute OSA to PTSD as this is considered a risk factor for OSA from uptodate.com".

My thought is that if both obesity and PTSD are considered risk factors, shouldn't it be a 50% chance that it could be either obesity or PTSD, and go to the veteran's favor?  And doesn't that mean that attributing OSA to obesity is just as speculative as attributing it to my PTSD?

I had Carpenter Chartered start an appeal, so I am hopeful to get it approved.  

Here is my post from a few months back on how i won OSA secondary to PTSD

 

 

[JonathanAD]

Ok, update is that the appeal has officially been filed by the attorney.  Here's what it says.

 

On April 22, 2020, VA issued a rating decision denying entitlement to service

connection for obstructive sleep apnea. Mr. D requests a Higher Level Review and

informal telephone conference with higher level reviewer in accordance with the AMA

of this Rating Decision.

 

Issue I: Under the correct application of the provisions of 38 C.F.R. § 3.310(a)

Mr. D is entitled to service connected compensation for his

D's disabilities from insomnia and sleep apnea as

 secondary to

his service connected disability from PTSD.

VA’s April 22, 2020 rating decision explained the reasons and bases for its denial

of secondary service connected compensation for his disability from sleep apnea as

secondary to his service connected PTSD as follows:

 

Quote

 

In support of your claim, new’ and relevant evidence has

been received and your claim is now reconsidered.

The examiner opined that the claimed condition is less likely

than not (less than 50 percent probability) proximately due to

or the result of your service connected condition. The

examiner explained that review of records show that you

have obesity from medical history. Review of literature shows

that obesity is consistently the most important risk factor for

OSA:https://www.nebi.nlm.nih.gov/pme/artieles/PMC3286

155/ Epidemiological studies have consistently shown that

body weight, and in particular BMI, is the strongest risk

factor for OSA. It is estimated that about 70% of those with

USA are obese and that the prevalence of OSA in obese men

and women is about 40%. Twenty-six percent of patients

with a BMI greater than 30 and 33% of those with a BMI

greater than 40 have moderate OSA. A large neck circumference

is also associated with an increased risk of

USA. In fact, neck circumference of 15.7 in (40 cm) or

greater may have a greater sensitivity and specificity than

BMI in predicting OSA, regardless of the person’s sex. You

submitted many articles re: mental disorders and OSA but

these studies show correlation and not causation. There is

also a statement by pulmonologist noting that your mild

insomnia is related to PTSD making OSA worse but didn’t

state that PTSD was directly causing OSA. In the absence of

other major risk factors such as obesity it would be

reasonable to attribute OSA to PTSD as this is considered a

risk factor for USA from uptodate.com. However since your

BMI is >30, to attribute OSA to another condition other

than obesity would be speculation. Based on this evidence it

is less likely than not that the veteran’s current OSA is related

to PTSD.

 

Favorable findings: You have been diagnosed with a

disability. Medical records, home sleep apnea test report,

obstructive sleep apnea, May 13, 2019.

 

 

VA did not address the argument that was raised by the evidence submitting as new and

relevant. Mr. D submitting medical evidence that his insomnia was at least as likely

as not related to his service connected PTSD. Therefore, Mr. D was entitled to

consideration and a grant of service connection for insomnia as proximately due to or

the result of his service connected PTSD. Neither the VA examiner nor VA addressed

entitlement to service connection for insomnia. Furthermore, Mr. D submitted

medical evidence that his insomnia aggravates is OSA. Pursuant to 38 C.F.R. § 3.310(b),

any disability that is aggravated by a service connected disability is entitled to service

connection.

 

Therefore, based on the evidence submitted, VA was first required to adjudicate

entitlement to service connection for insomnia and then address entitlement to service

connection for OSA based on aggravation. VA failed to do so and the higher level

reviewer must correct this error.

 

CONCLUSION

 

Mr. D is entitled to service connected compensation for both insomnia and

sleep apnea as secondary to his service connected PTSD from May 15, 2019, the date of

his intent to file claim which was followed by a VA Form 21-526EZ on June 17, 2019.

Mr. D requests that he not be contacted but rather his representative will

conduct the informal conference on his behalf. In order to assist in scheduling the

informal telephone conference, it is further requested that VA’s higher level reviewer

contact Mr. D’s representative via his e-mail address: carpgh@mindspring.com

regarding this request for a Higher Level of Review of VA’s April 22, 2020 rating

decision.