Higher Level Review for Sleep Apnea and Hypertension

[Wico1337]

Current service connections

Tinnitus - 10%

Retained Renal Calculus (Kidney Stones) - 30%

Adjustment Disorder (with anxiety and depression) - 50%

 

I had filed for both Sleep Apnea and Hyptertension before, but got denied. Sleep Apnea they said that I got it from being obese. I tried arguing that I went from being fit to being obese the year I seperated from the military. While honorable, I had a lot of bad stuff happen due to the military to me. All stuff out of my control, just bad luck. Affected mental health and gained like 100 pounds in first year out. Down 40 now, a lot to go. Anyway, the C&P doctor said that she did not see any link from Depression and anxiety and it causing weight gain/obesity. So claim was denied.

That was a few years ago. I am giving it another shot and made a new claim in October. They randomly closed it two month later. I called to ask why, they have no idea why. They reopened it, closed it again, then reopened it again. This time saying that they found a lot of errors in how it was handled and are sending me to a 3rd party to get an official outside opinion as a Higher Level Review.

A couple of points I plan on making for the claims.

 

Sleep apnea nexus - Been using Bi-pap for 3 years now provided by the VA. Sleep study provided by VA which is what got me it.

- .gov and .edu website publications on studies that link depression and anxiety to weight gain.

- .gov and .edu website publications on studies that link Effexor (Venlafaxine) (my med) to weight gain.

- History of sleeping issues with report of extreme exhaustion during my last 4 months of service when mental health declined. Same time I sought mental health assistance in Military and was prescribed stuff. (I did not get my Bi-pap until after 2 years of being out... When my wife first started sleeping in same bed as me and told me it sounded like I was choking at night. I never slept with anyone for years before due to wife being from Philippines. So noone ever told me this fact.)

- I am registered in the VA as someone who spent half a year in close proximity of burn pit. In Burn Pit Registry. Squadron sleeping quarters in deployed base was right on other side of wall of a base burn pit. Which could be causing the breathing issues.

 

Hypertension nexus - Been prescribed high blood pressure pills for 3 years now.

- .gov and .edu website publications on studies that link depression and anxiety to weight gain which is associated with high blood pressure.

- .gov and .edu website publications on studies that link Effexor (Venlafaxine) (my med) to weight gain which is associated with high blood pressure.

- I am going to connect it to my current Service Connection of Retained Renal Calculus. I pass 5-6 Kidney stones per year. Probably 1-2 per year I have to go to ER it seems due to extreme pains. Last month I was sick and dehydrated and passed one. One week later, I am passing a second one. Too painful, had to go to ER. Pass it next day. Week later pass a 3rd. It takes a week to pass, bringing me to hospital twice for it. On final visit, I was calm. 1 Hour prior it was moving and I was screaming in pain. So while I was calm after it had stopped moving for an hour, they took my blood pressure and it was at like 210/140. My argument is that I had gone nearly an entire month with this extreme pain due to VA service connection with this high of Blood Pressure. 

 

Does it sound like I am approaching this ok? Does anyone have any advice on things I may need to do to strengthen my case or does this all sound sufficient?

[john999]

Do you have to have in-service DX of sleep apnea or other sleep problems to get service connected?  I have been out of the service for 50 years.  The army never heard of sleep apnea back in the day.  I had sleep problems but never addressed in my medical records.  I could probably get some friendly doctor to say my OSA is related to one of my many conditions but will the VA buy it?

[broncovet]

Welcome to hadit.  Perhaps I can clarify. 

   Unfortunately, "its not enough" for "a medical study" which links sleep apnea to win your claim.  

   The VA doesnt care that much about medical studies, they want a link "from YOUR" medical service to your current diagnosis.  

    You will likely need an IMO/IME or VA docs opinion that "YOUR" sleep apnea is at least as likely as not due to an event in YOUR service, or secondary to "your" sc conditions.  

    Example: Lets say the "average" income in your county is $65,000 per year.  Does this mean "you" made 65k last year?  NO.  YOur income could be more, less, or equal to 65k.  You may or may not be "average" in income.    In a similar way, "you" were not a participant in the medical study, "YOU" are applying for benefits, not "Joe Average".  

    Bottom line:  To win, you will need medical evidence..if a "doctor" cites the medical evidence, it becomes credible.   If you or I cite medical evidence...yawn...it means little.  GET an IMO to win it. 

[Berta]

This statement is great!

"This time saying that they found a lot of errors in how it was handled and are sending me to a 3rd party to get an official outside opinion as a Higher Level Review."

a lot of errors- I sure bet they did make lots of errors in your claim.

I do agree you might need an IMO/IME from a independent doctor, it will cost you some money but it might be the Best investment you can make-

BTW-there is info here on Burn Pits and some veterans have been awarded already.

 

 

 

[Berta]

https://www.va.gov/vetapp20/files12/20080721.txt

The VA apparently used the Gulf War regulations for this claim- he had veen exposed to Burn Pits.

"Entitlement to service connection for sleep apnea is granted."

In Part:
"The examiner opined that the Veteran’s medical records do not support that his sleep apnea was caused by an in-service event or illness, to include exposure to burn pits.  The examiner noted that his exposure to burn pits has nothing to do with sleep apnea.  He could have lung disease from inhalation of fumes, but it would not affect sleep apnea.  Sleep apnea was not aggravated beyond its natural progression by a specific in-service illness, event, or injury—to include burn pit exposure.  The examiner concluded it is at least as likely as not that his complaints of sleep disturbances are due to a qualifying chronic disability that became manifest during active duty.  The examiner opined that the Veteran has issues with his sinuses which could be aggravating his sleep apnea.  The examiner then stated the Veteran has an undiagnosed sinus issue, which is the reason for his sleep apnea.  The examiner noted that sleep apnea is caused by an upper airway obstruction, and because the Veteran has an undiagnosed sinus problem, this has resulted in sleep apnea.  

The Veteran has consistently reported suffering from sleep apnea that originated during his time in service.  He has maintained that his first symptoms originated following his tour in Southwest Asia.  There are statements from his spouse attesting to his apneic episodes during service.  The January 2020 examiner explained the Veteran’s complaints of sleep disturbances are due to qualifying chronic disabilities that became manifest during active duty.  Further the examiner indicated the Veteran has issues with his sinuses which could be aggravating his sleep apnea.  The Veteran’s undiagnosed sinus issue has caused his sleep apnea.  This opinion leaves room for criticism as to its sufficiency, nevertheless given the numerous statements from the Veteran and his spouse that he suffered from sleep apnea symptoms since service, and the short period of time following discharge of his diagnosis, the Board will find all reasonable doubt in the Veteran’s favor. 

I will try to find more-is there any evidence of rhinitis or any other upper respiratory evidence of a problem in your SMRs?

Do you have a copy of your SMRs? ( Service Medical Records - STRs Service treatment records.

You can raise ANY potential theory of entitlement for anything you claim.

Congrats on the weight loss-

VA likes to blame obesity on anything they can, in order to deny-they tried to pull this on Vietnam vets when DMII became an AO presumptive.

If any of those vets with DMII were denied due to "obesity" I sure hope they succeeded on appeal.

[Berta]

This search feature link here has the skinny on Burn Pits:

https://community.hadit.com/search/?q=burn pits&quick=1

I will post any new info I get -

BrokenSoldier posted this recent info:

https://community.hadit.com/topic/84981-update-from-secretary-of-va-affairs-re-new-presumptives-and-new-airborne-exposures/#comment-508496

In part the Secretary states:

"The second decision involves Veterans who served in Southwest Asia, Afghanistan and Uzbekistan during the Persian Gulf War and after September 11, 2001. After a thorough review of the scientific evidence around toxic exposures, including the report from the National Academies of Science, Engineering and Medicine, I am directing initiation of rulemaking to consider creating presumptions of service connection for chronic respiratory conditions associated with exposure to airborne hazards during military service in Southwest Asia, Afghanistan and Uzbekistan during the covered periods of conflict, which may include asthma, sinusitis and rhinitis. Our approach to this process will be holistic, and we will base our decision on science, in fulfilling our responsibility to Veterans who may have suffered disability due to their service.

 

These decisions will affect millions of Veterans and families, and I encourage everyone in VA to always keep in mind the tremendous impact that we will be making in their health and quality of life as we go through these processes. I look forward to working with you as we further our goal of improving the lives of all Veterans."