Supplemental claim:

[Donny Dollaz]

I am looking for anyone who can provide me some guidance. I was awarded 20% disability for knee arthritis on 5-17-21 but denied sleep apnea as secondary to my knee disabilities on 5-24-21. I did have buddy statements, a letter from my wife, documented diagnosis of severe sleep apnea, a prescription for my CPAP and a nexus letter from my sleep doctor. The nexus letter was ok but probably not as strong as it could have been. I am in the process of obtaining a second nexus letter. My question is, does it make sense to file a supplemental claim or should I appeal directly to the VA Board of Appeals. My VA Rep said we could go either way but the board will take 4 years. I dont want to waste up to 120 days if the local office is more likely to deny me again. Does anyone have experience with getting sleep apnea service connected at the supplemental review? Thanks for any help.

[GBArmy]

Hi Donny Welcome to Hadit. PSA is very difficult to get service-connected because if you are prescribed a CPAP machine, as it is a 50% rated disability. I would suggest that you haven't proved s-c; more than likely the nexus letter isn't strong enough. I would get an additional IMO from a sleep doc that will counter what the c&P examiner has to say. Get a copy of the C&P exam and react accordingly. If it isn't strong enough evidence, going to BVA probably won't work without better evidence. If you want to redact your personal info and then post it on this link, we can look at the nexus. It would be hard to get it secondary to your knee IMHO. Maybe sleep disorder because of constant pain. Research secondaries to your knee disability also. Example does it alter your gate, cause you to walk differently, pain meds cause GERD, back injury from your altered gate, other knee problems., etc.  You have to do your homework.

[Donny Dollaz]

13 minutes ago, GBArmy said:

Hi Donny Welcome to Hadit. PSA is very difficult to get service-connected because if you are prescribed a CPAP machine, as it is a 50% rated disability. I would suggest that you haven't proved s-c; more than likely the nexus letter isn't strong enough. I would get an additional IMO from a sleep doc that will counter what the c&P examiner has to say. Get a copy of the C&P exam and react accordingly. If it isn't strong enough evidence, going to BVA probably won't work without better evidence. If you want to redact your personal info and then post it on this link, we can look at the nexus. It would be hard to get it secondary to your knee IMHO. Maybe sleep disorder because of constant pain. Research secondaries to your knee disability also. Example does it alter your gate, cause you to walk differently, pain meds cause GERD, back injury from your altered gate, other knee problems., etc.  You have to do your homework.

Thanks for your response. I will post the redacted letter tomorrow. Interesting enough, the VA never scheduled me for a C & P exam for sleep apnea, only for my eyes and knees.

[Donny Dollaz]

21 minutes ago, GBArmy said:

Hi Donny Welcome to Hadit. PSA is very difficult to get service-connected because if you are prescribed a CPAP machine, as it is a 50% rated disability. I would suggest that you haven't proved s-c; more than likely the nexus letter isn't strong enough. I would get an additional IMO from a sleep doc that will counter what the c&P examiner has to say. Get a copy of the C&P exam and react accordingly. If it isn't strong enough evidence, going to BVA probably won't work without better evidence. If you want to redact your personal info and then post it on this link, we can look at the nexus. It would be hard to get it secondary to your knee IMHO. Maybe sleep disorder because of constant pain. Research secondaries to your knee disability also. Example does it alter your gate, cause you to walk differently, pain meds cause GERD, back injury from your altered gate, other knee problems., etc.  You have to do your homework.

Thanks for your response. Interesting enough, the VA never scheduled me for a C & P exam for sleep apnea, only for my eyes and knees. I can post the letter, can you tell me how to post it? I only see a link to insert a url. Thanks again. I could even email it to you.

[ShrekTheTank]

Another piece here to add is you need to look through all of your medical records.  If at any point you said you were tired for no reason or something else linked to sleep apnea you can use this to link it.  An IMO is the strongest one, but there are other ways

[pacmanx1]

I agree with the above, not knowing what or if you have any other disabilities, it is hard to say. Keep in mind that any nexus statement must have a plausible medical rationale. In layman’s (plain language)words, your medical opinion must be believable in medical terms. SLEEP APNEA is not a known factor in knee injuries, but it could be connected to service connected: GERD, SINUS PROBLEMS, PTSD or something that has been well studied and or researched. I was awarded SLEEP APNEA secondary to my service-connected FIBROMYALGIA.

Edited July 18, 2021 by pacmanx1

[broncovet]

Agree, sleep apnea is often the most difficult to SC of all claims.  Without a doubt, appeal to the BVA, but make sure your evidence is in order.  

THINK: Caluza Elements

Additionally, for OSA your doctor needs to specify, in your records, that a cpap "is medically necessary".  I have heard of them being denied, lacking this statment, but this is a secret the VA does not want Vets to know.  

You would think Va would connect the dots, I mean, gee, are you wearing a cpap at night as a fashion statement?

Dont count on VA to connect the dots.  

I "assume" you are using the cpap, and you did not get a prescription  for one and leave it in your closet.  Most of those Cpap's record your use/lack of use.  I use mine every night.  Getting a cpap and not using it most of the time does not bode well for OSA Service connection.  

I was also denied SC for OSA.  Eventuallly I dropped the appeal, even tho I thought it was strong, mostly because my lawyer asked me to.  

It became moot, as I have 100 percent plus SMC S, and additional comp for OSA wont mean additional compensation for me.  

In the 70's when I was in service, virtually no one ever heard of OSA.  So there was certainly no diagnosis.  

Then, you get to Caluza element 2, in service event.  What is an in service event which causes OSA?  

A broken nose from a nose-fist collision could do it, as could a nose collsion with other objects.  

Perhaps you understand that, when you get an entrance physical, the VA presumes it correct, absent contrary evidence.  

So, when you exit service, the presumption is, if now noted on your exit physical, "you got it from service".  No osa when you go in, yes osa when you get out assumes you got it in service.  But you often have to fight for that presumption.  Rating specialists often point to "no in service event".  NO, you dont have to have a in service OSA DIAGNOSIS, that can come later along with the nexus.  

If your VSO thinks a nexus is a car made by Toyota, then you may need another VSO.  

Edited July 18, 2021 by broncovet