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ANYONE HAVE DIRECT EXPERIENCE CONNECTING SLEEP APNEA SECONDARY TO CAD


Corwin

Question

HI,

I AM VIETNAM VET RATED 60% CAD AND 10% TINITUS. ALSO HAVE BEEN TO APPROXIMATELY 12 MONTHS COUNSELING FOR PTSD BUT NEVER APPLIED. ABOUT 10 MONTHS AFTER CAD RATING ( AND 7 YEARS AFTER MILD HEART ATTACK AND STENT AT 54) I WENT TO LOCAL SLEEP CENTER STUDY GROUP DUE TO INCREASING SLEEP DISTURBANCE ISSUES, MULTIPLE AWAKENINGS, INCLUDING HYPER VIGILANCE, SNORING, ETC. NEVER HAD ANY ISSUES EARLIER IN LIFE. RECEIVED SLEEP APNEA DX (WHICH WAS SENT TO MY VA DOC) AND IMMEDIATELY WENT ON CPAP MACHINE-IT HELPED A LOT.  NEVER THOUGHT MUCH ABOUT SECONDARY OR ADDITIONAL CLAIMS UNTIL A FRIEND POINTED THEM OUT TO ME. HAS ANYONE HAD POSITIVE RESULTS PROVING SLEEP APENEA SECONDARY TO CAD? D O YOU HAVE A REFERENCE TO A GROUP OR SLEEP CONSULTANT WITH EXPERTISE TO WRITE A NEXUS OPINION.  IS THE "VA CALIMS INSIDER" A GOOD WAY TO GO AS I DON'T WANT TO SPEND THE REST OF MY LIFE GOING THROUGH APPEALS, ETC. THANKS IN ADVANCE FOR ANY HELP AND/OR ADVICE.

NICK USMC 66-70

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Corwin No,no experience. You will need a strong IMO from a medical person. I am curious though. Why don't you pursue a MH claim. You may get a 30% or higher and that would set the stage for TDIU and 100%. If you have med records of counceling/treatment, why wouldn't you? Certainly with a heart condition, depression and/or anxiety come into play even if PTSD doesn't. Pick the low hanging fruit IMHO.

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Why gear up for a fight?  The first thing to do is review your current treatment records, you may already have a good or strong IMO (MEDICAL OPINION) that your current mental health disorder is related to your military service or your current service-connected disabilities. Your current treating social worker and or your current psychiatrist can diagnose PTSD or any other mental health disorder. Again, simply filing a claim could possibly get you the rating that you seek and if not, you can then get help from an attorney. Veterans don’t need attorneys until their appeals go to the CAVC, but some veterans get when their appeals go to the BVA. The new appeal system, if it ever clears up appeals should not take but maybe a year or two compared to decades like mine.

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I don't feel you need an IMO just yet.

After an “incident” my doc sent me to a shrink and sleep apnea test.  Came out with PTSD determination and severe sleep apnea. 
applied for both separately.  PTSD approved and sleep apnea disapproved - not enough to make a service connectrion.

researched using Board of Naval appeals (great resource) and found 1) hard to prove sleep apnea without extensive med record documentation and 2) easy if apply as “secondary” to PTSD.  

Appears you qualify for PTSD and also sleep apnea.

my recommendation would be file a claim for PTSD and after approved, if that doesn't get you to 100% P&T, then file sleep apnea as secondary to PTSD. 
i got the sleep apnea approval back in record time   

just saying

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Great advice above!!!!!

I didnt search the BVA for SA secodary to CAD ( possible) but I think SA secondary to PTSD is the way to go-

"ORDER

Service connection for sleep apnea as secondary to posttraumatic stress disorder (PTSD) is granted."

https://www.va.gov/vetapp20/Files12/A20018537.txt
(This veteran had one  VA doctor's opinion against the claim, than one VA opinion for the claim. with   medical literature to support his claim 
and he was denied at the RO level-!!!
This case just goes to show that some ROs are illiterate or unwilling to consider probative evidence or weigh it carefully.
Unfortunately the BVA never stated what RO the claim came from, and it appears the vet might not have had a POA rep.
This was a CUE under violation of 38 CFR 4.6, if filed, on the January 2020 decision, that could have been awarded at the RO level.
However it appears the BVA made a fairly  fast appeals decision on this.)

One more:

"ORDER

Entitlement to service connection for obstructive sleep apnea, secondary to the Veteran’s service-connected posttraumatic stress disorder (PTSD), on a causation basis, is granted.  "
https://www.va.gov/vetapp20/Files12/A20019526.txt

(This veteran  had a strong IME from a private psychologist, that was weighed against the VA's examiner's opinion, thus relative equipoise kicked in ( Benefit of Doubt )
https://www.va.gov/vetapp20/Files12/A20019526.txt


"ORDER

Entitlement to service connection for obstructive sleep apnea as secondary to posttraumatic stress disorder (PTSD) is granted. 

FINDING OF FACT

The Veteran’s obstructive sleep apnea is at least as likely as not due to his service-connected PTSD.
The November 2017 medical opinion coupled with the medical articles submitted by the Veteran in June 2018 demonstrate a strong link between PTSD symptoms, treatment, and the development of sleep apnea, and indicate that the Veteran’s obstructive sleep apnea is caused by his service-connected PTSD.

The Board finds that the opinions are each sufficiently probative to place the question of secondary service connection in equipoise. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). When resolving all reasonable doubt in the Veteran’s favor, the Board finds that the evidence is at least in relative equipoise regarding secondary service connection. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Where the scales are balanced, the Veteran prevails. 38 C.F.R. §§ 3.102, 3.310(a). As such, service connection for obstructive sleep apnea as secondary to service-connected PTSD is warranted."
(The decision states  a study done by 
the National Sleep Foundation; “PTSD Severity Linked to Higher Risk of Sleep Apnea in Veterans” from Psychiatry Advisor, “High Risk of sleep apnea in Young Veterans with PTSD” -as many others have used to bolster their SA from PTSD claims. 
I will try to find the study and post the link here.


 

 


 

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PS- you will need proof of a stressor for the PTSD claim,  but VA will usually concede the stressor if you have the PH, CAB, or CIB on your DD 214-and maybe even your MOS would indicate stressor without trying to get a lot of proof.If you have the PUC or other awards decorations, those too might be enough to concede the stressor or stressors.....

My dead husband was 1stMARDIV 65-66 , Danang ,close to your incountry time frame and he had muliple stressors all verifiable.

But a VA Director, also who was a VA shrink, was at the scene of a stressor my husand relayed to him-

( a horrible volunteer recovery job-I think it was at the Purple River Vietnam) and the VA director had to treat some of the Marines at the scene, as a psychologist-)

while my husband was waiting for the VA to arrest him. He had tried to choke an Oriental VA loan officer who looked to him like the enemy.)

No arrest, a PTSD diagnosis and a buddy statement from the Director. 1983- and 30% SC fpr PTSD in a few months ( up to 100% P & T when I became the claimant on his pending claims at death.

I have the complete History of Vietnam War and Unit info etc etc and if you need help to prove the stressor(s) I can help with that here.

BTW, have you ever applied for a DD 215?

Prior to my huysband;s discharge they were all herded into a big room to fill out forms for their DD 214. His unit -First Amphibious tractor Battalion- ( formerly 3rdMARDIV, Changes by Admiral Zumwalt )heard scuttlebutt that they got the PUC but they had no proof of that and did their best to put down what they had decorations./ awards for.

My husband applied for a DD 215 and it came shortly before his death- and it had the PUC and other awards/decorations on it-and he felt worthwhile and even  proud for about a few days-then went into a rage over it because all of those awards meant the deaths of so many Marines-and he fell into a depressionm with many angry outbursts.

Also he had sent the VA a wall tracing of his closest friend in Vietnam whose death he witnessed.I dont think the VA ever even noticed it.

If a Vietnam vet knows the actual name ( nicknames were popular there ), of a dead Marine and knows their Hometown, and approximate date of their death, in Vietnam, ,the Wall people can find their place on the Wall for a tracing. The Wall is also on line. And the Travelling Wall is still available too as far as I know. 

When I took my daughter to DC to see the Wall, the week it was dedicated,long ago ,I never knew at that time what the aftermath of the Vietnam War would mean to me...or to my daughter.....it changed our lives completely. Still does. Every day.

DD 215 :

The application has changed a little-you can put No injustice just verification of my awards/decorations, and any that are missing from My DD 214.

They will send a DD 215 in lieu of the 214-

many years ago they sent a short  DD215 that you had  to submit along with the corrected regular sized DD214.

https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd0149.pdf

 

 

 

Edited by Berta
CTS (see edit history)
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I stopped wasting my time a long time ago with asking for DROs and now HLR reviews from the VARO raters as they rubber stamp the denials of a fellow former VARO raters and I go straight to a BVA appeal with a more open minded and "professional" BVA lawyers and judges where I recently received two fair analysis and favorable decisions from the BVA.  There is no comparison between the BVA and DA slug VARO just say NO raters.

In order to save time DO NOT use the direct appeal to the BVA as you close off any option to send any late new and/or material evidence to the BVA to support your case that may come your way late in the appeal.  To make sure the BVA actually sees Dr. Anaise nexus opinion send his MO AGAIN directly to the BVA as it hurts you not one bit to do so or at least include his MO with your appeal Form.

If you have not yet done so then send it with your NOD.  Although rare it might work.

You are in good shape to win a BVA appeal.  Good luck.

My comment is not legal advice as I am not a lawyer, paralegal or VSO so do not contact me for more info folks.

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On 1/23/2022 at 1:45 PM, Corwin said:

HI,

I AM VIETNAM VET RATED 60% CAD AND 10% TINITUS. ALSO HAVE BEEN TO APPROXIMATELY 12 MONTHS COUNSELING FOR PTSD BUT NEVER APPLIED. ABOUT 10 MONTHS AFTER CAD RATING ( AND 7 YEARS AFTER MILD HEART ATTACK AND STENT AT 54) I WENT TO LOCAL SLEEP CENTER STUDY GROUP DUE TO INCREASING SLEEP DISTURBANCE ISSUES, MULTIPLE AWAKENINGS, INCLUDING HYPER VIGILANCE, SNORING, ETC. NEVER HAD ANY ISSUES EARLIER IN LIFE. RECEIVED SLEEP APNEA DX (WHICH WAS SENT TO MY VA DOC) AND IMMEDIATELY WENT ON CPAP MACHINE-IT HELPED A LOT.  NEVER THOUGHT MUCH ABOUT SECONDARY OR ADDITIONAL CLAIMS UNTIL A FRIEND POINTED THEM OUT TO ME. HAS ANYONE HAD POSITIVE RESULTS PROVING SLEEP APENEA SECONDARY TO CAD? D O YOU HAVE A REFERENCE TO A GROUP OR SLEEP CONSULTANT WITH EXPERTISE TO WRITE A NEXUS OPINION.  IS THE "VA CALIMS INSIDER" A GOOD WAY TO GO AS I DON'T WANT TO SPEND THE REST OF MY LIFE GOING THROUGH APPEALS, ETC. THANKS IN ADVANCE FOR ANY HELP AND/OR ADVICE.

NICK USMC 66-70

If you had exposure to solvents let me know and I can send some good info

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Here is a direct quote from a private doctor's medical nexus opinion that helped me win my OSA Sleep Apnea appeal from BVA recently.

"A smaller group of claims request designation of service connection for non-service-connected conditions which were aggravated by a service-connected condition. The best examples are sleep apnea aggravated by service-connected PTSD, or coronary artery disease caused by Agent Orange. In these cases, individualized evaluation and physical examination are not helpful in determining how Agent Orange was a substantial factor in developing coronary artery disease years after the Vietnam War. Rather, the veteran is a member of a class of individuals who was exposed to Agent Orange and in-whom by excellent scientific studies scientists found that the incidence of coronary artery disease is far higher in that class of veterans serving in Vietnam as compared to veterans who do not serve in Vietnam.
Such is the case here – the veteran is a member of a class of individuals. Physical examination does not contribute to answering the question of whether or not PTSD and IHD can cause and/or aggravate sleep apnea; these are scientific questions".

As you can see he successfully argued in a 22 page detailed explanation that both my VA Vietnam service connected long term AO IHD Ischemic Heart Disease and my VN long term PTSD caused and aggravated my OSA Sleep Apnea with CPAP machine.

He also supplied many pages of medical treatise, research studies from reputable creditable institutions to support his lengthy favorable opinion. His charge to me was only $1500.00 for TWO separate opinions for TWO separate medical appeals.  

The VARO totally ignored all my other extensive positive medical evidence to support my claim and gave me a denial with stupid statement of "NO EVIDENCE"

I sent the doctor's nexus opinion directly to the BVA after denial from VARO.

This was first and only time I used a formal nexus statement from a doctor as many other claims and appeals were granted to me based upon other medical and non medical evidence I submitted with my claims.

This comment is not legal advice as I am not a lawyer, paralegal or VSO.


https://www.facebook.com/Vietnam-Dustoff-Medevac-112614780575067/?ref=pages_you_manage

BA Degree Finance & Tax Accounting, Former SEC CFP, Former Army Guard and Civilian helicopter pilot to Two Texas Governors, 

Advanced FAA and British CAA/Singapore Helicopter Airline Transport Pilot IFR License, FAA and CAA Helicopter Instrument Instructor Pilot License for all Weather Flight, etc. etc. 

Former volunteer Army medevac Pilot Vietnam with Purple Heart, CMB, DFC medal, AMs 1970,

Former volunteer UN civilian solo helicopter rescue pilot 1980 south China Sea (Saved over 1000 VN boat people)

235442534_CloseupcombinedphotoofPerkins498thUH-1HDustoffmedevacStarsStripesnews-Copy-Copy(2).thumb.JPG.7f251e91eaac1d53ed49004c4f1e95a9.JPG

Edited by Dustoff 11 (see edit history)
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On 3/29/2022 at 4:46 AM, Dustoff 11 said:

Here is a direct quote from a private doctor's medical nexus opinion that helped me win my OSA Sleep Apnea appeal from BVA recently.

"A smaller group of claims request designation of service connection for non-service-connected conditions which were aggravated by a service-connected condition. The best examples are sleep apnea aggravated by service-connected PTSD, or coronary artery disease caused by Agent Orange. In these cases, individualized evaluation and physical examination are not helpful in determining how Agent Orange was a substantial factor in developing coronary artery disease years after the Vietnam War. Rather, the veteran is a member of a class of individuals who was exposed to Agent Orange and in-whom by excellent scientific studies scientists found that the incidence of coronary artery disease is far higher in that class of veterans serving in Vietnam as compared to veterans who do not serve in Vietnam.
Such is the case here – the veteran is a member of a class of individuals. Physical examination does not contribute to answering the question of whether or not PTSD and IHD can cause and/or aggravate sleep apnea; these are scientific questions".

As you can see he successfully argued in a 22 page detailed explanation that both my VA Vietnam service connected long term AO IHD Ischemic Heart Disease and my VN long term PTSD caused and aggravated my OSA Sleep Apnea with CPAP machine.

He also supplied many pages of medical treatise, research studies from reputable creditable institutions to support his lengthy favorable opinion. His charge to me was only $1500.00 for TWO separate opinions for TWO separate medical appeals.  

The VARO totally ignored all my other extensive positive medical evidence to support my claim and gave me a denial with stupid statement of "NO EVIDENCE"

I sent the doctor's nexus opinion directly to the BVA after denial from VARO.

This was first and only time I used a formal nexus statement from a doctor as many other claims and appeals were granted to me based upon other medical and non medical evidence I submitted with my claims.

This comment is not legal advice as I am not a lawyer, paralegal or VSO.


https://www.facebook.com/Vietnam-Dustoff-Medevac-112614780575067/?ref=pages_you_manage

BA Degree Finance & Tax Accounting, Former SEC CFP, Former Army Guard and Civilian helicopter pilot to Two Texas Governors, 

Advanced FAA and British CAA/Singapore Helicopter Airline Transport Pilot IFR License, FAA and CAA Helicopter Instrument Instructor Pilot License for all Weather Flight, etc. etc. 

Former volunteer Army medevac Pilot Vietnam with Purple Heart, CMB, DFC medal, AMs 1970,

Former volunteer UN civilian solo helicopter rescue pilot 1980 south China Sea (Saved over 1000 VN boat people)

235442534_CloseupcombinedphotoofPerkins498thUH-1HDustoffmedevacStarsStripesnews-Copy-Copy(2).thumb.JPG.7f251e91eaac1d53ed49004c4f1e95a9.JPG

Dustoff,

As fate has it, in early march I actually used that self same Dr to review my case and I included his multi page analysis and nexus conclusions as to sleep apnea being secondary to both (and/or) my service connected DX of CAD and tinnitus. The VA reviewer blew me off in a 30 days response with a denial. The denial was bare bones, no detail in explanation (i.e. ...the evidence of record does not show that your current condition is related to any other service connected conditions.Therefore, secondary service connection cannot be established (38 CFR 3.307, 38 CFR 3.310.)), etc.

The fast track system only allows claimant to show one disability in their format but I attached a statement saying I was also claiming sleep apnea as secondary to my tinnitus DX. This was never addressed at all!  There was not a  C&P exam request and the reviewer only showed as asking for/apparently reviewing my discharge physical as well as only the past 18 months of VA appointments even though my CAD and tinnitus dx were from 2010. BTY, my first actual CAD incident as (minor heart attack and stent) used to document my original claim occurred in 2004. MY sleep apnea DX as reported to the VA occurred in 2012 ( i enclosed copies) and I had VA physician appointments about sleep apnea in 2013 and 2014, both of which it took me about 15 minutes to find using my ebenefits account. The Dr's nexus letter  which addressed both the CAD DX as well as the tinnitus DX was never addressed at all. No rebuttal, no counter theory or fact, they just ignored it!  Even worse, the reviewers "favorable findings" section only identified my CAD DX and then stated .."you have been diagnosed with a disability. Your VA examination conducted on March 8, 2022 confirmed an active sleep diagnosis."  You will note that my latest VA appointment was on Jan 25th-haven't been there since.  I guess I naively expected that the reviewer would be sensitive to his responsibility to "assist" in substantiating a claim. And I am still waiting for a surgical referral based on my Jan 25 visit. Irony?

In your opinion or any of the more experienced folks out there, do I bother with a higher level review  and point out all the errors, disservice in view of VCAA, etc. or just go to a BVA review? 

 

Thanks in advance,

NIck C-tired old Marine

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