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Sleep Apnea secondary to depression meds


Lavish

Question

I am trying to decide if I should file a supplemental claim for Sleep Apnea to get back pay from a claim I've kept alive since 2015.   My last Sleep Apnea claim was a HLR that was denied April 2021.   As of 2020, I'm rated 100% P&T for depression and anxiety, after filing for an increase.    

In 2015, I was rated 50% for depression.  In 2021, I received back pay for a 40% Fibromyalgia rating, with an effective date of 2015, since I'd also kept that claim alive.   I was denied Headaches and CFS, but later awarded 0% for CFS in a HLR with an effective date of 2015.     The CFS C&P Exam was conducted as part of a Gulf War General Medical Exam.   

During the Gulf War General Medical Exam, several different DBQs were done as part of presumptive conditions related to the Gulf War - two of them were Headaches and Sleep Apnea.   However,  none of these DBQs were addressed in the HLR, CFS, decision letter - apparently since the exam was specifically requested for CFS. 

I'm going to submit the supplemental for Headaches and I think I will be awarded 30%, due to the examiner stating they are "a diagnoseable but medically unexplained chronic multi-symptom illness of unknown etiology".

My question is, based on the below information from the DBQ for Sleep Apnea and the fact that I want to claim as secondary to medications that cause weight gain - which IS the reason I've gained the weight (I've taken every med in the book for depression) and perhaps also claim as secondary to Fibro, do you think I have a chance or am I just wasting my time?   

I've gone back through as many records that I could find to document my weight history, but have only been able to locate 1991 - 1998 (VA records) and 2005-present  (PCP records).   I stopped going to the VA in 1998 and my PCP said all of my records, prior to 2005, have been destroyed.  Unfortunately,  I started taking the depression meds in 2001 and that is part of the missing years.   I am able to document a 62 pound weight gain from 1998 to 2005, but I don't know if VA would consider that to be normal progression or not, but the weight didn't start piling on until I started taking the meds.  

Note:  VA previously denied sleep apnea due to the examiner stating that sleep apnea is more likely due to me being obese and taking sedatives.   

My headaches were denied because examiner stated my headaches are more likely due to the sleep apnea and use of sedatives.   I am prescribed the sedatives (sleeping pills) due to my depression and insomnia.  I've been having the headaches since the Gulf War.

SECTION I - DIAGNOSIS

Does the Veteran have or has he/she ever had sleep apnea?

 [X] Yes   [ ] No
 [X]  Obstructive     ICD code:  G 47.33      Date of diagnosis: 2/1/2010
 
SECTION II - MEDICAL HISTORY
Date of onset:  1990s
Details of onset:  Veteran started having trouble falling asleep and staying asleep
Course of condition since onset: 
[X] Stayed the same
Any treatment, medications, or surgery?  Zolpidem extended release
 
2B.  Is continuous medication required for control of a sleep disorder condition?
{X] Yes 
(if  "Yes" list only those medications required for the veteran's sleep disorder condition):
Zolpidem extended release
  
2C.   Does the Veteran require the use of a breathing assistance device such as continuous positive airway (CPAP) machine?
 [ X] Yes   [] No
 
SECTION III - FINDINGS, SIGNS AND SYMPTOMS
Does the Veteran currently have any findings, signs or symptoms attributable to sleep apnea?
[X] Yes   [ ] No
If yes, check all that apply:
[X]  Persistent daytime hypersomnolence 
 
SECTION IV - OTHER PERTINENT PHYSICAL FINDINGS, COMPLICATIONS, CONDITIONS SIGNS AND/OR SYMPTOMS
[] Yes [X] No
 
SECTION V - DIAGNOSTIC TESTING
5A.  Has a sleep study been performed?
[X] Yes   [ ] No
(If "Yes" does the Veteran have documented sleep disorder breathing?)
 [X] Yes   [ ] No
Date of sleep study:  02/01/2010
Results: Obstructive Sleep Apnea.
5B.  Are there any significant other significant diagnostic test findings and/or results?
[] Yes   [X]  No
 
SECTION VI - FUNCTIONAL IMPACT
6.  Does the veteran's sleep apnea impact his or her ability to work?

   [X] Yes   [ ] No

(If "Yes" describe impact of the veteran's sleep apnea, providing one or more examples):

Can't do physically demanding work; can't do work requiring accuracy

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The exam, above, "does not" give the etiology.  Etiology means "the cause" of your sleep apnea.  

Often, the c and p exam doc "does not" give an etiology, but rather leaves the cause to others.  

This is a claim killer, you must have an etiology, (nexus), something close to 

"The Veterans sleep apnea is at least as likely as not due to his SC PTSD"

You can look in your file, to see if other doctors have rendered a similar opinion.  

The doc "could" say, that your sleep apnea is due to medications for PTSD, but you do need an opinion (nexes) before you get an award.  

My advice, is therefore:  Check your records to see if a doctor has put in a nexus statement, like that I described.  If you have the nexus, well appeal. 

If you dont have the nexus, you can still appeal, but you will likely need an IMO/IME opinion that your sleep apnea is at least as likely as not due to PTSD.  

Here is where my advice turns.  "If" getting OSA (50 percent if SC and you use a cpap) means you will get additional comp, go for it.  

But, if another 50 percent wont increase your pay, I probably would drop it.  I dont fight VA for "funsies", if there is little chance of increasing comp, I dont do it "UNLESS" it could benefit my spouse with DIC.  

For DIC remember these 2 things:

    If you die "of a sc condition" then your spouse should get DIC.  OR, if you die of "any" condition, after you have been 100 percent P and T for 10 years, you should also get DIC.  

    So, if you already have been P and T for 10 years, your spouse should get DIC regardless of whether or not you died from sleep apnea.  But, if you have been P and T LESS than 10 years, and its possible sleep apnea could cause your death, by all means provide for your spouse by getting SC for sleep apnea even if it means no money for you.  

Take care of your spouse!  I do!  

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3 hours ago, broncovet said:

The exam, above, "does not" give the etiology.  Etiology means "the cause" of your sleep apnea.  

Often, the c and p exam doc "does not" give an etiology, but rather leaves the cause to others.  

This is a claim killer, you must have an etiology, (nexus), something close to 

"The Veterans sleep apnea is at least as likely as not due to his SC PTSD"

You can look in your file, to see if other doctors have rendered a similar opinion.  

The doc "could" say, that your sleep apnea is due to medications for PTSD, but you do need an opinion (nexes) before you get an award.  

 

broncovet, thank you for your response.  That was my concern (I don't have a nexus) - just my theory of the cause of the weight gain due to the meds which likely caused the sleep apnea along with some documentation of the weight gain.   I wouldn't mind paying someone to give an IMO to provide a nexus, but I read so many post about people who were still denied even after a nexus.    The reason for pursuing it is for the back pay. 

 I may not pursue it; however, I'm wondering if the VA denial letter stating that the examiner said "sleep apnea is more likely due to being obese and taking sedatives" is a nexus in itself, since I take the sedatives to part of the treatment for the mental health condition.  Your thought?

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Were the "sedatives" prescribed for SC PTSD?  If so, then I agree this may be a nexus, but, it really does not matter what "I" think, but rather the decision maker.  

If it were me, I would appeal, and you can decide at a future time, if, or where to get an IMO.  

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16 minutes ago, broncovet said:

Were the "sedatives" prescribed for SC PTSD?  If so, then I agree this may be a nexus, but, it really does not matter what "I" think, but rather the decision maker.  

If it were me, I would appeal, and you can decide at a future time, if, or where to get an IMO.  

broncovet,

I've been diagnosed with major depressive disorder and anxiety for over 20 years.  The VA only awarded it as of 2015, after over 20 years of filing claims, it taking VA years to make a decision - only to deny, and then me letting the claims die w/o appealing. 

But, yes the "sedatives" are prescribed as treatment of the insomnia related to the depression and side affects of the depression medications. 

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2 hours ago, Dustoff 11 said:

 

U.S. CAVC veterans court has ruled in several decisions that the above medical evidence is adequate for granting a BVA appeal and without a doctor's nexus statement being required but of course very helpful.

As expected and usual the C&P examiner and VARO denied all this evidence as "No evidence".  Even without Dr. Anaise nexus letter statement I feel confident I would have won my appeal because I have read many BVA appeals where the BVA granted overweight vets OSA sleep apnea due to PTSD and based upon the other evidence I listed above and some of those vets did not have a doctor's medical opinion connecting OSA to PTSD. So no a doctor's nexus statement is not absolutely required if you have other combined favorable medical and non medical evidence to support your claim.  Often the BVA will state the examiner and/or VARO gave an inadequate reason and basis explanation or none at all when ruling against the VARO and granting the vet his appeal.

 

Dustoff, 

I think most have to actually go to BVA to get awarded OSA, even when there is sufficient documentation in the file.   I just don't think I'm willing to do that because the long wait for the decision would be too nerve racking for me.  I know one should file it and forget it, but I wouldn't be able to do that... my mind already runs a 1000 times a minute worrying about things.

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Just remember that it may be harder for some individuals to get a 50% rating that they can get currently when the new proposed changes to OSA are approved and implemented. It will drop to 30% for many people., even if you do use a CPAP. If you have the evidence now, I would suggest you appeal now.

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