Sleep Apnea secondary to depression meds

[Lavish]

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

[pacmanx1]

19 hours ago, Lavish said:

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.   

I have posted this several times, I had my VAMC Rheumatologist write a nexus opinion that my service-connected fibromyalgia caused my sleep apnea. I am rated max at 40%, when the VA granted my Sleep Apnea with a CPAP machine it was rated as 50%. I was expecting the VA to fight me on this claim, but it was granted as soon as the VA got my LHI C & P exam.

[deedub75]

Did you initially claim OSA as direct service connection or secondary? If you are service connected for insomnia and depressions (insomnia is rated under the depression diagnostic code), you could file a supplemental and claim OSA secondary to the obesity caused by the medications you take to treat insomnia and depression. It seems that the examiner already made that nexus for you although I'm not sure if the VA would honor it. It may get granted but then you'd likely have to appeal for an earlier effective date. 

My OSA was granted secondary to chronic sinusitis. I asked my VA doctor at the time if he could order a sleep study because my wife said I snored and stopped breathing at night. When I get the results back I asked him directly if my chronic sinusitis could cause OSA. He said it was it was more than likely the cause of my OSA. I made sure I had him put that statement in my medical records and that became my nexus.  

[Lavish]

4 minutes ago, deedub75 said:

Did you initially claim OSA as direct service connection or secondary? If you are service connected for insomnia and depressions (insomnia is rated under the depression diagnostic code), you could file a supplemental and claim OSA secondary to the obesity caused by the medications you take to treat insomnia and depression. It seems that the examiner already made that nexus for you although I'm not sure if the VA would honor it. It may get granted but then you'd likely have to appeal for an earlier effective date. 

deedub75,

Yes, I filed as secondary, but the examiner said OSA was likely cause by obesity and sedatives (she apparently didn't fully review my records because if she had, I'm SURE she wouldn't have said that).   I agree that the examiner may have already made the nexus with the statement about the sedatives, since I take them as part of my treatment for the depression and anxiety.   I also feel, as you stated, that the VA will would probably not honor it.