UPDATE---Insomnia NOT secondary to PTSD

[flynsolo2]

UPDATE Sept. 19, 2022....

 

Still fighting this. I received a sleep study through the VA, where they diagnosed OSA and snoring and ordered a CPAP. I asked my VSO to resubmit this claim under supplemental, since the VA has now deemed a CPAP machine medically necessary and he said it would still probably get denied. I thought once the VA orders you a CPAP, it all but guarantees you a MINIMUM rating of 30%? Am I wrong? Anyone out there, how were you able to get your OSA approved?

 

Okay, so I know that a lot of times, insomnia is put under the symptoms of PTSD, however, I am trying to get it as a separate condition ( that insomnia is now worsened by my PTSD).

I was treated for insomnia (with medications) while active duty. I was not diagnosed with PTSD until several years AFTER I was discharged, and after years of being on medications to treat my insomnia. I have tried putting in for the insomnia, and they keep putting it under PTSD and denying the claim-I even put in for a higher review, which was just quickly (20 days) denied. I am now sending in my medical records while active duty (because apparently they are not even looking at these), but I am wondering if anyone has any idea/verbiage, etc.. to get them to look at my insomnia as a separate claim from PTSD? My PTSD has increased now to 70%, and they are listing insomnia under symptoms, but, again, the insomnia was being treated for years, while active duty, and BEFORE PTSD was diagnosed AFTER being discharged..... 

Side note: I am personally not submitting these claims. I am working with a VSO, who is working on this claim...

Also of note: I am not having breathing issues/CPAP; I  cannot fall asleep or stay asleep,  (even with some serious medications being prescribed). And the insomnia has gotten worse as my PTSD has also worsened......

 

Edited September 19, 2022 by flynsolo2
new update in claim

[Dustoff1970]

Yes, flynsolo the BVA backdated my OSA grant for 5 years and they automatically granted me an additional SMC-S rating as I was P&T TDIU  with a 30% additional IHD heart disease rating and the new 50% OSA rating added up to more than the required additional 60% rating to qualify for SMC-S that is over $300.00 a month more in pay.

This SMC-S rating is one reason vets with 100% ratings file claims for other additional disabilities.  The choice is yours.

[flynsolo2]

@broncovetI am at a 90% disability rating as of right now. I think the last time I calculated it out, it was maybe 93%? I cannot remember, honestly. 

My concern now is that the insomnia is seriously affecting me and my ability sometimes to get through the day-I am so tired and I am on medicines that are strong and my dr is concerned about upping my dosage, but, then I am on medications for PTSD and I keep thinking if being on all this medication eventually has some effect on my health, I do want it recognized as a disability. You just never know what the end may hold, and if something is caused from medications I am taking now for a condition, I do not want my family to be denied on a technicality or something....

I do wish I was 100%, but the VA seems to make it impossible to get there.....they also denied my Degenerative disc disease -related to back issues and surgery that were service-connected.  It's very frustrating.

[JKWilliamsSr]

2 minutes ago, flynsolo2 said:

@brokensoldier244th Yes, that is what I think they could state, that my insomnia may have been a part of undiagnosed PTSD, however, then wouldn't they have to show that my PTSD was current while active duty, (and then possibly have to change the date of my PTSD? Can they claim PTSD without an active diagnosis at the time of another actual diagnosis?) I  don't know how all this works, (and you may be right-that my insomnia was caused by undiagnosed PTSD), however, they diagnosed insomnia and medications while in service but did not diagnosed PTSD until several years later. If they claim that the insomnia is a symptom of PTSD, wouldn't it also mean they would have to change the date of my PTSD? I am not sure how they could state the insomnia being a symptom of PTSD without a PTSD diagnosis (on file for the same time period). 

Again, just talking out loud, not sure how all of this goes.....

Any service connected disability only has to shown to have been caused or aggravated while on active duty.   If I am understanding it correctly some of the PTSD and Insomnia symptoms overlap and one could easy tie the symptoms to both of them.  Most people will not be seen for PTSD issues while on active duty because that would be a fast track out the door.   When filing for PTSD the stressor would need to be shown to have occurred while on active duty.  For example a friend of mine did not file for PTSD for 10 years after he got out.   When he finally filed his service records showed him being in combat areas and I believe he had a combat service medal. 

[JKWilliamsSr]

4 minutes ago, flynsolo2 said:

....they also denied my Degenerative disc disease -related to back issues and surgery that were service-connected.  It's very frustrating.

Do you still have the denial letter?  If you can put what they list in the reasons and bases for the denial we may be able to give information that could help there as well.  Are these conditions service connected but rated at 0%?

Edited April 6, 2022 by JKWilliamsSr

[brokensoldier244th]

If you didnt claim PTSD within 1 yr of service then the date of the rating is from whatever date you filed the claim.

There doesnt have to be a current diagnosis for something to 'be' under something else. I work MST/PTSD claims exclusively and I get a lot of stuff, things that we call 'markers', that manifest while in svc, shortly after, or sometimes long after, that end up being indicative of MST related traumatic PTSD. It doesn't change the effective date if they claimed it years later but it DOES serve as evidence that a condition might have existed while in service, which is a path to service connecting it. 

[flynsolo2]

@JKWilliamsSr I have the original denial letter from 2011 and then the most recent denial letters. 

The original denial letter stated that, "service treatment records from April 30 2002 to April 29 2006 (my active time) note no complaints, treatments or diagnosis of lumbar disc disease with chronic pain and lumbar radiculopathy. 

Private treatment records from May 5, 2008 to October 1 2009 notes complaints of low back pain radiating in to the left leg and into the thigh, calf and knee. You were diagnosed with discogenic low back pain and left lower extremity radiculopathy; you underwent an anterior lumbar interbody fusion on March 17 2009; treatment records from October 1 2009 notes residual complaints of pain but substantial improvement from preoperative status. "  

It then goes on to state that, "VA outpatient reports were reviewed. Treatment records shows you started with VA pain management in October 2010; first lumbar spine x-ray, dated April 3, 2008, noted normal lumbar lordosis, apparent minimal old compression deformities of some of the lower dorsal vertebrae noted, otherwise no definite evidence of recent fracture. "

"VA medical opinion, dated on June 1, 2011, noted is not likely that your claimed lumbar disc disease condition is the same as or is the result of back complaints during active duty. The examiner's rational for the pinion given is noted as there is no medical documentation of lumbar disc condition during active duty. Additionally, the examiner opined is not likely that your lumbar disc disease i8s due to not aggravated by your service-connected lumbar strain. The examiner's rationale for the opinion given is noted as there is no medical evi8dence of lumbar disc condition in service; and, per medical definition/literature, a lumbar stain is a self-limiting event and does not involve the disc. Although there is evidence of a current disability, as the evidence fails to show that your lumbar disc disease with chronic pain and lumbar radiculopathy began in military service or was caused by some event or experience in service, or that it was diagnosed to a compensable degree, withi8n one year after military discharge, service connection for lumbar disc disease s/p lumbar fusion with chronic pain and lumbar radiculopathy is denied."

As the letter states, I did have surgery for service-connected disability on my L4-5.

Right now, I have residuals, lower back musculoskeletal strain, status post laminectomy L4-5 at 20%,  right shoulder bicipital tendonitis (previously rated as residuals, right shoulder musculoskeletal strain) 20%, radiculopathy, left lower extremity, sciatic nerve 20%, residuals, left knee patellofemoral syndrome with shin splints 0%, and residuals, right knee patellofemoral syndrome with shin splints 0%. Both left shoulder and the lumbar disc disease related to these disabilities have all been continually denied. 

I put in for, and am currently awaiting a hearing, for appeals. I filed it back in April 2021 for the lumbar claim that keeps getting denied; I am hoping I will have more luck on this route...

Edited April 6, 2022 by flynsolo2