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flynsolo2

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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 by flynsolo2
new update in claim
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Heh...there are days. I spend a lot of my time reading through NCIS/CID/local police/domestic violence MSW notes, UCMJ proceedings, etc- if im lucky. Sometimes is more needle in a haystack because they didnt report it. Thats when I get to put on my monocle and grab the pipe and funny hat, 'cause I have to start looking for psycho-social markers. Physically its about the cushiest job I could ask for but mentally its really hard sometimes. My wife is a trauma survivor- happened while we were friends in college before we started dating later. I was there to listen to, and see, the physical and mental fallout. That's why I volunteered for this subgroup of VSRs. I figure I couldn't do near as much as I would have wished, then, being on a different campus, but now at least I can try to get some resolution for these vets. 

 

If you believe the symptoms (PTDS/back issues) manifested sooner than your effective date there IS an avenue to attempt to change that. 38CFR 3.157 covers effective dates. You can appeal under that and see what happens. There are a lot more people on here versed in appeals than I am, I don't work them. If you search under EED, Earlier effective date, 3.157, etc, you'll find threads about it. Your back issues might not need that, though, if you can show that you underwent surgery in svc that shoudl be all you need. 

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You posted:

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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. 

     My comment:  Do you have a current diagnosis of lumbar disc disease, as they said?  

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.

    My comment:  Is this about insomnia, or lumbar disc disease?  This negative exam will need to be fixed before you can get  SC for lumbar disk disease, probably with an IMO/IME. 

The examiner's rational for the pinion given is noted as there is no medical documentation of lumbar disc condition during active duty.

 

     My comment:  You need to fix this is you want SC for lumbar disc disease.  Can a friend from the service write you a buddy letter, if, indeed, you had an "event in service" which caused your lumbar disc disease.  When my son was in the Army, he had to carry a back pack of about 150 pounds, and he was about 130 pounds back then.  That is too much weight, and can cause back problems.  But, you need to tell your doc, if that is what happened, and I have no idea if that is the case for you or not.  You may be able to find a person you trained with, who could document (WRITE A BUDDY LETTER) about the excessive weight .  Of course, I dont know if this happened but it could have happened to you, also.  

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Quote

 

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."

   A well known law firm has written some advice for Vets seeking SC for insomnia.  

https://www.hillandponton.com/va-disability-ratings-for-insomnia/#:~:text=VA rates insomnia anywhere from,for service connected insomnia issues.

    Reading the above link and following their advice is likely to be productive.  

    

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@broncovet After this original denial letter, the VA did recognize several times within service that my back was put under pressure that could have resulted in different injuries-which is why my back surgery was covered and is rated. I thought I had a IMO at one point; sometimes I have some memory issues and have had so many dr appointments, I honestly cannot remember. I will have to look through all my paperwork. My VSO said because I had surgery, the lumbar disc disease could be secondary to that, and should not have been denied in the first place, but, here we are....I am going to keep fighting it. Just waiting on my court date to be set. That process seems to take forever.

In terms of the insomnia, I read the article, and went to the link in the article, but, I am still not sure how to separate the insomnia claim from PTSD. I am hoping that showing that I was prescribed and treated for insomnia while active duty will help to separate it, but I may go the route others have stated, and possibly get an EED, if they claim the insomnia is being caused by the PTSD (that was undiagnosed while active). I feel like the PTSD came later, when I was discharged, but maybe it was there and I was just unaware....I did schedule a sleep study today as well, so we will see if that leads to anything.

I also wonder how ratings for PTSD will change with the new proposed changes (if they go into effect). I have tried reading it, and of course they make it sound like it will be a bigger benefit for veterans (and I hope that it is)., especially for PTSD and other symptom manifestations......

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UPDATE Sept. 19, 2022....

 

@brokensoldier244th, since you work with PTSD claims, I will ask you-but if others have answers, @broncovetor anyone else, please feel free to answer....

I am  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 (it is still within the time-frame), since the VA has now deemed a CPAP machine medically necessary and he said it would still probably get denied as a secondary condition from PTSD. 

I thought once the VA orders you a CPAP, it all but guarantees you a MINIMUM rating of 30%? Am I wrong? Is it impossible to get OSA rated as a secondary to PTSD? I only put it as secondary to PTSD because I was told by the VSO it couldn't be its own separate claim, but now he tells me it will probably keep getting denied as a secondary too.....I don't know what to do....

Edited by flynsolo2
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