Sleep apnea question

Gomez

PEB Forum Regular Member
PEB Forum Veteran
SPC Leggett, I saw a doc before being discharged and he noted that SM experiences sleep disturbances and is fatigued during the day, but did not diagnose sleep apnea or recommend that I seek treatment for possible sleep apnea. Being in the guard, they seemed inclined to give us the "bum's rush" out the door rather than opening a can of worms by suggesting a condition might exist. As I mentioned, the VA later conducted a sleep study and diagnosed me with sleep apnea.

Also, I was treated for the symptoms: narcotic sleep meds. Probably wasn't the right treatment for sleep apnea, but that's the treatment I received after going to the MTF clinic.
 

SPC Leggett

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Registered Member
SPC Leggett, I saw a doc before being discharged and he noted that SM experiences sleep disturbances and is fatigued during the day, but did not diagnose sleep apnea or recommend that I seek treatment for possible sleep apnea. Being in the guard, they seemed inclined to give us the "bum's rush" out the door rather than opening a can of worms by suggesting a condition might exist. As I mentioned, the VA later conducted a sleep study and diagnosed me with sleep apnea.

Also, I was treated for the symptoms: narcotic sleep meds. Probably wasn't the right treatment for sleep apnea, but that's the treatment I received after going to the MTF clinic.

Then there u go, you have a doctor backing up your PDHA statements
 

maparker

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It is good his doctor commented on his reported symptoms on his PDHA. However, you can get a doctor to back up the PDHA statements post discharge as well. One needs to be proactive and get a doctor to state that based on the sleep study, the post discharge diagnosis and the PDHA reportings, it is more likley than not (or as likley or not) that the condition began while on active duty. You have to be proactive and understand the rules and what will compel the VA to service connect the condition.

Mike
 

Zomglawlz

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It used to be common to medically separate for slep apnea, but from what I understand now it is rare if it happens at all.
 

Warrior644

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Can I go to PEB while on active duty for sleep apnea?
Welcome to the PEB Forum! :)

As based upon how the Sleep Apnea medical condition affects your ability to perform your assigned Military Occupational Specialty (MOS) and basic soldiering skills from an U.S. Army perspective only, is whether it could potentially be determined as "medically unacceptable" by the DoD IDES MEB then "unfit for duty" by the DoD IDES PEB.

In retrospect, I have an OSA with CPAP medical condition but it was determined to be "medically acceptable" by the MEB; therefore, it was not found to be an "unfit for duty" medical condition by the PEB.

In short, the answer to your inquiry is yes with the aforementioned stipulations. ;)

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

usmcgeorge

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PEB Forum Veteran
Registered Member
my brother just got out of the military and he is having sleep problems he went to his outside doctor and they diagnose w/ sleep apnea. I have told him to put a claim in it. being that its not in his medical record will the va still consirded a service connection disability because he went into the service w/ no sleep issue.
 

Warrior644

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my brother just got out of the military and he is having sleep problems he went to his outside doctor and they diagnose w/ sleep apnea. I have told him to put a claim in it. being that its not in his medical record will the va still consirded a service connection disability because he went into the service w/ no sleep issue.
In retrospect, the DoVA will compensate a Veteran with disabilities that are the result of a disease or injury incurred or aggravated during active military service. Compensation may also be paid for post-service disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service.

To that extent, the DoVA will schedule your brother for a C&P examination to obtain updated medical evidence or a nexus opinion stating the condition is indeed due to military service. Moreover, please ensure that your brother obtains a copy of the civilian medical documentation (e.g. sleep study and CPAP/BPAP authorization, if applicable), and give accurate contact information with a medical release authorization to the DoVA. If the DoVA does not get the aforementioned information, the D-RAS may not give the correct rating or even worse, they shall potentially deny the claim due to the lack of supporting evidence.

With that all said, please remember that the burden of proof falls upon the veteran; therefore, your brother will need a nexus statement to link his new Sleep Apnea medical condition to an existing service-connected disability or secondary service-connection. The nexus statement must be very clear to fit the criteria required by the DoVA. More specifically, the evidence need to show a reasonable possibility that the disability your brother have was caused by injury or disease which begin or was made worse during military service.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

usmcgeorge

PEB Forum Regular Member
PEB Forum Veteran
Registered Member
thanks, I help my brother file the VA claim online. he never had sleep issues until he just got out. we did fill out the form so the DOVA could obtain the documents. from his outside doctor.
 

Jason Perry

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With that all said, please remember that the burden of proof falls upon the veteran; therefore, your brother will need a nexus statement to link his new Sleep Apnea medical condition to an existing service-connected disability or secondary service-connection. The nexus statement must be very clear to fit the criteria required by the DoVA. More specifically, the evidence need to show a reasonable possibility that the disability your brother have was caused by injury or disease which begin or was made worse during military service.

Best Wishes!
Not exactly. This is somewhat complicated issue which depends on the context of the issue...however, in many instances, the burden of proof is on the VA to show that a condition is not service connected or rateable. (The main issue is covered in Gilbert v. Derwinski , 1 Vet. App. 49, 54 (Vet. App. 1990).

To really cover the issues raised, it would take many pages...sometime the burden is on the Veteran to show certain things. However, the VA has a strict "duty to assist" the Veteran in developing their claim and they have to give "reasons and bases" for denial of claim.

@Warrior644 you have given, and continue to give, a lot of very helpful advice and support to members of this site and to Veterans. I don't mean to "sharpshoot" you or to detract from the very helpful support you give. I just want to make clear that the burden is not always on the Veteran (and generally, it is not). The "duty to assist" places a lot of the burden on the VA (or, in IDES cases, oftentimes on the military- though, in IDES cases, the regulatory requirements and burdens are slightly different- at least as written in IDES regs; I am not sure that the regulations accurately reflect the statutory requirement or, superior regulatory requirements...I think that there are many legal challenges apparent in the entire paradigm applied by the military in the IDES system).

My main concern is that folks understand who bears the burden once a claim is made. The VA has a strict obligation to assist the Veteran in developing their claims.

It is very important to understand who bears the burden of proof at each level of the process, when (if ever) the burden shifts, and to understand the substantive standards (and how to meet them) to support a claim for service connection or for proper rating of a compensable condition.
 

Warrior644

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thanks, I help my brother file the VA claim online. he never had sleep issues until he just got out. we did fill out the form so the DOVA could obtain the documents. from his outside doctor.
You are welcome! :)

Good deal! That said, your brother is definitely on a forward path to the receipt of a potential favorable decision by the DoVA D-RAS; in my opinion!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

Warrior644

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Staff Member
PEB Forum Veteran
Lifetime Supporter
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Not exactly. This is somewhat complicated issue which depends on the context of the issue...however, in many instances, the burden of proof is on the VA to show that a condition is not service connected or rateable. (The main issue is covered in Gilbert v. Derwinski , 1 Vet. App. 49, 54 (Vet. App. 1990).

To really cover the issues raised, it would take many pages...sometime the burden is on the Veteran to show certain things. However, the VA has a strict "duty to assist" the Veteran in developing their claim and they have to give "reasons and bases" for denial of claim.

@Warrior644 you have given, and continue to give, a lot of very helpful advice and support to members of this site and to Veterans. I don't mean to "sharpshoot" you or to detract from the very helpful support you give. I just want to make clear that the burden is not always on the Veteran (and generally, it is not). The "duty to assist" places a lot of the burden on the VA (or, in IDES cases, oftentimes on the military- though, in IDES cases, the regulatory requirements and burdens are slightly different- at least as written in IDES regs; I am not sure that the regulations accurately reflect the statutory requirement or, superior regulatory requirements...I think that there are many legal challenges apparent in the entire paradigm applied by the military in the IDES system).

My main concern is that folks understand who bears the burden once a claim is made. The VA has a strict obligation to assist the Veteran in developing their claims.

It is very important to understand who bears the burden of proof at each level of the process, when (if ever) the burden shifts, and to understand the substantive standards (and how to meet them) to support a claim for service connection or for proper rating of a compensable condition.
@Jason Perry, due to your outstanding vision to provide military service members and veterans an electronic web-based platform to ask for non-legal advice/guidance/insight/feedback, I am able to potentially provide any very helpful advice + support to the PEB Forum members and Veterans.

To that extent, thank you for your very kind words of continuing support; I am open-minded to all feedback! For me, it's all about raising the awareness of information to the military service members and supporting military veterans.

Moreover, I shall say again it is truly...no worries, it's all good! Via your continuing sound advice/feedback/clarification of information, you are definitely a well-season experienced "expert" in your highly competitive occupation! ;)

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

farrell77

PEB Forum Regular Member
Registered Member
You have the right to appeal until they tell you that you have to stop. I wouldn't get my hopes up about connecting the active duty in 2011 with the sleep apnea, especially considering that it is connected to the study to verify your sleep apnea. The worst that will happen with an appeal is that they will tell you no. It can be challenging with a claim and the VA because if it isn't on paper and documented they aren't likely to sway in favor of it. You would probably have some trouble connecting things in a way that links it to active duty.
 

CClns559

PEB Forum Regular Member
Registered Member
I am a National Guard Soldier and was deployed in 2003. I was diagnosed with sleep apnea and initially given a CPAP machine but was treated with UPPP surgery that temporarily corrected the sleep apnea out of fear of being medically discharged or given the unthinkable, non deployable status. I applied for a VA claim for sleep apnea 2006 and was given a response that there were no supporting documents that it occurred while on active duty (which is wrong) and stated not service connected. I provided all the supporting documents including medical documents that supported the diagnosis, minus the sleep study, the CPAP machine order and surgical notes. I also provided the DD214 with the dates of service that supported it all occurred while on active duty.
I was deployed on another deployment and missed the deadline for the appeal but reapplied to get it service connected.
last week I attended my Comp and pension appointment with the same MD that processed my prior claim. He had a huge attitude that I was back filing a claim for the same issue. I asked him why was I denied. He stated I failed to provide the sleep study with the initial claim and that was the reason I was denied. He has ordered a sleep study and was doubtful I would be found service connected.
My question, I was diagnosed and treated for sleep apnea while on active duty, is there any reason why I would not get at least a 0 percent rating for sleep apnea? what do I need to do?
 

maparker

Moderator
PEB Forum Veteran
Registered Member
The $100 dollar question is if it incurred or became aggravated on active duty. Just because it occurred, was diagnosed or was treated on active duty does not mean it incurred or was aggravated while on active duty.

That being said, if the condition was not noted on your physical for entry onto the active duty stint, then there is a presumption the condition incurred or was aggravated on active duty absent clear and unmistakable evidence to the contrary. See 38 USC 1111. Hold the VA to this standard and demand the clear and unmistakable evidence that overcomes the presumptions of service connection and service aggravation.

Mike
 

Warrior644

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The $100 dollar question is if it incurred or became aggravated on active duty. Just because it occurred, was diagnosed or was treated on active duty does not mean it incurred or was aggravated while on active duty.

That being said, if the condition was not noted on your physical for entry onto the active duty stint, then there is a presumption the condition incurred or was aggravated on active duty absent clear and unmistakable evidence to the contrary. See 38 USC 1111. Hold the VA to this standard and demand the clear and unmistakable evidence that overcomes the presumptions of service connection and service aggravation.

Mike
Mike,
Thanks for the advise.
Indeed, hold their feet under the fire until they give in; never default acceptance to potential injustice! ;)

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

Bamboonga

PEB Forum Regular Member
Registered Member
Gomez,

This might come a bit late but hopefully in time to be of some help; give the attached file a read. It was given to all of us without a name filled in for pretty much anybody at Kandahar Air Field. If the location/timing fits or is close enough, you may want to include it in your medical records during an appeal. If not, try to find out if one of these exists for the period and location of your deployment. Hell, they might not even look at the location, just a thought.

Your PDHA - I'm a reservist, I know how the PDHA people work. It's managed by a contractor called Logistics Health Inc. (LHI), and the contract is (mis)managed by the Federal Strategic Health Alliance (FEDS-HEAL) When I demobilized I checked the box stating I'd been in more than one blast, and the Fort Dix demobilization personnel just cut/pasted a phrase stating that the Soldier (me) reported no blast exposure. With that in mind, when you checked that box, what happened within the following 30-120 days? What they're supposed to do when one of those boxes is checked is normally refer you for a sleep study. I don't know how ARNG does it but for us, they usually contract with a local provider since most of us don't live near a military hospital. In my case it was USC in Los Angeles.

Now, obviously this didn't happen. So the PDHA form you have is actually doubly useful as evidence. It shows that;

(1) the symptoms were reported prior to the end of the 12 months after your REFRAD (if you're doing mass google searches for info on this, the common phrase used to refer to that 12 months is the 'presumptive period'). The PDHA isn't something you're supposed to fill out so the Army can check some box. That tends to be how it's used by the Army in my experience doing Medical Readiness, but the actual purpose of the PDHA is to find out if there's anything that the Army needs to follow up on. So you fill it out, the Army reads it (yeah, right), looks at any answers that indicate problems (in your case, sleep), and refers you to providers. For that reported symptom alone they should typically call you back and ask for more specifics, i.e. 'do you have trouble falling asleep, staying asleep, or both?' Falling asleep leads to certain questions, staying asleep leads to 'do you ever wake up short of breath or feeling like you're choking?' or something to that effect.

Did you ever get a call like this?

If so, do you remember what they asked and what you answered?

If not, they dropped the ball and it's been sitting where they dropped it for 14 months. Short version is, if you reported it within the presumptive period and it was never referred to a provider (and your PDHA form PROVES this), they may as well have stopped time the day of your PDHA. The burden is on them to either say 'yeah, Pt reported sleep problems. Reviewer [usually some form of nurse] referred Pt to Dr. Acula, MD on this date. He ordered lab work, referred to head shrinker, referred to sleep lab for sleep study, and prescribed water and motrin because he's in the Army. Pt has OSA/CSA/a 2-foot weasel in his bed that bites him every time he falls asleep/whatever.' What they CAN'T realistically do is say 'golly gosh no, he never told us he had sleep problems that developed during the deployment.' Actually, let me rephrase. They can't realistically get away with it. In all likelihood they would say something like that until they realize you can read English and you have a copy of the form.

(2) more importantly, this form serves as proof that the ball left your court, and it's in the Army's. If you never got a call back, or referred, or orders to report to a doc's office, it was reported and never explored.

Please note that the word 'Army' appears quite a few times throughout the text, while the word 'VA' doesn't appear anywhere. This is because the duty to identify the presence/cause of whatever is keeping you awake/waking you up was the department that put you on title 10 orders. Which would be the Department of the Army/Department of Defense, not the Department of Veterans Affairs. I know it seems like one ought to know what the other knows, but that isn't always the case. Actually it's not even often the case.

The reason this distinction is important is because if the VA does a sleep study today and determines that you have apnea, it began today or sometime in the last couple of months. If the Army does the same sleep study today, they'll also claim it began today or sometime in the last couple of months. Typically people only come down with disabling conditions on days when it won't cost the Army money. It's a rather odd phenomenon. So this is when you begin flailing your arms wildly and waving the PDHA form in their faces. Be prepared for a run, because you'll need to run in order to stay with them during the furious backsliding and tap dancing routine that follows. The end result you should keep as a goal is they document that you 'fell through the cracks', give you your sleep study (Yes, you probably need to do another one. Because all physicians that don't work for the Army are quacks whose every every diagnoses has to be verified). The reason you want to do this through the Army is that they'll document that this should have been done over a year ago, but they saw a shiny thing and went off to investigate. They'll also document that you had this problem at that time.

Good luck - I know all of ^that^ crap is a lot to digest but I hope it helps. Even if it doesn't help with your rating it will probably help you sleep. For what it's worth I got a 50% rating from VA just for my apnea by itself (because I submitted that document I attached). The exact phrasing they used was;

"6847 - Obstructive Sleep Apnea (also claimed as respiratory complaints due to hazardous environmental exposure)
[Disability Evaluation System (DES)/DES Claimed]
Proposed DES Service Connected, Gulf War, Incurred
50%"

P.S. I don't know why they put Gulf War - I was busy getting yelled at by my 4th grade teacher for most of the Gulf War.
 

Attachments

  • OEF Hazards (2).pdf
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Bamboonga

PEB Forum Regular Member
Registered Member
Oh I forgot to ask; were you near a burn pit or waste dumping area during a significant part of your deployment? (Port-a-Johns may count...not sure, but we lived right next to a burn pit which was right next to this huge pool where all the sewage from the base was processed. Lovely smell. All day, every day, especially in the lovely Kandahar summer sunshine.)
 

Gomez

PEB Forum Regular Member
PEB Forum Veteran
Since I originally posted this, I have been medically retired at 100% DOD and 100%P&T VA for conditions other than obstructive sleep apnea (OSA). Therefore, although I might have a good chance of successfully appealing the VA OSA denial, I have dropped the OSA claim because I can’t increase from my current rating. So, in my case, I don’t see any benefit now in submitting an appeal to the VA for OSA and doing so might “open a can of worms” that could adversely affect my current P&T rating. It seems to me that it would be better to not pursue the OSA claim in my case at this time.

Thanks for the input! Hopefully others with OSA claims can benefit from the great input provided.

Bamboonga, to answer your question, I was deployed in OIF near burn pits and was hospitalized in the combat zone for respiratory issues. Has a successful link has ever been established between burn pit exposure and OSA?
 
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