Sleep Apnea Question

M

MandaJo111

PEB Forum Regular Member
My husband is awaiting the outcome of his informal MEB. He has 11 1/2 years of service. They are reviewing several issues the main ones being: several spinal issues (20% ROM) from injuries sustained in Iraq, Spondylolysis and Spondylolisthesis (he had an alif/plif combo done at Walter Reed with a titanium cage, disk, rods and screws implanted that did not fix the problem), radiculopathy to his left leg and arm, severe migraines (3-4 most weeks), chronic knee issues, and sleep apnea.

My question is about the sleep apnea. I was under the impression it carried a 50% rating if using a CPAP machine. My husband uses a CPAP with a humidifier every night. Now however I am finding some mixed information stating that sleep apnea with CPAP use no longer gives an automatic 50%. I have been unable to locate a clear source that gives valid info. Some people have said that they were told that after 2009 they were no longer giving ratings for it, another said it dropped to 30%, and yet another said they are scrutinizing it more because of too many people trying to get the diagnosis after finding out about the 50% rating.

This is not the case with my husband. He has severe sleep apnea -- to the point I have to wake him up because I think he won't wake up. He also has excessive daytime sleepiness and was diagnosed with narcolepsy. He has actually fallen asleep at red lights and while driving. His doctor back in 2007 even with the sleep apnea diagnosis brushed it off and cleared him to go overseas again. All he did was give him some meds to keep him awake during the day so he wouldn't fall asleep while driving or working. This new pulmonologist was not too happy with the previous doctor’s actions. He has been far more thorough and is handling all of the issues not just him staying awake. He also noted he is not allowed to drive.

I just want to know ahead of time what to expect when the PEBLO comes back to us with the outcome of the MEB. If the ratings have changed that is fine, but I need accurate information going into things in case it has so I know what we are dealing with ahead of time. I have seen Jason answer several of these types of questions and if anyone can get me a good source or documentation -- or at least a straight answer -- I know he can! But any input from anyone would be great!

Thanks so much!

Amanda
 
I spoke with a PEBLO about a week ago. He saw my medical record and gave me an estimate rating regarding my condition. Among the medical conditions I have sleep apnea and its rating is still 50% unless it was changed in the past week.
 
Amanda,

To answer your main question, if unfitting with use of CPAP, the rating is 50%.

For historical background, what used to happen before 2008-2009, the DoD has set up an "alternative" rating for certain conditions including Sleep Apnea. Instead of rating per the VASRD, they set up a rating system based on degree of "Industrial Impairment." Mild Industrial Impairment would warrant a 0% rating (even with CPAP use). So, what would happen is that members would often be boarded for Sleep Apnea and say back pain. Both might be found unfitting, and the Sleep Apnea would be rated at 0% and the back pain would be rated at 10 or 20%. After the 2008 National Defense Authorization Act made clear that DoD had to rate per the VASRD, the same conditions would then have to be rated at 50% for the Sleep Apnea and the back would be rated at the same or higher (due to the requirement to rate on loss of functional use due to pain). So, what you had is all these cases that would qualify for a retirement rating at a very high percentage. Mysteriously, all these cases that would have previously been found unfitting due to OSA were suddenly found to be not unfitting. I would characterize this as "dirty pool." I used to see a great many sleep apnea cases unfitting. Now, it is relatively rare.

That said, the symptoms that you describe, especially with residual excessive daytime sleepiness, would be what I tend to see in cases where sleep apnea is found unfitting.
 
Thank you that answers my question. :)

Since my husband knew his PEBLO a little before this process it makes it a little easier I think. I know the PEBLO was glad when this pulmonologist perscribed a CPAP for him -- so I assume that was so he could put him down for the 50%. Overall this is a long process and I tend to overthink things. You have put my mind at ease. Thank you!
 
I have severe OSA. I stop breathing about every so many breaths. I was set up with an appointment to go to walter reed for a sleep study. They put me on the machine @ 3am, and I was out the door @ 10 with a Cpap machine and I get new masks and everything every couple of months.

Anyways, this is the deal as I went through it. You have to use the machine every day for 30 days (There is a card in the back that tracks your usage and if its on your face. What this means is, they run it in the computer and you must be 80% Compliant using the mask.

Once you do that, they give you paperwork to give to your VSO on base. I was just there yesterday with him again, and he stated there are tons of rumors, but OSA is still 50%. Plus, I honestly dont know why you or even if you could fake having sleep apnea. Your recorded all night long.. and wearing that mask every night SUCKS!!!!!!!!

Now, when you forget to wear it one night... watch out.... That day you will wake up, you will feel so exhausted and felt like you have been up for 72 hours!. no joke.

Anyways,

Get with your primary care person, and have them test you for it.

GL
 
You can't fake OSA during a sleep study. They hook electrodes up to your head, temples, etc. that know if you are sleeping or not. They can even tell when (if) you enter REM sleep. So, if you are unsure if you have sleep apnea (excessive snoring, waking up at night suddenly in a jerk type movement and daytime fatigue all all classic OSA symptoms), schedule a sleep study! When I had mine, It was found that I stop breathing 75 times per hour, which is categorized as severe OSA.
For the sake of MEB outcomes, I just had the results of mine: severe persistent asthma requiring daily cortiocosteroid usage, severe OSA, Hashimoto's, hypothyroidism. The board only looked at the asthma and OSA in the MEB as being potentially unfitting. The reulsts came back fit for duty with C-2. My flight doc is working a waiver to get me back in the cockpit. They also said they would work a waiver to get me deployed anywhere I need to go. I wanted the fit finding, but I don't know how I feel about the fact that the VASRD has me at 60%+ disabled for the asthma alone, not to mention the severe OSA w/CPAP or my thyroid disease. Seems like a good strong Commanders letter and being in a critical AFSC play heavier than medical conditions.
I now know that there really is no rhyme or reason to this whole board process. I thought for sure I would be med retired, but instead I'm back in the saddle.
 
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