sleep apnea va claim denied

Was it inhaling the air around the Burn Pits? "Among veterans with PTSD, sleep disturbances are nearly universal. 3 Steps to Veteran Disability Benefits for Sleep Apnea, 6 Tips for Your C&P Exam for Sleep Apnea Secondary to PTSD, 3 Ways to Get a VA Rating for Insomnia (The Insiders Guide). The most common reason for denial of secondary claims is not establishing a strong enough connection between the service-connected disability and the sleep apnea. The most documented VA percentages for sleep apnea are as follows: 0% Sleep apnea with documented sleep disorder breathing that is currently asymptomatic. Here is just a sampling of the problems that can obstruct the airway (notice how FEW of them have to do with obesity): * Deviated Septum (damage to the piece of cartilage that separates your nostrils), * Swelling in your nose due to allergic or other conditions, * Your tongue can fall back and obstruct the airway, * Reduction in the opening in the throat, or a narrowing of the side walls of your throat, * Damage to your vocal chords can restrict your airway. As a fellow disabled Veteran this is shameful and Im on a mission to change it. To understand HOW the diagnosis drives a veterans VA Sleep Apnea Claim, we have to first understand the 3 different types of Sleep Apnea, * Damage to the lungs themselves can lead to OSA. Brian Reese here, Air Force service-disabled Veteran and Founder @ VA Claims Insider. In order to establish direct service connection for sleep apnea, a claimant must show that they have: A veteran can also establish service connection for sleep apnea on asecondarybasis. Thousands of other Veterans in our Community are here for you. Travis Studdard is an attorney who focuses on representing veterans in VA disability compensation claims. No current medical diagnosis (within the last 12 months), or improper diagnosis, #3. During an evaluation for sleep apnea, a doctor may ask some of the following questions: During the exam, the doctor may also take into consideration your weight, neck circumference, or blood pressure (all which could put you at higher risk for sleep apnea). When he got to the BVA the following evidence was in his C-File: A VA C&P exam concluding that sleep apnea was less likely than not related to military service. There are three components to proving direct service connection for any VA disability claim: For the legal principles of direct service connection, see 38 CFR 3.303. Recently, it has been widely accepted by the, According to theNational Sleep Foundation, insomnia is a chronic sleep disorder, characterized by complaints of unsatisfactory sleep, despite having ample opportunity to sleep. So if this proposed change for sleep apnea ratings goes through, its possible that veterans may start getting lowballed ratings. Example: How a Sleep Apnea Diagnosis Drives the VA Sleep Apnea claim. 40 percent disability rating: $731.86 per month. After first reading these examples, the obvious answer is that the private examiners opinion in VA sleep apnea claim #2 was what made the difference. For the most part, if you're a disabled veteran with a sleep apnea claim, the 50% sleep apnea rating is your best-case scenario. See our tips on how to obtain a credible nexus letter. Her husband told her she would snore loudly and wake up in the night often stopping breathing. The VA refers to mixed sleep apnea as a combination of the obstructive and central forms of the condition. The VA will call you from the following phone number: 1-800-827-1000. Sleep apnea is a serious sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. The doctortold her that the genioglossus muscle the muscle that connects the tongue to the jawbone was substantially weakened and causing her tongue to fall backward while sleeping, blocking the airway. If youre claiming sleep apnea as a secondary condition, make sure you already have a medical diagnosis before you make your claim. Bottom Line: Understanding YOUR VA Sleep Apnea diagnosis Drives YOUR Claim. Citation Nr: 21055584 Decision Date: 09/08/21 Archive Date: 09/08/21 DOCKET NO. Court of Appeals for Veterans Claims (CAVC). Sleep apnea VA disability claims account for nearly 1 in 4 respiratory claims. This guide will outline the basics of sleep apnea, how the VA disability rating works for this condition, and how qualifying veterans can prove direct service connection as well as sleep apnea as a secondary service connected condition to PTSD. If you have sleep apnea and sinusitis/rhinitis, your next step would be to get a doctors medical opinion supporting that your service-connected sinusitis/rhinitis caused or aggravates your sleep apnea. Its an essential piece of evidence. Claire Szewczyk is a Digital Content Coordinator for Hill & Ponton, PA in Florida. Traumatic brain injury and physical pain are also conditions that affect many veterans and can lead to sleep apnea. If accepted into our ELITE membership program, youll get free up-front access and permission to use $13,119 worth of proprietary VA claim resources, including access to our network of independent medical professionals for medical examinations, disability evaluations, and credible Medical Nexus Letters, which could help you get a HIGHER VA rating in LESS time. Some conditions that can be secondary to sleep apnea may include but are not limited to: If you have a service-connected condition that you believe is causing your sleep apnea, it may be a good idea to start to talk to your doctors about it. Sleep apnea treatment depends on the type and severity of the condition. If you are among the former military service members living with sleep apnea, you may be eligible for veterans disability compensation through the Department of Veterans Affairs. By subscribing to the Veterans Law Blog you get a free copy of the eBook version - along with many more training manuals and instructional videos. Sometimes the VA will schedule re-examinations to determine if there has been an improvement with a veterans sleep apnea has improved. These sleep disturbances can occur from tens to hundreds of times per night. The Veteran inVA sleep apnea claim #2 included the statement of the veterans wife describing the symptoms of sleep apnea from service discharge to diagnosis. Bringing someone with you to the appointment may also be useful. Sleep apnea can be service-connected in two ways: either direct service connection or secondary service connection. Why? The causes of the condition can be a combination of CSA and OSA causes; it can also be that your CSA presents as OSA, and only becomes apparent as CSA after OSA treatment (this is called Treatment Emergent CSA). Why would a VA claim be denied Sleep Apnea? What really makes your VA Sleep Apnea claim race through the VA disability claim system is this one thing: Your response, I imagine, might be something like this: To understand HOW the diagnosis drives a veterans VA Sleep Apnea Claim, we have to first understand the 3 different types of Sleep Apnea: obstructive, central, and complex. VA may deny a sleep apnea claim based on different aspects, whether theres not enough medical evidence of sleep apnea or perhaps no logical connection between your military service and your current sleep apnea. Making the Sausage: Heres what you need to know about new VA Claims regulations. The most common VA rating for sleep apnea is 50 percent. Check out the VA Sleep Apnea Field Manual. Brooklyn, NY: 300 Cadman Plaza West, One Pierrepont Plaza, 12th Floor, Brooklyn, NY, 11201 When youre granted a sleep apnea VA rating, you may also be assigned a re-evaluation period (unless the condition is classified as static). Brian Reese here, Air Force service-disabled Veteran and Founder @ VA Claims Insider. A study conducted by the VA Healthcare System for San Diego and National Center for PTSD found that between 40 percent and 98 percent (!) As a veteran, youre four times more likely than other Americans to develop sleep apnea. This can range from CPAP therapy, lifestyle changes such as diet, exercise, and others. For all about getting a VA rating for sleep apnea, see our post Your Sleep Apnea VA Rating A Guide to Getting a VA Disability Rating for Sleep Apnea. In April 2004, he wastreated after his military service ended for fatigue and insomnia. San Jose, CA: 2880 Zanker Road, Ste. In our experience, most VA disability claims are won or lost based on medical evidence. Proposed rating must be based on entire medical history, Must show there has been improvement in veterans functionality, If you have a rating that has remained the same for over five years (stabilized), If you have a total disability rating, meaning 100 percent rating. Additionally, there are some cases that the VA cannot schedule re-examinations: If you are interested in learning more about C&P examinations, check out our guide! How to File a Claim on VA.gov (step-by-step)! Even if you have a medical diagnosis during active-duty service, without a sleep study this is difficult to claim successfully. Was it the blow to the throat when you were thrown against the side of the Hum-vee in that mortar attack? In this article, well help you understand the top 5 reasons OSA claims are deniedand even better, what to do about it if youve received a denial for your OSA claim. Sleep apnea can be aggravated by PTSD (secondary to PTSD), also an extremely common disorder for veterans. Both disorders have risk factors that affect both sleep apnea and symptoms of PTSD, and the conditions can aggravate each other. or particulate exposure in burn pits, for example), blocks the air path at the point where the lungs move oxygen into the blood stream. Typically the re-evaluation period is anywhere from two to five years after your initial examination. Since sleep apnea can correlate with conditions like heart disease and obesity, its important to seek treatment options. At VA Claims Insider, we help veterans understand and take control of the claims process so they can get the rating and compensation theyre owed by law. Sleep apnea and secondary service connection. We can helpreach out so we can show you how. Signup to never miss a beat with special offers, blog updates, exclusive trainings, and more delivered right to your inbox! If you have symptoms of OSA, consider obtaining a sleep study, also known as polysomnography. Finally, a 100% rating is available when sleep apnea is so severe that it involves organ damage. Note: Millions of Philips CPAP Machines have been recalled due to toxic chemical seeping into mask and unknowingly being inhaled by sleep apnea patients. We are sorry that this post was not as useful for you! Weve supported more than 15,000 veterans to win their claims. How to Hire an Attorney For Your VA Claim or Appeal. Your sleep apnea rating will compensate you based on your conditions severity. Accomplish you want to succeed in your Sleep Apnea VE Impairment Claim? In our experience, OSA denials are almost always due to one or more of these five gaps: #1. Obstructive sleep apnea is estimated to affect between 2-9% of adults (about 15 million Americans) but is believed to be frequently undiagnosed. At VA Claims Insider, we help you understand and take control of the claims process, so you can get the rating and compensation youre owed by law. Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim (FDC). Episodes where you stop breathing during sleep, Daytime sleepiness (hypersomnia) or insomnia, Lack of focus or difficulty concentrating, A medical diagnosis of sleep apnea confirmed by a sleep study in VA medical records or private records, A nexus (link) shown via medical evidence establishing a connection between the service-connected disability and the current disability (in this case, sleep apnea), Sleep apnea secondary to medication side effects, A medical diagnosis of sleep apnea confirmed with a sleep study, A service-connected PTSD disability rating (or another service-connected mental health condition), A medical nexus establishing a connection between your PTSD and sleep apnea, A basic CPAP, which keeps pressure constant all night long, A bilevel device (BiPAP), which provides two levels of pressuremore when you breathe in and less when you breathe out, An auto-CPAP device, which changes pressure throughout the night based on your body position, sleep stage, and snoring, You have difficulty working and lose productivity during the day due to napping, You have to use a CPAP or other breathing machine at night, Your depression or anxiety, exacerbated by loss of sleep, affect your relationships and work, Your inability to focus or concentrate or loss of memory affects your job or your safety, Your disability is considered permanent by the VA, Your disability is considered static by the VA, Sleep apnea symptoms persist without material improvement for five or more years (this is known as a stabilized rating), You have a continuous sleep apnea rating for 20 years or more, The VA has reviewed your entire medical history. A doctors diagnosis will be one of the keys to getting a sleep apnea VA rating. * Sleep Apnea is NOT a disease of the obese: just about any neurological condition, or any interference (physical or neurological) with the body's airway can - and will - cause some form of sleep apnea over time * 3 out of every 4 Veterans who file a claim for Sleep Apnea are denied by the VA Regional Office or the Board of Veterans Appeals. If the first half of the nights results confirm you have sleep apnea, the second half of the night will utilize the PAP device to prepare you for ongoing treatment. If youre dealing with sleep apnea as a secondary condition to PTSD, you arent alone! Sleep apnea is proven to significantly reduce a persons quality of life (in one study, the reduction in quality of life was equivalent to that observed with diabetes or hypertension). The sleep study, while a critically important piece of evidence, is not DRIVING your VA sleep apnea claim. * Damage to the lungs themselves can lead to OSA. His eBook, the9 Secrets Strategies for Winning Your VA Disability Claimhas been downloaded more than 300,000 times in the past three years and is the #1 rated free VA disability claims guide for veterans. If your VA disability claim has been denied, contact our office today for a free consultation at (401) 753-6359. Why do so many veterans have sleep apnea? The three most common conditions resulting in a secondary service connection for sleep apnea and therefore a are: Research shows that combat veterans with PTSD may be at higher risk for sleep apnea than the general population. Learn what youve been missing so you can FINALLY get the disability rating and compensation youve earned for your service. Box 449, Deland, FL 32721, Orlando, FL: 605 E. Robinson Street Suite 635, Orlando, FL 32801 The VA will usually order a sleep study to be performed in order to confirm a current diagnosis of sleep apnea. I submitted my claim and tried to Link my Sleep Apnea to my PTSD. This field is for validation purposes and should be left unchanged. This study will serve as medical evidence for the veterans case and can help to prove the medical condition or medical conditions that go into a total rating. Is a CPAP machine the only treatment for sleep apnea? Its FREE to get started, so click Go Elite Now below to complete our 3-step intake process. Your email address will not be published. Service connection on a secondary basis requires evidence of aggravation or causation.This requires that the secondary disability be shown to be proximately due to or proximately aggravated by another service-connected disability. Since 2009, veterans' claims for sleep apnea have increased 150%, more than 94% of these coming from veterans of Gulf War I or the Iraq and Afghanistan wars. OSA largely results from a disruption inthe normal breathing process. In our experience, a well-crafted nexus letter for sleep apnea is the single most crucial document you can provide to help prove service connection on an at least as likely as not basis. If youre experiencing any of the symptoms listed above, and suspect your sleep apnea arose from your time on active duty (or was or aggravated by a currently service-connected disability), you should consider seeking a diagnosis and pursuing compensation for this disability. The denial of disability claims for unconfirmed, undiagnosed sleep apnea is a regular occurrence for the VA. Learn how your comment data is processed. Get a Free Case Evaluation, The Link between Sleep Apnea and Hypertension, VA Disability Ratings for Insomnia and Sleep Disturbances, Sleep Apnea Secondary Connection to PTSD VA Disability, Other Medical Conditions Sleep Apnea is Connected With, VA Proposes Changes to Sleep Apnea Ratings, Common Sleep Apnea and Sleep Problems Symptoms in Veterans, VA CPAP Machines for Sleep Apnea Treatment, Establishing Service Connection For Sleep Apnea, C&P Exam for Sleep Apnea and Sleep Studies. #2: It crosses the uvula that dangling thing in the back of your throat. Contact Us Brian isalso the CEOofMilitary Disability Made Easy, which is the worlds largest free searchable database for all things related to DoD disability and VA disability claims and has served more than 4,600,000 military members and veterans since its founding in 2013. The VA assigns the following ratings for veterans based on the severity of their sleep apnea: PTSD, Hypertension, Asthma, Cardiovascular Conditions, Type II Diabetes, Mental Health Conditions, Respiratory Conditions, Alzheimers disease. This is rare, because most veterans dont realize they have sleep apnea until after theyve left military service. I do not response to Individual claim and legal questions, although I do catalog them for post / video ideas. By law, there are three evidentiary elements that must be satisfied for sleep apnea secondary conditions to prove secondary service connection: The first part can be satisfied with any existing medical evidence service treatment records, VA medical records, or any private medical records, assuming you do have a diagnosis of sleep apnea. In this case, there must be a medical nexus to link the sleep apnea to their already service-connected disability. LIFETIME Subscription to the Veterans Law Blog, Quarterly Subscription to the Veterans Law Blog, Annual Subscription to the Veterans Law Blog, no evidence of service connection for her Sleep Apnea. How to File a Claim on VA.gov (step-by-step)! A sleep apnea VA rating can be reduced by the VA. We also connect veterans with independent medical professionals in our referral network for medical examinations, disability evaluations, and credible independent medical opinions and nexus statements (medical nexus letters) for a wide range of disability conditions. Lets look a little deeper at OSA for a minute Obstructive Sleep Apnea is by far the most common type of Sleep Apnea that affects veterans. Some veterans with sleep apnea may experience improvement with lifestyle changes, but CPAP therapy is still among the most common treatments. Sleep apnea also ranks #2 on our List of the Top 5 Secondary Conditions to PTSD. Think about it this way: if you are diagnosed with severe hearing loss, then to win your hearing loss claim, you arent going to waste your time telling the VA about your knee injuries. Unfortunately, VA does not always apply the law correctly. I was however granted 10% for Asthma, as they said I would have gotten 30% if I had meds, which I did, and did submit that as evidence. A 50% rating would be given if treatment was ineffective or you were unable to use therapies due to another condition. A VA claim for sleep apnea can be denied for many reasons. In order to prove a secondary service connection, youll need three things: PTSD doesnt have to be the main cause of your sleep apnea, but it does have to be connected. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1952 to March 1954. Learn how your comment data is processed. However there are several rules that must be followed in order for this to occur: If the VA does propose a reduction of rating, then the veteran can submit an argument against it. OSA secondary to PTSD (or other mental health claim) is a more challenging claim to make, but it is still a top candidate for secondary service connection of sleep apnea. She has also spent several years working with the Department of Veterans Affairs audiology programs in Salt Lake City, UT and Pocatello, ID. Need a C&P exam for sleep apnea secondary to PTSD? Please call for an appointment before visiting: Mail Processing Center: P.O. For a limited time, you can book a free, no-obligation VA Claim Discovery Call with one of our experts. Phone. A VA claim for sleep apnea can be denied for many reasons. I just recently order the VA SLEEP APNEA FIELD MANUAL, I wonder if it is current its dated 2014. Copyright 2023 VA Claims Insider, LLC. VA claim for sleep apnea denied? Lets take a look at 2 VA Sleep ApneaClaims. This Veteran served in Iraq and Kuwait in 2003 to 2004. Sleep apnea often is thought of as a mild annoyance, but it is a significant condition that can lead to health issues ranging from hypertension, stroke and heart attack to depression, anxiety and headaches. Its free to join and we dont win unless you win.). No current medical diagnosis (within the last 12 months), or improper diagnosis #3. Complex Sleep Apnea: In September 2006, researchers at the Mayo Clinic identified a new type of Sleep Apnea whichthey are calling complex sleep apnea. Typically, sleep apnea symptoms are at their worst during REM Sleep due to the bodys naturally-occurring reduced muscle tone in the bodys airway. Veterans that obtain a VA sleep apnea rating can regularly also service-connect strokes. Conditions like COPD (due to asbestos or particulate exposure in burn pits, for example), blocks the air path at the point where the lungs move oxygen into the blood stream. Were seeing veterans coming back from Iraq, Afghanistan, and the southwest Asia theater of war with severe sleep issues, which can oftentimesbe linked to PTSD. 11:30 Why this obstructive sleep apnea claim was denied Sleep disordered breathing, as well as the myriad of symptoms linked with it (such as sleepiness and fatigue), can all exacerbate the relationship between sleep apnea and PTSD. Camp Lejeune Lawsuit. Your email address will not be published. There are many different symptoms that go, Sleep apnea is a common medical condition that can be caused by many different factors, including conditions like Posttraumatic Stress Disorder (PTSD). The independent opinion of a private medical professional can also influence the C&P examiners medical opinion, as well as the VA rating officials final disability decision. If youre stuck, frustrated, underrated, and currently rated between 0%-90%, VA Claims Insider Elite is for you! Many of them have been diagnosed with the condition many years after leaving active duty. Symptoms of Sleep Apnea Loud snoring Gasping for air during sleep Awakening with a dry mouth Morning headache Hypersomnolence, or excessive daytime sleepiness Difficulty concentrating Oftentimes, the symptoms of the three types of sleep apnea can overlap, making diagnosis more difficult.

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