I had a Modified UPPP surgery in service (1987) for sleep apnea. I retired in 1994 and got a 0% rating for residuals of uvulopalatopharyhngoplasty and tonsillectomy. I had a sleep study in March 1991 where they stated results were negative because of no significant desaturation or arrhythmia. I had a sleep study in 2011 by a civilian doctor and the VA prescribed me a CPAP machine. I applied for disability in March 2012 and 22 August 2013 was denied because of the 1995 sleep study. No mention was made of current CPAP use. Someone please tell me they screwed up. I'm writing a letter to the VA for reconsideration but I have no more proof to send them. I'm retired Navy at 70% disability and I think 70% CRSC. I don't think a rating for sleep apnea would change my rating much but I feel it should be service connected. Thanks for any help.
|Lead Moderator, Veterans Issues |
The requirement is continuous treatment. Since it was resolved by surgery, the service connection does not exist. Sleep apnea can have multiple etiologies, and your current one is probably different than the one for which the surgery was performed in 1987. It is over 20 years since and you had not been treated during that time for the issue.
My opinion. I will try to have some of our experts review this later today.
....Taking Out The Neuro Trash
It wasn't resolved during surgery. UPPP surgery is not a cure for sleep apnea. And the Academy of Sleep Medicine does not endorse UPPD as a sole procedure for treating sleep apnea.
We know the success rates for sleep apnea surgery are rarely greater than 65 percent, and frequently with time it averages 50 percent or less long term. Most folks require still require CPAP treatment after surgery.
It is common to have a normal or borderline sleep study after surgery.
The OP needs to contact a VSO, and request his file be re reviewed. I would also suggest he get a current evaluation, and sleep study from his ENT and submit those as well.
Thank you so much. You've given me some hope again. I'll start making appointments and see how it all turns out. I'm not in compliance with using my CPAP right now so I'm a bit afraid to contact the VA but we'll see what happens.
What was the AHI number on your 1991 study? (Apnea-Hypoapnena Index)
It's doubtful that it took 20 years to come back.
How long have you had symptoms (post 1987/1991)?
Any documented sleep related doctors visits between 1991 and 2011?
Regardless, it shouldn't be hard to get an ENT or sleep doctor to write a letter stating that your sleep apnea was not cured. As stated surgery is not anywhere near 100% effective, especially over the long term.
I don't have a copy of the 1991 sleep study. The AHI total events on the 2011 study is 23.4 per hour. That's 8.4 obstructive apneas per hour and 15 hypopneas per hour. I haven't been to the doctor for sleep apnea since my surgery because I didn't think they would do anything about it. I think I'm going to go back to the civilian sleep doctor and ask for a letter. They said it would cost me $100 for the appointment but it might work.
I want to put in a reconsideration request for sleep apnea because my county VA rep is telling me I should put in a fully developed claim for I/U. In my latest decision I have:
40% for radiculopathy, right upper extremity
20% for residuals, cervical strain injury
10% for muscle tension headaches
10% for tinnitus
10% for epididymis
0% for hearing loss
0% for dyshidrosis
0% for residuals, uvulopalatropharyngoplasty and tonsillectomy(UPPP)
Total combined 70%
Well since UPPP is normally for sleep apnea if you have that documentation that should be enough along with your current doctors letter and reports.
14000 posts as Cider33Alpha
I see a big problem for your case in that you failed to follow up with your surgeon (afraid they wouldn't do anything about it), have been non-compliant or less than diligent about compliance with use of your CPAP, and have a lack of documentation regarding treatment or appointments related to sleep apnea in the years since your surgery.
I'm not saying you don't have the problem, only that - as we all know - the VA just doesn't take your word that you have a problem that is service-related.
I strongly second Pipedreamsandbabies' advice to contact and engage a VSO to assist you in organizing and filing your claim. I would also suggest holding off on scheduling sleep studies and specialist appointments, etc., until you and your VSO have a developed a plan for submission of your claim and the back-up documentation you might (or might not) need.
Good luck and keep us posted.
Thank you for the comments. I have a really good doctor at Dayton Respiratory Center. Dr. Allen stated in my Disability Benefits Questionnaire, "This disease process occurred while on active duty. It was addressed with UP3 surgery which only lasts 2-5 years before OSA recurs."
"Obstructive Sleep Apnea diagnosed in 86, had UP3 with transient relief but OSA intact, recurred and requires CPAP to treat."
He said he spent 14 years in the Air Force as a MD and fills these out all the time because the VA likes to deny claims. He said his statement will get my claim approved. If Tricare won't pay for the appointment I'll have to pay $50-100 but I'm thinking it's a pretty good bet so I'm happy.
My VSO is going to send it to DAV rep to see if they will walk my reconsideration request through. Any thoughts, good or bad???
....Taking Out The Neuro Trash
For those reading this thread Hangfire is the OP.
I mentioned this earlier in the thread, and I agree with Dr. Allen, with that evidence your claim should be approved.
I would be shocked if the VA denied your claim.
PS. Most folks are not compliant with CPAC machines, or medicines. Don't worry about that.
Thank you for your help pipedreamsandbabies. Until you told me different I was under the impression that the UP3 surgery was a permanent solution for my sleep apnea, and until Dr. Allen said the surgery only lasted 2-5 years I didn't know that either. Funny how the Navy surgeon didn't mention anything about temporary prior to or after surgery.
I'm 70% now so I think if they approve sleep apnea it will take me to 80%. In my reconsideration I'm also including Dysphagia that was denied in my last decision. I'll still be at 80% so I guess I'll be done until I have the next surgery for cervical fusion.
BTW, after the UP3 surgery I started having problems swallowing. I had cervical fusion surgery Feb. 2012 for C5/6 and C 6/7 and swallowing and choking became much worse. They want to go in from the back of my neck and fuse C 3 through C 7 and leave a hole in my spine open so the nerves can move. Do you know if swallowing problems are common after UP3 surgery?
....Taking Out The Neuro Trash
Difficulty swallowing can be an important and worrisome issue. And difficulty swallowing as you describe can be both related to the UP3 surgery and the cervical fusion you had for the herniated disks in your neck.
You should be evaluated. Talk to your neurosurgeon. He/she needs to do an evaluation, and should refer you to a speech language pathologist for a swallowing assessment.
Time to update. I sent my reconsideration request for sleep apnea and Dysphagia to my VSO (a new one) and he sent it off to my rep at DAV. DAV sent in a request for reconsideration for sleep apnea and requested a higher rating for Cervical Strain Injury (which I did not request). I notified DAV of the mistake and they requested reconsideration for Dysphagia. I don't really know what has been requested because my claim has been in the "under review" phase for 4 months. I just found out that my claim has been out for over 3 months to be scanned to digital. My DAV rep went upstairs to the VA and talked to someone and found out my claim should be back be mid Feb. and hopefully complete around August of this year. I'll post again when I find out something else. Thanks.
I almost forgot to comment on the swallowing assessment. I went to the VA and they did what they called a swallowing test. I swallowed a few things in front of a screen and they watched it go down. They told me to eat slower. That's it. I just hope that wasn't what they will consider a C&P Exam.
....Taking Out The Neuro Trash
My file is finally done being scanned. I got a letter from the VA. My claim is on hold until I respond to their letter. As usual, I have questions.
How can I find out if the VA received my Sleep Apnea Questionnaire? Or should I just send another copy of it? Ebenefits doesn't have any of my claim info on it.
My rep. at DAV requested reconsideration of "residuals, cervical strain injury", not me. Should I tell the VA that I didn't ask for that or just let them reconsider it? It's already at 20% and an increase was just denied. I don't want to waste their time.
Lastly, should I request Unemployability on my 4138 statement? Or should I request it on a different new 4138? The homeless vet coordinator from the VA Regional Office called me and said I meet all the qualifications they are looking for for UI and that I should consider requesting it. Would it slow down my claim or would it be considered separately?
I am so thankful for everybody's help on this site. Just being able to write it all out has been a huge help clearing my head, allowing me to think and giving me hope.
When you're 55 yrs. old, divorced, in pain, kids are 1000 miles away, unable to work or get out much, and dealing with the VA it gets very depressing. I can't admit depression though.
Thank you for your support.
My claim is 817 days old now. I found out yesterday it went back to the gathering evidence phase for the 4th or 5th time now. I haven't found out why yet but Ebenefits says it was sent from Cleveland to a "temporary office of jurisdiction" in Columbia. I guess that's either S.C. or Mo.
I did request that they delete the injury I didn't ask for. It only took 2 days for them to remove it from my claim.
I'm just hoping they make a decision soon because my health is getting a lot worse fast.
Well, I got denied again in July 2014 and then the proposal to reduce benefits by 20%. I have a DRO hearing in the morning 232 miles from my house. It's only a hearing for the 20% reduction for radiculopathy, right upper extremity. I got the hearing pretty quickly because I sent my NOD to my rep and they sent it in late by a few days. I'm hoping I can also give them additional evidence I have for the sleep apnea that was denied and I think I'm going to drop the dysphagia claim until I get some more evidence.
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