Morning Jim,

I've put in a claim for sleep apnea. Below is what was provided as a nexus letter from my VA physician as I'm trying to get it as secondary to my BiPolar/PTSD claim. I was medically discharged from the military for BiPolar disorder and rated by the VA at 30% in 2003 and recently had my claim for PTSD aproved and it my "psychiatric" condition to 50%. Do you have any recommendations other than what I've submitted? Thanks in advance for your input.

(The nexus letter) Dear Sirs:

I am a medical doctor, duly authorized and licensed to practice medicine in the State of Missouri. I am board certified in the field of psychiatry. The above named veteran is currently a patient of mine.

It is my opinion that Mr. ____'s Obstructive Sleep Apnea is intertwined with his mental health diagnosis of Bipolar Disorder. The intensity, worsening and perpetuation of each of these disorders is negatively influenced by the other.

Reply:

I think you'll have a challenge to get a rating for OSA.

You are more than 10 years from your ETS. Most OSA claims that are awarded these days are those that have significant evidence (a sleep study) while the service member is still on active duty.

A psychiatrist is not a sleep expert. He/she is not particularly qualified to comment on OSA. A more effective statement would come from a pulmonologist who is certified as a sleep expert or a physician who is expert in Independent Medical Opinion (IMO) for disability claims.

http://www.vawatchdog.org/imo-ime-medical-opinions-exams.html

Your nexus letter doesn't include the all important statement that the connection between your mental health condition and the OSA condition is "more likely than not".

Without that clear and unequivocal statement, the letter may not be very effective. The VA lexicon is very important. Using the specific words that VA wants to hear is required.

http://www.vawatchdog.org/How_To_Write_A_Nexus.html

Daytime sleepiness can occur with numerous health conditions. In your letter, you point out many references to daytime somnolence but there is no mention of OSA being observed by health care professionals. Depression, for example, may have been the cause for the daytime sleep patterns, not OSA.

Statements from a spouse are rarely effective. The VA knows that spouses, pastors, friends and neighbors are biased. The attitude is, "What would a spouse say in a statement? Of course she's going to be supportive." A spouse is not a medical professional and isn't qualified to determine whether or not you had OSA.

Finally, OSA is under significant scrutiny these days. Most veterans have learned that a service connected CPAP is a 50% rating. That's a gold mine in terms of a rating. It's a lot of money and thousands of veterans have jumped on the bandwagon to try to get the rating. VA is carefully reviewing these claims and that isn't good news for anyone who doesn't meet the precise requirements for the rating.

Snoring is not OSA. OSA has definitive guidelines for diagnosis. Just because a person snored in the past does not mean that he/she has OSA. To receive a diagnosis and a prescription for a CPAP 10 years after military service doesn't necessarily mean that the service is somehow connected.

Obstructive sleep apnea is a serious health issue. It is also a health problem that is closely associated with aging. As we get older we tend to gain a few pounds and our body reacts with the typical snoring and so on. Medical science has advanced in recent years to a point where the diagnosis and treatment of OSA has become relatively easy and inexpensive. So, more and more people are getting the OSA diagnosis and taking home a CPAP.

That doesn't mean that most veterans will be eligible for the 50% rating though. Prior to filing for the rating, I advise veterans to be sure they're qualified by the strictest standards. Otherwise, to file is a waste of time.