<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/ecde9dfe-ddaf-462c-9ad7-cfd35f596fd4/BookmarkDictionary.gif" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/ecde9dfe-ddaf-462c-9ad7-cfd35f596fd4/BookmarkDictionary.gif" width="40px" /> Diagnostic Criteria: 6847

Rating
(a) the condition continues over a long period of time and causes respiratory failure with right heart ventricle failure 
                                         OR

****(b) with too much carbon dioxide in the blood stream OR ****(c) if it requires a tracheotomy | 100% | | requires the use of breathing assistive device such as a continuous positive airway pressure (CPAP) machine during sleep (*can also be a special pillow) | 50% | | (a) causes serious sleepiness during the daytime OR (b) not feeling rested after sleeping | 30% | | diagnosed by a sleep test, but does not cause any significant symptoms | 0% |

*38 C.F.R. § 4.96(a) precludes separate evaluations for certain listed respiratory conditions (including all forms of sleep apnea)

</aside>

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/7a8d350d-2500-42fa-b835-400fae1c43cb/no.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/7a8d350d-2500-42fa-b835-400fae1c43cb/no.png" width="40px" /> Common Reasons the VA Denies Service Connection for Sleep Apnea

  1. Undeveloped Lay Evidence

    Solution: submit well developed lay statements regarding continuity of symptomology (when, how often, how bad)

  2. No Nexus

    Solution: get a medical opinion connecting the veteran's past symptoms/diagnoses to his current symptoms/current diagnosis of sleep apnea

  3. Wrong Theory of Service Connection

    1. Diagnosis in service - still requires a nexus opinion
    2. Post-Service Diagnosis - no reference of symptoms in service treatment records
    3. Post-Service Diagnosis reference of symptoms in service treatment records
    4. Sleep Apnea causes/aggravates or is caused/aggravated by another service-connected condition - secondary service connection </aside>

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/5bf61af1-a01f-41a4-bb42-a0e0088a33e6/bindersonshelf.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/5bf61af1-a01f-41a4-bb42-a0e0088a33e6/bindersonshelf.png" width="40px" />

Resources

Service-Connecting Sleep Apnea: Direct

Service-Connecting Sleep Apnea: Secondary

Sleep Apnea Secondary to PTSD

Aggravated Obesity (Weight Gain) as “Interim Link” for Secondary SC

</aside>

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/53ce3db7-6458-4f4e-9142-f039d9bcb196/cardiovascularsystem.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/53ce3db7-6458-4f4e-9142-f039d9bcb196/cardiovascularsystem.png" width="40px" /> Effects of Sleep Apnea

daytime fatigue, heart damage, liver damage, blood sugar issues, headaches, stroke, hypoxia/hypoxemia, irregular heartbeat, depression, ADHD, memory loss, high blood pressure, weight gain, nocturia

</aside>

Advocacy Advice

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/5e21a3ed-dfac-4527-bd1d-ea4c7f9e8434/bookshelf.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/5e21a3ed-dfac-4527-bd1d-ea4c7f9e8434/bookshelf.png" width="40px" /> Urban v. Shulkin, 29 Vet. App. 82 (2017) - 2 step analysis for evaluating multiple respiratory conditions:

  1. Determine which respiratory condition predominates; then
  2. Apply the diagnostic code for that disability, considering all signs and symptoms attributable to any of the service-connected respiratory conditions.

</aside>

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/f709f38c-0c7d-4fe5-bbb9-7d9fcb75994c/sharing.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/f709f38c-0c7d-4fe5-bbb9-7d9fcb75994c/sharing.png" width="40px" /> Rule Change: Effective April 18, 2016 (published in M21-1MR):

  1. As long as there is proof that a breathing assistive device is medically necessary, lack of compliance with the device is "not relevant"
  2. A CPAP is no longer the only breathing assistive device that will qualify for a 50% rating evaluation: can also be a special pillow </aside>

osa.jpg