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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey, guys. It's Leah Bee from Prestige Veteran Medical Consulting. I am a US army veteran, physician assistant, and former compensation and pension examiner. So welcome back to our channel, and today, we're going to dive into a big one. Why are so many VA sleep apnea claims denied?
leah bucholz:If you've ever filed and gotten the dreaded denial letter, you are not alone. In fact, this is one of the most commonly denied claims out there. We've done a ton of videos on sleep apnea, so I hope you guys have enjoyed some of those. And if you haven't seen them yet, please go check them out. We've got a ton of information on sleep apnea.
leah bucholz:So let's just go ahead and break down the most common mistakes, the evidence VA actually looks for, and how you can support your case. But before we get into denials, let's start with the basics. What is sleep apnea, and why is it so common among veterans? So sleep apnea is a disorder where your breathing repeatedly stops and starts while you sleep. Obstructive sleep apnea is one of the most common types that I see and and many veterans suffer from.
leah bucholz:That is when your airway actually collapses during your sleep. So central sleep apnea, the brain doesn't send the right signals to breathe. K? And then you can also have a mixed version of this where you can have a combination of central sleep apnea and obstructive sleep apnea where that airway collapses. Symptoms can include loud snoring, choking, or gasping during sleep, and daytime fatigue.
leah bucholz:And it's not just about being tired. Untreated sleep apnea raises your risk for things like high blood pressure, heart disease, diabetes, and stroke. So sleep apnea in veterans. Let's talk about veterans specifically. So studies show sleep apnea is far more common among veterans than the general population.
leah bucholz:A 2014 study in the Journal of Clinical Sleep Medicine found that nearly sixty percent of post nine eleven veterans screened were at high risk for sleep apnea. A VA health services research and development report showed that more than one in five veterans receiving VA care have a sleep apnea diagnosis, and that number just keeps rising. Veterans with PTSD are significantly at a higher risk. A 2015 study found that seventy to ninety percent of vets with sleep apnea, I'm sorry, with PTSD symptoms also screen positive for sleep apnea. Military service comes with unique risk factors, irregular sleep schedules, exposure to dust and burn pits, weight gain from step stress and medications, and, of course, PTSD.
leah bucholz:All of this makes veterans much more likely to develop sleep apnea later in life. So let's talk about primary versus secondary service connection. And, again, we have a ton of videos on primary and secondary service connection for sleep apnea. Really, just a ton of videos on that secondary sleep apnea and a couple on that primary. So this is where the most claims can hit a roadblock.
leah bucholz:So service connection. There are two main paths. Primary service connection. So if your sleep apnea began in service, that can mean documented snoring, fatigue, or a sleep study during active duty that supported that diagnosis. So secondary service connection, your sleep apnea developed because of another service connected condition.
leah bucholz:Some of the most common ones are things like PTSD, hypertension, GERD, weight gain from medication, TBI, or traumatic brain injury is often related to central sleep apnea, and we've got a good video on that as well. So the evidence requirements are a little bit different for primary versus secondary service connection. And if you don't clearly establish which one applies to you, the VA may deny your claim. So common reasons sleep apnea gets denied. So let's hit the big reasons claims for sleep apnea often get denied.
leah bucholz:So you don't number one, you don't have an official sleep study. So the VA wants to see that polysomnogram or that sleep study report that confirms the diagnosis. That can be ordered by your primary care doctor. They can send you to a sleep lab. You can have a home sleep study test.
leah bucholz:Both of these types of sleep studies are pretty common. So number two, there's no proven service connection. Even if you're diagnosed now, the VA wants to see that link or that nexus between your service and the sleep apnea. So simply having sleep apnea is not enough. A lot of veterans will come through and they'll say, you know, VA diagnosed me with sleep apnea.
leah bucholz:Why aren't they giving me a rating for it? Well, VA can diagnose a lot of things. Right? So you can be you know, there's you're receiving veterans health care. Yes.
leah bucholz:They may diagnose you with sleep apnea, but you might have retired twenty years ago. So just because they diagnosed you with it now doesn't mean that there's a link to your service, and that's the thing that you need to be able to show is how how is that current medical condition linked to your service or another service connected condition. So that leads us to that missing or weak nexus. K? So a medical professional has to explain how your sleep apnea is at least as likely as not caused by your service.
leah bucholz:Without that, you don't have a lot of support. Now you can you don't have to necessarily have a, nexus letter, like a big robust nexus letter from somebody like me or, your treating doctor. The C and P examiner is able is capable. If you file a claim for sleep apnea, you go to your C and P exam if if VA orders you one, and that that nurse practitioner, PA, or doctor is going to provide an excess if they believe there's a relationship. They're going to state that there is a connection.
leah bucholz:Now it's not up to them. Right? It's up to the adjudicators, but they give a medical opinion whether or not they believe it is related to your service. Now they may not give that opinion. They may say it's not related to your service, and that's that's kind of the tricky part.
leah bucholz:Sometimes the C and P examiner will actually provide a negative Nexus statement. They may blame your sleep apnea on things like obesity unrelated to your service. Now that is that is not to kinda get confused with people that can have sleep apnea related to weight gain as an intermediate step. And I'm not gonna jump off on a huge tangent on that because we've got some other videos that talk about that. But if the VA is saying, hey.
leah bucholz:This person is obese, and that's, like, the number one cause of one of the number one causes of sleep apnea, and there's and and they're obese because of their own personal lifestyle choices, not because of their service, then, you know, that may be pretty tough. So obesity related, unrelated to service, they'll say it's, your age may be a risk factor. You have a naturally crowded airway. So maybe you have a really big tongue. You have you know, maybe you've got some kind of upper airway obstruction.
leah bucholz:Maybe you had a septal deviation unrelated to your service. Male gender is another big risk factor. So when that happens, you don't have to stop there. You can fight back with using an VA accredited medical I'm sorry. Not medical professional.
leah bucholz:A VA accredited legal professional, like an attorney, a VSO, or accredited claims agent. If you're comfortable doing the appeals through the Appeals Modernization Act that VA outlines on their website, you can try that. There's a lot of options, and there are a lot of people out there that can assist you. You can get a medical opinion. You can get a private doctor can review your history and connect those dots for you if if they believe there's a, or attempt to connect those dots from you, your treating doctor, or whatever.
leah bucholz:You can get a private DBQ or disability benefit questionnaire, that has a medical opinion in it as well. You can ask your doctor to review the medical literature, and you can include that, like studies linking, OSA to PTSD, TBI, medications, etcetera. Now maybe you had the symptoms in service. You know, there was not always sleep sleep apnea was not super common decades ago. So maybe you had those symptoms in service, it went undiagnosed for years.
leah bucholz:And then you get some buddy statements. I see this all of the time. You have a buddy statement from somebody who observed you snoring in service, having apneic events where you're gasping for air, you stop breathing while you're sleeping. Maybe it's your wife. Maybe you were married to your your current spouse, you know, twenty years ago, and she can attest to that in a in a written statement for you.
leah bucholz:So a negative C and P exam doesn't have to be the end of the road. So strong credible evidence can help support your you overturning that in some cases. So another thing that can be misunderstood is a CPAP requirement. So the CPAP requirement is not or a breathing device requirement is not necessarily gonna prohibit you from getting a connection. Right?
leah bucholz:But that currently, so this is subject to change. Okay? So we've already done a video, on the new sleep apnea ratings that has not changed yet that I'm aware of, but it's been pending for a while. But, currently, that 50% rating requires documented the the need for a breathing assistance device. K?
leah bucholz:So maybe your doctor says you don't require it. You may benefit from it. That may bring you down to that 30% level. It just depends on how the adjudicators look at that and whether you are required to use a device. That doesn't mean you have to use it.
leah bucholz:You should use it, right, if you're prescribed it, but, not wearing your device doesn't necessarily prohibit you from you know, you still have the disorder. So another thing that can be detrimental is weak supporting evidence. So buddy statements and spousal testimony can help your case in some circumstances. If they're not included, especially if it's that direct service connection, something like that can be helpful in some cases. So sleep apnea is a serious condition, especially common among veterans, but VA claims get denied all the time because of things like we mentioned, missing evidence, missing medical evidence, unclear service connection, weak nexus, and misunderstanding of the rating system, you know, when you look at those specific ratings once you get connected.
leah bucholz:So the good news is is these issues are fixable. If you know what the VA is looking for, you can help support your claim and improve your chances of approval. Again, always seeking that advice from an accredited legal professional can be very beneficial. So if you found this helpful, make sure to hit that like button, subscribe, and share this with another veteran who might be struggling with sleep apnea. Let me know in the comments if you enjoyed this.
leah bucholz:Have you had your sleep apnea claim denied? What your reason was? Check out some of those other videos we've made on sleep apnea, and they may be helpful as well. So until next time, take care of yourselves, and as always, thank you for your service.