Put It To Rest.

MYTH

"...not everyone who has sleep apnea is overweight. Thin people develop this disorder." - Mayo Clinic

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"70 percent of people with OSA are obese" - Deepak Chopra (Jan 2012)

When you grow up like that, seeing a one-armed individual not giving into ‘the disability,’ [and] then to see people with no disability whatsoever sucking huge amounts of money out of federal coffers…it pissed me off.....this is a sham and it rankles me to the core.

"Major contributing factor for sleep apnea .... is large neck size"

REALITY

Sleep apnea is a Hurricane

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300% - 500% Increase in Death Rate

BVA issued 1845 decisions in Veterans Sleep Apnea Appeals

WHAT IS SLEEP APNEA?

OSA
CSA
Complex

Obstructive Sleep Apnea

Central Sleep Apnea

Then.....Complex Sleep Apnea

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Effects

4 PILLARS OF A VA CLAIM

Pillar 1:

Diagnose with Polysomnogram

• Home Based Test ($500 - $1300)
• In-Lab Test ($1k - $5k)

Duty to Assist

• Every VISN has at least 1 Sleep Center (4 bed)
• Choice Card?

Pillar 3:

Impairment Ratings

Special Issues

• 38 CFR 4.96a
• Alternative to CPAP (Mouth/Dental Guards, Oral Therapy Devices, etc)

Pillar 2

Direct
Secondary
Aggravation

Common Problems

PROBLEM #1

Solution

Fortified Lay Evidence

• Frequency
• Chronology
• Severity

Problem #2

Solution

Ask:

• Same Type of SA
• Same "causation" of SA
• Intervening factors

Problem #3

Solution

4 Most Common Scenarios

• Dx in Service still requires Nexus.
• Post Service Dx, no reference in STRs
• Post Service Dx, reference in STRs
• SA Causes/Aggravates, or is Caused/Aggravated by, another Condition

bit.ly/VASleepApnea

Unique Symptoms not adequately or accurately reflected in rating schedule. 38 C.F.R. 3.321(b)

TDIU - unemployability:
4.16(a): 60/70-40 rule
4.16(b): any rating
Focus in on inability to perform sedentary work

Secondary & Aggravation