sleep apnea secondary to rhinitis and sinusitis

sleep apnea secondary to rhinitis and sinusitis

OldGringo
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Joined: 10 Sep 2017, 14:42

10 Sep 2017, 15:19 #1

I am new to the forum.  Just got service connected for chronic rhinitis (30%) and chronic sinusitis (10%), for service in 1982.  It took over a year, and I also have severe OSA with oxygen deprivation.  VSO recommended not filing the OSA until after the claim was done.  Actually the sleep study was not completed until my claim was already 9 months in the process.  I also have a diagnose of asthma that did not show up until 2014.  We filed the claim last month and I had a C and P this last week.  The contract nurse who did the C and P just asked only the  DBQ questions and would not let me explain or add anything.  SO, my questions are:  (1) since I am service connected to rhinitis and sinusitis, what are my chances of winning the OSA claim?  (2) same question as to asthma?  I have read blog stuff both way, yeas and no.  Thanks for any help.
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USAFE7
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Joined: 17 Jan 2009, 20:47

11 Sep 2017, 18:21 #2

If you just got SC disabilities for service in 1982, I would think that was a good sign. It would be hard for anyone to guess if it will be SC, without reviewing your whole medical record/exams. If you can get a copy of C/P exam, see if the examiner noted "as likely as not" connected to your other disabilities. Good Luck.
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OldGringo
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Joined: 10 Sep 2017, 14:42

11 Sep 2017, 19:49 #3

USAFE7 wrote: If you just got SC disabilities for service in 1982, I would think that was a good sign. It would be hard for anyone to guess if it will be SC, without reviewing your whole medical record/exams. If you can get a copy of C/P exam, see if the examiner noted "as likely as not" connected to your other disabilities. Good Luck.
Thanks.  Yes, I know to get a copy.  My last exam the C and P exam did not post in my medical records for a long time, so I drove to the VA and got a copy under the FOIA office.  This C and P contractor would not listen to any comments I had, just asked the DBQ questions.  My claim did not really spell it out.  Last claim took 8 months  to get a C and P exam, so I was shocked when this one was like 3 weeks after filing.   My question really is has anybody recently made claims for OSA and asthma secondary to sinusitis and rhinitis.  I know there are some BVA cases that did approve them as secondary, but they both had very strong nexus letters and I do not have one, (yet).  MY VSO said not to spend the money on one, until we see what the C and P said.  Again, thanks. 
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Cruiser
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Joined: 27 Nov 2003, 23:33

11 Sep 2017, 21:12 #4

OldGringo wrote: SO, my questions are:  (1) since I am service connected to rhinitis and sinusitis, what are my chances of winning the OSA claim? 
That will most likely depend on what you submitted to support your claim.  Did you submit something from your doctor opining that the sleep apnea is due to your rhinitis and/or sinusitis or associated with your military service in some way?  If not then the probability of success is greatly lowered.

(2) same question as to asthma?
See my response to #1.

Cruiser
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OldGringo
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Joined: 10 Sep 2017, 14:42

11 Sep 2017, 22:12 #5

Cruiser wrote:
OldGringo wrote: SO, my questions are:  (1) since I am service connected to rhinitis and sinusitis, what are my chances of winning the OSA claim? 
That will most likely depend on what you submitted to support your claim.  Did you submit something from your doctor opining that the sleep apnea is due to your rhinitis and/or sinusitis or associated with your military service in some way?  If not then the probability of success is greatly lowered.

(2) same question as to asthma?
See my response to #1.

Cruiselr
No sir.  We did not submit a nexus letter.  My pulmonary specialist does not get involved in  VA, Social Security or workers comp claims. I asked him about it about a year into treatment and he made it very clear he did not get involved with claims or lawsuits.  He is supposed to be the best of his specialty in this area, so I will not change.  My VSO suggested that we wait for the C and P results before we consider an IME.  He is service connected for OSA secondary to Rhinitis himself and thought my particular fact pattern was good.  I was service connected after 33 years after the even and nearly 20 years after I retired.  In the first claim they had lost all my military medical records.  Suddenly after decades they appeared.  I am retired military and  did not file all these years because I did not think I would ever get to 50%.  As I aged my problems got much worse.   My new claim is that OSA and asthma are secondary to chronic sinusitis and chronic rhinitis with deviated septum and polyps. I was under the impression that the medical literature was pretty strong on these issues. So, I assume you suggest I go ahead and line up an IME?  Don't mind paying for it.  I am very sick and my asthma guy said totally uncontrolled and he is writing up a justification for a drug called Nuclara, which costs over $3,000 per month.  Anybody know if Tricare will pay for it?    Thanks Cruiser, I have read your comments many times and value your experience and expertise.  Thanks.    
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ScottNavy
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Joined: 14 Jun 2014, 22:16

13 Sep 2017, 22:00 #6

I am also service connected for Sinusitus (30%).  I also have Asthma but was denied service connection for it (in service it was diagnosed as Bronchitis).  I have had these issues for 30 years but was only rated in 2013 (just because of my lack of knowledge at the time of how VA disability worked).  I have recently been diagnosed with Churg-Strauss syndrome as the cause of all this.

Anyway recently the VA has agreed to provide me with Nucala (also known as Mepolizumab).  I have taken 4 doses so far (one injection a month).  It certainly has reduced my eosinophil levels and has allowed me to reduce my Prednisone intake.
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OldGringo
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Joined: 10 Sep 2017, 14:42

13 Sep 2017, 22:40 #7

ScottNavy wrote: I am also service connected for Sinusitus (30%).  I also have Asthma but was denied service connection for it (in service it was diagnosed as Bronchitis).  I have had these issues for 30 years but was only rated in 2013 (just because of my lack of knowledge at the time of how VA disability worked).  I have recently been diagnosed with Churg-Strauss syndrome as the cause of all this.

Anyway recently the VA has agreed to provide me with Nucala (also known as Mepolizumab).  I have taken 4 doses so far (one injection a month).  It certainly has reduced my eosinophil levels and has allowed me to reduce my Prednisone intake.

Thank you Scott.  I was just recently tested by my private doctor and told I need Nucala as my eosinophils are high and I am up to 10-12 cycles of steroids per year plus my daily low dose inhaler  The cost of Nucala is high, I think over $3,000 per shot/month, so I am thrilled to learn VA has approved it.  I will see if my doc can get VA to provide it.  

My VSO says they denied my claim for OSA but approved my claim for asthma due to rhinitis, so I am pleased. If they just go by my steroid use the last few years I should get 60% which would be great.  And if I can get the Nucala approved that would be great too.  Best news I have had in this process.  Thanks for your info as it will tell me what to do next. 
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ScottNavy
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Joined: 14 Jun 2014, 22:16

14 Sep 2017, 00:07 #8

Have a look at this VA form

https://www.pbm.va.gov/PBM/clinicalguid ... ograph.pdf

I had my non VA pulmonologist fill it out and then I asked my VA primary care doctor to submit it and while it took 4 months it was approved.  The pulmonologist included a letter with this form that discribed his reasoning why he wanted the Nucala prescribed.  At least in my case I think the drug has helped.

Good luck!
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ScottNavy
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Joined: 14 Jun 2014, 22:16

14 Sep 2017, 00:18 #9

One more thing.  The manufacturer of Nucala recommends monitoring of the patient after the injection.  My non VA pulmonologist wanted 2 hours of monitoring with the first dose and then 1 hour each time after.  I have had no bad reactions to this drug.  My VA PCP wasn't willing to do this at his office but arranged for me to go to my VAMC ER to have this done.  So I have been going on Saturdays every 4 weeks.  I call the pharmacy about 10 days in advance to have them order it and then I call them again the day before the injection to be sure it is there.  As you said it is expensive so they will not order more then one dose at a time.

I hope this helps.

Scott
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OldGringo
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Joined: 10 Sep 2017, 14:42

14 Sep 2017, 00:59 #10

ScottNavy wrote: One more thing.  The manufacturer of Nucala recommends monitoring of the patient after the injection.  My non VA pulmonologist wanted 2 hours of monitoring with the first dose and then 1 hour each time after.  I have had no bad reactions to this drug.  My VA PCP wasn't willing to do this at his office but arranged for me to go to my VAMC ER to have this done.  So I have been going on Saturdays every 4 weeks.  I call the pharmacy about 10 days in advance to have them order it and then I call them again the day before the injection to be sure it is there.  As you said it is expensive so they will not order more then one dose at a time.

I hope this helps.

Scott
  Again, thank you so much.  I have gotten to where I have allergic type reactions frequently that set off my asthma and I learned the hard way not to let them get too bad or I would be sick for weeks at a time.  So, maybe this stuff will help.  I will try the form.
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