Hello all,
I just got my decision letter for my sleep apnea claim. I was denied for service connection secondary to PTSD.
I submitted as much evidence as I could with this claim - nexus letter, CPAP diagnosis/sleep study from the VA clinic, personal statement, and a DBQ.
I was hoping that since PTSD can cause sleep disturbances that obstructive sleep apnea could be considered secondary to this. I have read some posts/comments from people in this subreddit that have been successful with this secondary claim.
A frequent method with this secondary claim that I see is people will connect their service-connected PTSD to weight gain, and then that weight gain to their sleep apnea. The issue I have with this is that I have not gained any weight since getting out of the military.
My question is do you guys think it's worth submitting a HLR for this? Do you know if it's possible to argue the connection between PTSD and sleep apnea without associated weight gain?
Thank you in advance.
P.S. Here is a direct passage from my VA claim denial letter:
On VA examination the examiner opined, "PTSD does not directly cause obstructive sleep apnea because the two conditions arise from fundamentally different mechanisms. OSA is a mechanical disorder caused by repetitive collapse of the upper airway during sleep, often due to anatomical narrowing or reduced neuromuscular tone of the pharyngeal muscles. PTSD is a neuropsychiatric condition marked by hyperarousal and dysregulation of the central nervous system. PTSD does not induce structural changes in the upper airway or compromise the anatomical integrity needed to keep it open. The heightened sympathetic activity in PTSD does not produce the airway muscle relaxation that leads to obstruction in OSA. OSA development is mainly influenced by factors like obesity, craniofacial anatomy, and upper airway soft tissue characteristics. While PTSD can cause sleep disturbances such as insomnia or fragmented sleep, these do not create the airway collapse required for OSA. Therefore, there is no direct physiological mechanism linking PTSD to the onset of obstructive sleep apnea."
The medical opinion we received from the VA contract examination was more persuasive than [doctor's name], private physician's opinion because it was based on a thorough review of your relevant military and/or personal history and contained a more convincing rationale. (38 CFR 4.6)
On VA examination the examiner opined, "Moreover, while the private DBQ is read and acknowledged, however, current medical literature does not support PTSD as a cause of chronic worsening or progression of OSA. Records likewise show the veteran's OSA remains manageable and well within the level of mild OSA. This indicates that there is no objective clinical evidence of worsening of OSA symptoms. Hence it is my opinion that the veteran's OSA is less likely than not caused by nor aggravated by his SC PTSD."