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CrustySMSgt
05-31-2013, 10:12 AM
I've definitely heard a lot of folks "trying to get diagnosed" with sleep apnea over the years, as the barracks lawyers say it'll get you an automatic 50% rating. Looks like the numbers back up the fact that it is a problem. Given this disorder is most often connected with obesity, you'd think it'd have a low occurance over the military population.


Attorney urges Congress to end sleep apnea claims 'abuse'
By Tom Philpott
Stars and Stripes Tweet

Published: May 30, 2013
In 2001, the year U.S. forces invaded Afghanistan, 983 veterans began to draw disability compensation from the Department of Veterans Affairs for sleep apnea, a disorder linked to obesity and characterized by pauses in breathing during sleep that can cause chronic drowsiness.

Last year, 25 times that number of veterans and military retirees (24,791) were added to VA compensation rolls for service-connected sleep apnea, raising the number of vets and retirees drawing apnea payments to 114,103, double the number VA reported just three years earlier.

VA compensation for sleep apnea now exceeds $1.2 billion annually under the most conservative of calculations. Michael T. Webster, a former naval aviator and family law attorney in Shalimar, Fla., calls this boom a scam and an offense to veterans who suffer from “real disabilities.”

Webster seeks to shine a spotlight on what he sees as “widespread abuse” of the VA claims system, mostly by recent retirees. He began with a May 6 letter to his congressman, Rep. Jeff Miller (R-Fla.), who is chairman of the House Armed Services Committee.

“Virtually every single family law case which I have handled involving military members during the past three years has had the military retiree receiving a VA ‘disability’ based upon sleep apnea,” Webster wrote. “A recently retired colonel told me that military members approaching retirement are actually briefed that if they claim VA disability based on sleep apnea, then they receive an automatic 50 percent disability rating thereby qualifying for ‘concurrent’ payment status.”

A spokesman for Chairman Miller said: “These are obviously very serious allegations and the committee is looking into them to ensure that veterans benefits go only to those who have earned them.”

VA data show 88 percent of veterans diagnosed with sleep apnea have a 50-percent disability rating. That’s because if a sleep study confirms apnea on active duty, or the condition can be linked back to time in service, and a CPAP (continuous positive airway pressure) machine is prescribed, then the current VA rating schedule requires a 50 percent disability rating.

Ironically, physicians who treat the disorder say that if a CPAP provides relief, vets no longer should be viewed as disabled, a nuance ignored by the Veterans Affairs Schedule for Rating Disabilities (VASRD).

“Many people who have sleep apnea and are on treatment are not disabled. I would say the majority,” said Dr. Samuel Kuna, chief of sleep medicine at the Philadelphia VA Medical Center, in a phone interview.

That seems to support Webster’s argument that VA is compensating increasing numbers of veterans who aren’t disabled. Webster said he knows of retired Air Force pilots diagnosed with sleep apnea who have passed rigorous flight physicals to be able to fly commercial aircraft.

VA’s Dr. Kuna stopped short of sharing his opinion on whether thousands of veterans he views as not disabled should still draw VA compensation.

“I’m a clinician on the front line taking care of the patient. My focus is on managing that patient’s medical problem,” Kuna said. “So I am not involved with their disability claim, other than providing information that they may need for their applications.”

VA has been compensating for sleep apnea only since 1996 when VASRD ratings for respiratory diseases received a major overhaul. The ease with which a claimant with sleep apnea reaches the 50-percent threshold is significant for retirees. Ratings below 50 percent, for those who don’t have a CPAP, have no relief from the ban on concurrent receipt of both retired pay and VA compensation. Retired pay is cut dollar-for-dollar by VA payments.

With a 50-percent rating, retirees boost monthly income by at least $810, more if they are married or have other dependents.

Webster said word has spread, particularly among careerists nearing retirement, that if they snore they’d be foolish not to request a sleep study to check for apnea. Such testing used to be done in a lab. More often today it is conducted at home using a headband or wristband device that collects medical data during sleep.

If there is cessation of airflow into the lungs for at least 10 seconds and at least five times an hour, mild sleep apnea is diagnosed, and a CPAP can be prescribed. Patients with severe apnea have 30 or more events per hour. Severe apnea, if not treated, can damage the heart or lead to respiratory failure or other injuries.

Kuna said he finds no unique association between sleep apnea and the rigors of service life except in cases of wounds or injuries to nasal passages. In those cases, surgery is the usual treatment rather than a CPAP.

“The greatest risk factor for sleep apnea is obesity,” Kuna said. “And we have had an epidemic of obesity over the last two decades, at least in the United States…We do see a lot of young veterans who are overweight a year or two after they have left the service.”

A sleep study is needed to diagnose apnea. If done on active duty, the condition is service-connected and usually compensable. For vets and retirees diagnosed after service, establishing a “medical nexus” to service time is more difficult but still possible. Claimants provide statements from spouses or colleagues that they snored heavily in service, had difficulty sleeping and point to medical records showing fatigue or trouble sleeping.

Tom Murphy, compensation services director for VA, said compensation claims for sleep apnea or any other medical condition are “demand driven” and not something VA would want to discourage. Veterans today, he said, simply “are more aware of what their benefits are and are taking advantage of it.”

Verna Jones, director of American Legion’s veterans’ affairs and rehabilitation division, called Webster’s letter “hurtful” to vets with sleep apnea who only in recent years have discovered why they snored so loud and were chronically tired. She said any surge in claims is a credit to VA, the Legion and to other veteran service organizations that are briefing veterans more thoroughly “on all types of disabilities they can apply for.”

Webster, however, said it’s a slap at veterans “truly disabled,” like his late father who, as a 21-year-old Marine, lost an arm at the shoulder from gun mount explosion at sea. His dad later married, raised seven children and could fix anything as long one of his kids helped with a tool or nail. Carved on his tombstone, said Webster, is “HHT” for “Here, hold this.”

“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, while our airplanes are being grounded and ships are not putting to sea…it pissed me off. Somebody needs to blow the whistle. By God, if somebody is disabled, compensate them. But this is a sham and it rankles me to the core.”



http://www.stripes.com/news/veterans/attorney-urges-congress-to-end-sleep-apnea-claims-abuse-1.223588

Measure Man
05-31-2013, 02:24 PM
Yeah...interesting.

I get that sleep apnea is a real thing and can cause real problems...I don't get the "disability" of it, and I don't get how it is service connected most of the time.

50% disabled is a lot...you don't even get that for losing a foot. Yet, I know retirees drawing this that are fully capable to work, and in fact, work for the govt. as GSs.

TSgt"M"
05-31-2013, 02:31 PM
The flight physical example says it all.

sandsjames
05-31-2013, 02:39 PM
According to the VA, you don't have to have a "service related" disability in order to qualify. You could have had a pre-existing condition that became worse while you were in and still qualify. Though I think that the payout for sleep apnea is excessive when people with back, and other body, injuries that actually affect their physical well being and can't be controlled with a machine recieve much less.

CrustySMSgt
05-31-2013, 02:40 PM
Yeah...interesting.

I get that sleep apnea is a real thing and can cause real problems...I don't get the "disability" of it, and I don't get how it is service connected most of the time.

50% disabled is a lot...you don't even get that for losing a foot. Yet, I know retirees drawing this that are fully capable to work, and in fact, work for the govt. as GSs.

Same thing the article points out... if you have it and get the machine, you're good to go, so what's the remaining problem (and how is it service related?)

TSgt"M"
05-31-2013, 02:42 PM
The flight physical example says it all.

Pullinteeth
05-31-2013, 04:46 PM
Yeah...interesting.

I get that sleep apnea is a real thing and can cause real problems...I don't get the "disability" of it, and I don't get how it is service connected most of the time.

50% disabled is a lot...you don't even get that for losing a foot. Yet, I know retirees drawing this that are fully capable to work, and in fact, work for the govt. as GSs.

While I get what you are saying, the fact of the matter is that I would lay money that MOST disabilities that the VA is compensating vets for isn't actually service related. Female gets a hysterectomy while on AD because of a family hx of uterine cancer? 50% disability (or more). Was THAT service related? Family history of cancer and get cancer while a Reservist? =disability. diagnosed with ALS while in the Guard? 100% disabled. All you really have to show is that it occured while you were in the military.

Couldn't find the foot reference....loss of use of foot is 40%...I would have to believe loss of the entire foot would be more but didn't see it....

Measure Man
05-31-2013, 04:56 PM
While I get what you are saying, the fact of the matter is that I would lay money that MOST disabilities that the VA is compensating vets for isn't actually service related. Female gets a hysterectomy while on AD because of a family hx of uterine cancer? 50% disability (or more). Was THAT service related? Family history of cancer and get cancer while a Reservist? =disability. diagnosed with ALS while in the Guard? 100% disabled. All you really have to show is that it occured while you were in the military.

Yeah, I know...it's all a little crazy. I'm 20% disabled from sports injuries...yeah, they were during squadron sports activities, though.

My professional softball career hopes are dashed...but, that wasn't really a career option for me anyway.

I was denied for a heart defect...that was unknown until I was in the service...because the VA said "most of them are congenital, so, it is unlikely this is service connected"

garhkal
05-31-2013, 06:19 PM
Yeah...interesting.

I get that sleep apnea is a real thing and can cause real problems...I don't get the "disability" of it, and I don't get how it is service connected most of the time.

50% disabled is a lot...you don't even get that for losing a foot. Yet, I know retirees drawing this that are fully capable to work, and in fact, work for the govt. as GSs.

Neither do i. And if it's controlled by a CPAP, i would like to know how someone can claim to still be disabled.

But i would also like to see it where if someone IS diagnosed with it, they are prohibited from certain jobs.


According to the VA, you don't have to have a "service related" disability in order to qualify. You could have had a pre-existing condition that became worse while you were in and still qualify. Though I think that the payout for sleep apnea is excessive when people with back, and other body, injuries that actually affect their physical well being and can't be controlled with a machine recieve much less.

I knew of (chatter around the smoke pit) who came in with a pair of buldged disks, but since he had a desk job (IT) he was waivered for it. Got out at 8 yrs and had it wrote in that cause one eventually 'popped' it was a 'service connected disability. iMO that should NOT have been SCD'ed as he had it when he came in. Just like most i know who have had SA had it from childhood.


While I get what you are saying, the fact of the matter is that I would lay money that MOST disabilities that the VA is compensating vets for isn't actually service related. Female gets a hysterectomy while on AD because of a family hx of uterine cancer? 50% disability (or more). Was THAT service related? Family history of cancer and get cancer while a Reservist? =disability. diagnosed with ALS while in the Guard? 100% disabled. All you really have to show is that it occured while you were in the military.

Which to be is BS. All of it.


Yeah, I know...it's all a little crazy. I'm 20% disabled from sports injuries...yeah, they were during squadron sports activities, though.

My professional softball career hopes are dashed...but, that wasn't really a career option for me anyway.

I was denied for a heart defect...that was unknown until I was in the service...because the VA said "most of them are congenital, so, it is unlikely this is service connected"

So you had a potential congenial heart issue which got denied, but someone comes in with a child hood issue that got worse (or finally diagnosed while in) and it IS connected? total BS!

efmbman
05-31-2013, 09:18 PM
Neither do i. And if it's controlled by a CPAP, i would like to know how someone can claim to still be disabled.

Just to play devil's advocate... from that logic, there is a medical issue existing but the CPAP machine controls it so it is no longer a disability.

Does that mean that once a servicemember is fitted with a prosthetic limb (replacing the missing limb) the disability no longer exists?

The issue, from what I can tell, is the wording in the VA rating of disabilities. As it stands now, the VA will assume ownership of anything that causes your quality of life to be less than when you joined.

garhkal
06-01-2013, 05:07 AM
Good point.. sometimes playing devil's advocate does get people thinking.

TSgt"M"
06-03-2013, 12:53 PM
Just to play devil's advocate... from that logic, there is a medical issue existing but the CPAP machine controls it so it is no longer a disability.

Does that mean that once a servicemember is fitted with a prosthetic limb (replacing the missing limb) the disability no longer exists?

The issue, from what I can tell, is the wording in the VA rating of disabilities. As it stands now, the VA will assume ownership of anything that causes your quality of life to be less than when you joined.

Wish they would take ownership of all the old Air Force fillings falling apart in my mouth.

raustin0017
06-13-2013, 04:16 PM
Funny how folks approaching retirement all of a sudden get sleep apnea, back problems, loss of hearing, etc....

TJMAC77SP
06-13-2013, 04:35 PM
Funny how folks approaching retirement all of a sudden get sleep apnea, back problems, loss of hearing, etc....

Generally also called aging.............

garhkal
06-17-2013, 05:40 AM
Funny how folks approaching retirement all of a sudden get sleep apnea, back problems, loss of hearing, etc....

For my last year and a half in, i had several people urging me to at least get tested for it, cause for all i know i could have it and not know it.. and as they said there was no harm in asking. So i do feel some are milking it to get all they can.

CrustySMSgt
06-17-2013, 06:33 AM
For my last year and a half in, i had several people urging me to at least get tested for it, cause for all i know i could have it and not know it.. and as they said there was no harm in asking. So i do feel some are milking it to get all they can.

This has been my experience as well.

efmbman
06-17-2013, 10:42 AM
For my last year and a half in, i had several people urging me to at least get tested for it, cause for all i know i could have it and not know it.. and as they said there was no harm in asking. So i do feel some are milking it to get all they can.

In my last year in, I was urged to be tested for Gulf War Syndrome (I never did, but that's a different story). What's the difference?

garhkal
06-17-2013, 08:41 PM
Who urged you to test? If medical staff, then i would say there is a good potental something else in your record alerted them to the possibility that you might be worthy.
If just comrades in your shop urging you to test for it, just to milk the system, that is imo something else.

CYBERFX1024
06-17-2013, 09:19 PM
Funny how folks approaching retirement all of a sudden get sleep apnea, back problems, loss of hearing, etc....

That is true. But I have also heard it how people have been living with a symptom of something without having to go to sickcall. Then when he/she is about to get out go to sickcall and be seen for it. So that yes it is annotated and on record. That way IF it gets worse later on, then they can claim it.

I, myself have a compensation claim going through the VA right now. I have claimed literally everything that has ailed me and still does to some extent. I did that for the sole purpose of what if they throw out one problem and find me disabled for another problem.

Chief_KO
06-17-2013, 10:00 PM
From the VA website: "Disability compensation is a monthly tax-free benefit paid to Veterans who are at least 10% disabled because of injuries or diseases that were incurred in or aggravated during active duty, active duty for training, or inactive duty training. A disability can apply to physical conditions, such as a chronic knee condition, as well as a mental health conditions, such as post-traumatic stress disorder (PTSD)."

I've never known anyone to suddenly "develop" Apnea, knee problems, back problems, etc. right before retirement. But, I've known many who were tested for Apnea (with about half coming back as not having it...just loud snoring. It is up to the individual to shift their focus from "Service Before Self" to "I Better Take Care of Myself (and provide for my family)" before they end their service committment...cause once your retired...it all changes. If it's not part of your separation/retirement VA claim (even if it's a zero %) and it flares up later..."it's obvious that this condition must have just happened Mr. Jones" cause there's nothing in your records showing any connection to your service.

Service members sacrifice a lot during our time in uniform...there is no reason to continue that sacrifice into your post-service life. The day you turn in your CAC...you become PNG (persona non grata).

WillsPowers
06-17-2013, 10:45 PM
Don't eliminate the condition as a defined compensation illness---reschedule it. If there's no surgery or prescription involved rate it as 10% and with surgery and or meds rate it at 40%.

garhkal
06-18-2013, 05:23 AM
Also what of those who had it BEFORE they came in?? Should those be able to get 'va disability ratings" just cause they had it anotated in their med records?

Greg
06-18-2013, 11:36 AM
Some very interesting comments:

"Strong, Divided Reactions to Sleep Apnea Claims
Jun 13, 2013
TOM PHILPOTT

Ordinarily I enjoy reading Military Update. However, I was more than a little dismayed at your column on sleep apnea and the comments by Michael Webster.
I have severe obstructive sleep apnea (OSA). I use a CPAP, including when I travel. I am dependent on it to sleep without interruption. I was diagnosed with OSA while on active duty, two to three years before I retired and well before I even knew that it was a VA disabling condition.

Sleep Apnea is not new. It's been described as early as the Roman era. What is new, dating from about 1981, is the CPAP. Even more recent is the recognition of the disease and its effects on human physiology including interrupted sleep, depression, increased in risk of a heart attack or stroke, and even an increase in cancer mortality rates."

http://www.military.com/benefits/2013/06/13/strong-divided-reactions-to-sleep-apnea-claims.html?comp=700001076338&rank=7

CrustySMSgt
06-18-2013, 11:58 AM
Some very interesting comments:

"Strong, Divided Reactions to Sleep Apnea Claims
Jun 13, 2013
TOM PHILPOTT

Ordinarily I enjoy reading Military Update. However, I was more than a little dismayed at your column on sleep apnea and the comments by Michael Webster.
I have severe obstructive sleep apnea (OSA). I use a CPAP, including when I travel. I am dependent on it to sleep without interruption. I was diagnosed with OSA while on active duty, two to three years before I retired and well before I even knew that it was a VA disabling condition.

Sleep Apnea is not new. It's been described as early as the Roman era. What is new, dating from about 1981, is the CPAP. Even more recent is the recognition of the disease and its effects on human physiology including interrupted sleep, depression, increased in risk of a heart attack or stroke, and even an increase in cancer mortality rates."

http://www.military.com/benefits/2013/06/13/strong-divided-reactions-to-sleep-apnea-claims.html?comp=700001076338&rank=7

Granted this comment is anecdotal, with no evidence to back it up, but I suspect this is much closer to the truth!!


I was a clinic manager and an independent duty corpsman in VA while on active duty. I have written many consults for sleep studies. It seemed every person retiring wanted a sleep study. The Naval Hospital was so overwhelmed we had to start sending consults out to civilian clinics. On average about 40-50 percent of patients seen at the Naval Hospital were diagnosed with sleep apnea. On the other hand, 100 percent of the patients sent to civilian clinics where diagnosed with sleep apnea.I brought my concerns up to my chain of command and was told there was nothing that could be done. I agree that this was, and still is, being abused. The sad part is the vets with combat-related injuries who are well below 50 percent, including myself.

I have no problem with my disability rating below 50 percent. I do have a problem with people getting 80-100 percent for conditions that have no possible correlation with military service.

Most of the persons I see with 50 percent and above have conditions directly related to personal choice. The military did not make them fat, give them diabetes or give them sleep apnea. If they had taken better care of themselves they would not have the conditions. I understand some of these conditions are genetic, but family history should also not be a reason for disability.

Solution: Make all personnel diagnosed with sleep apnea send a printout of their CPAP machine showing it is being used. Anyone who has a family history of diabetes, heart disease, etc. in their health records should not be eligible for disability. Not maintaining proper body weight and failing physical fitness should not be rewarded with compensation for a self-inflicted disease.

PAUL. H.
Chief Hospital Corpsman, USN-Ret.
Via email

garhkal
06-18-2013, 06:52 PM
I fully agree with his statement of "Solution: Make all personnel diagnosed with sleep apnea send a printout of their CPAP machine showing it is being used. Anyone who has a family history of diabetes, heart disease, etc. in their health records should not be eligible for disability. Not maintaining proper body weight and failing physical fitness should not be rewarded with compensation for a self-inflicted disease."

Calmo70
06-18-2013, 08:08 PM
Also what of those who had it BEFORE they came in?? Should those be able to get 'va disability ratings" just cause they had it anotated in their med records?

Can't say about sleep apnea - but I retired in 1998 with 28 years service. Had lower back pain documented well over 20 times in my medical record - never had an x-ray, mri, etc while active duty except at retirement physical. Doctor said I had been born with very mild case of spina bifada (sp?) - a small bulge in my lower spine. I asked about disability claim - Doc said no because it was a pre-existing condition. Didn't get any disability at retirement nor now.

Second issue - family genetics. My brother-in-law is a Vietnam vet (only did two years - draftee - one year in Vietnam). Both of his parents were Type 1 diabetic. He developed Type II diabetes at about 45 years old. Went to the VA - Vietnam vet - agent orange - automatically got 20 percent. Then went back for sleep apnea (he uses CPAP) - got another 30 percent. He is now going for hearing loss (he was a truck driver in the Army). Back then - no hearing protection and he says he had a 50 cal mounted on his truck. Looks like he is going to get another 20 percent. Having said all that - he is still working road construction - driving heavy equipment. I'm not jealous - but I am skeptical all that was a result of his Vietnam tour.

garhkal
06-19-2013, 09:58 PM
Having said all that - he is still working road construction - driving heavy equipment. I'm not jealous - but I am skeptical all that was a result of his Vietnam tour.

So he is getting (or might be) 70% disability, and is STILL working. Cases like this is why i feel disability claiments should be vetted.

Calmo70
06-20-2013, 01:49 PM
So he is getting (or might be) 70% disability, and is STILL working. Cases like this is why i feel disability claiments should be vetted.

Yea - and he just turned 62 and is applying for early Social Security - surprised a bit he never applied for Social Security disability too.

garhkal
06-20-2013, 07:14 PM
That definitely sounds like someone willfully milking the system...

garhkal
06-21-2013, 05:42 AM
Its like when i lived in the UK as well as being stationed there.. Many a show on the news, or on the show Watchdog had people claiming disability, but still working under the table elsewhere, or in 2 dicked up cases, claiming 100% disability but getting caught on camera REFEREEING at a soccer match. To me that comes under the fraud heading.

Chief_KO
06-21-2013, 07:33 PM
VA Disability Compensation and Pension (Comp & Pen) are not equatable to physical disability and employment.
That is considered "Individual Unemployability" which would qualify a person for Social Security Disability and other state benefits.

From www.benefits.va.gov:
"IU eligibility requirements: 1. You must be a Veteran 2. You must have at least one service connected disability rated at least at 60%, OR
Two or more service connected disabilities at least one disability ratable at 40 percent or more with a combined rating of 70 percent or more.
3. You must be unable to maintain substantially gainful employment as a result of service-connected disabilities (marginal employment, such as odd jobs, is not considered substantial gainful employment for VA purposes)."

"IU Evidence Requirements: 1.Evidence of at least one service connected disability AND That the service-connected disability or disabilities are sufficient, without regard to other factors, to prevent performing the mental and/or physical tasks required to get or keep substantially gainful employment AND
That one disability is ratable at 60 percent or more, OR If more than one disability exists, one disability is ratable at 40 percent or more with a combined rating of 70 percent or more."

"Under exceptional circumstances this benefit may be granted with a lower disability rating than noted above provided the evidence shows the service-connected disability or disabilities present such an exceptional or unusual disability picture, due to such factors as marked interference with employment or frequent periods of hospitalization, that applying the normal disability requirements is impractical."