Welcome everyone to another edition of CCK Live. My name is
Michael Lostritto. I'm an attorney here at the firm and today
we're going to be discussing Hypertension and sleep apnea
and how those two conditions are connected and interrelated
with us today. We have attorneys Amy Odom and also
Caitlyn Dena and so why don't we jump right in Amy? Why don't
we get started with you? Could you give us a little bit of
information as to what is Hypertension? What is the
medical community think Hypertension is what is VA
think Hypertension is and can you describe that a little bit
for us? Sure Mike So Hypertension means high blood
pressure and blood pressure is the pressure of the blood
pushing up against the walls of your arteries. It's measured
using two numbers, systolic blood pressure and dias blood
pressure. systolic blood pressure is the pressure in
your arteries when the heart beats and Dias blood pressure
is. Pressure in your arteries between heartbeats generally a
normal blood pressure level is less than 120 systolic and
eighty dias. The American Heart Association recognizes
Hypertension at systolic pressure of 130 or higher and
dias pressure of eighty or higher, But VA does not
recognize Hypertension as a disabling condition until.
Systolic pressure is to 160 or higher and or dias pressure is
ninety or higher, and it'll rate the disability based on
systolic and dias pressure. The big thing about Hypertension is
that it presents a greater risk for heart problems and stroke
if it's left untreated. So that's a great point. Amy. So I
think what I hear you saying, is that a veteran may. Think or
they're they're treating private doctor may say they
have high blood pressure, but in VA's eyes that might not
actually be the case in order for it to be service connected
and rated is that correct. Yes, unless your Hypertension blood
pressure is at least ninety dias or 160 systolic. VA will
not recognize it as a current disability. Yeah, and that
that's that's a great point. I know I've seen Veterans. In my
practice, I'm sure we all have where they you know. they have
high blood pressure, according to their doctor, and they can't
understand why VA doesn't recognize that the reason
really is because you know the regulations state that that's
not the standard. It's a little bit different of a standard for
VA to consider it a disabling condition. So yeah, that's a
critical difference and a good point now the American Heart
Association's definition of. Dias or higher that's
relatively new in the past few years, So maybe in the near
future, VA's regulations will catch up with medicine. But
until that happens, you're kind of out of luck unless you have
these particular blood pressure readings. Thanks Amy. So
Kaitlyn turning to you, the second condition that we're
talking about today is is sleep apnea. So maybe you can talk to
us a little bit about you know what is sleep apnea Are there
different types of sleep apnea? What are those different types?
Can you can you talk to us a little bit about that sure so
sleep apnea is a potentially serious sleep disorder where a
person's breathing is repeatedly interrupted during
the course of their sleep. There's three main types of
sleep apnea. The first and most common is obstructive sleep
apnea, which occurs when the throat muscles intermittently
relax. And block your airway while you're asleep. the second
is central sleep apnea, which occurs when your brain does not
send the proper signals to the muscles that control that
breathing and the third type is complex or mixed sleep apnea,
which basically means that you have symptoms of both
obstructive sleep apnea and central sleep apnea. Yeah and
II think it's important to know that. despite there being three
different main types of sleep apnea, they all kind of have
very similar signs and symptoms and Veterans really. Because
often times they're they're lay people right, they're they
don't have medical knowledge. They're not expected
necessarily to know which condition they have or which
type they have and claim that specifically, but you know all
all of the signs and symptoms are more or less the same and
somewhat overlap. so some common symptoms include you
know bowed snoring gasping for air during sleep, you know
awakening with a dry mouth. having a morning headache
insomnia that might result from sleep apnea, You know
difficult. Difficult concentration or having
difficulty concentrating I should say these are all kind
of symptoms and things that you know a veteran might experience
that would relate to anyone of those three types of sleep
apnea. Kaitlyn that you that you just talked about. so so
Amy turning back to you. How is sleep apnea diagnosed well,
generally a veteran will seek treatment for the symptoms that
you just mentioned like the snoring. Usually somebody in
the house is complaining about how loud the snoring is or.
Somebody's witnessing these moments in the night where the
veteran is gasping for air and so the veteran will seek
treatment for these particular symptoms. The doctors will.
Will will consider sleep apnea as a possible explanation for
the symptoms and send the veteran for a sleep study,
which is usually overnight and you know, doctors monitor the
veterans Sleep and oxygen levels during sleep and based
on that study, the doctor will diagnose sleep apnea or
something else. But for VA purposes, it's really important
that you actually have the sleep study done just a doctor
saying well, this veteran has these symptoms of snoring and
choking and gasping and headaches, and so it sounds
like sleep apnea isn't going to be sufficient for the VA.
They're going to require that there has been an actually a
conservatory sleep study sleep study done. Yeah. That's a good
point. You know. I see that a lot of our veterans they they
may obviously not know what happens during their sleep, but
they might have a spouse or a family member or a friend. Even
that would you know right? A statement in support of their
claim, but without the diagnosis without a sleep
study, it's going to be difficult and in many cases for
veterans to actually get the condition service connected. so
that is something that's that's a really critical piece here in
terms of rating, the condition one service connection has been
established for sleep apnea. You know there are various
ratings depending on the severity of the condition they
range from a 0% to a thirty to a fifty all the way up to a
100% rating again based on the severity. Of the condition,
according to the applicable regulation. Kaitlyn Turning
turning back to you again here now that we've kind of talked
about the two conditions generally speaking Hypertension
and sleep apnea. Can you talk to us a little bit about the
relationship between those conditions? You know how they
impact the other. you know, are there any you know, trends or
medical evidence that shows that there's a relationship
between Hypertension and sleep apnea. Sure, so research by the
American Heart Association and others has shown or has
suggested at least that obstructive sleep apnea is
highly relevant to patients with Hypertension it. That
translates to an estimated of 50% of patients with
Hypertension also having obstructive sleep apnea, and
that condition represents one of the most prevalent secondary
contributors to Hypertension. Another study has also found
that people with untreated sleep apnea were 2.6 more time.
excuse me 2.6 times more likely to experience cardiovascular
complications, which included Hypertension, researchers
believe that when breathing is restricted oxygen levels in the
body decreased and that causes an increase in blood flow and
this. Blood flows places additional pressure on the
blood vessels walls ultimately, causing higher than normal
blood pressure levels, and overall, there appears to be a
causal relationship between sleep apnea and the development
of Hypertension or at least the research suggests that there is
yeah and that that kind of leads into the next point here.
if there's medical research that shows that you know
Hypertension or rather sleep apnea can impact or cause.
Maybe Hypertension in some way is there an ability for
veterans to seek compensation service connection for their
Hypertension based on sleep apnea and so here we're looking
at you know what's known as secondary service connection
for Hypertension based on sleep apnea. Both sleep apnea and
hypertension may be granted service connection. You know
independently if a veteran can prove that the condition began
in or was caused by something that happened during service.
So you know, advocates and VA typically calls that direct
service connection something happened in. That directly
leads to or causes in layman's terms, the condition sleep
apnea Hypertension, but there's another avenue available to
veterans and it speaks to that relationship that you were just
discussing and so that is what's known as secondary
service connection so secondary service connection is is
essentially if a veteran has a condition that's service
connected and that service connected condition causes or
contributes to causing or aggravating another condition,
then that secondary. Condition can be service connected in its
own right based on that that primary or first condition that
was service connected. so for our purposes here, it is
possible to get Hypertension service connected secondarily
to a veteran's already service connected sleep apnea, and so
with secondary service connection, the medical nexus
opinion that you know a private physician or you know an
expert. Offers or maybe even a VA examiner offers it has to
link the veteran's secondary disability. In this case, the
Hypertension to the veterans already service connected sleep
apnea. So that really is a critical point here because of
the relationship Kaitlyn that you discussed and even if a
veteran may not be able to prove that their Hypertension
on, it's own directly was related to something that
occurred in service. There's another path here. There's
another avenue for veterans to consider for veterans advocates
to consider. So with with that in mind, Amy turning back to
you. How does. One prove that you know Hypertension is
actually secondary to sleep apnea. How do we how do we
apply these concepts to you know, make it more concrete you
know and actually proving the claim. Well, you have to have a
medical nexus opinion like you mentioned Mike. It's not enough
to just have a diagnosis of Hypertension, even one that
meets VA's criteria and sleep apnea confirmed by sleep study.
You also have to have medical evidence linking the two
conditions. And that, in most cases is going to need to be in
the form of a medical nexus opinion by a competent medical
professional who can say that based on your history, your
specific history, the sleep apnea has caused or aggravated
the Hypertension.
And so Kaitlyn, when we're thinking about you know
practically how we submit this evidence or the types of
evidence that we want to submit and what goes into that. can
you talk to us a little bit about you know how a veteran
would want to go about doing that what they would want to
keep in mind the types of evidence that they'd want to
submit Yes. So, as Amy said, you know you need a competent
medical nexus opinion. so one thing that you can do is that
if your doctor you know does believe that there's a
relationship between your sleep apnea and your Hypertension he
or she could. Provide an opinion that states it is at
least as likely as not that the Hypertension is caused by the
sleep apnea. You can also submit medical relevant medical
records that might show you know associations between the
two condition. You can submit medical articles that talk
about the relationship between the two conditions and you can
also submit lay evidence now Veterans as lay persons, you
know can't render an opinion of themselves, but they can talk
about their experiences with. The two conditions that could
inform that kind of opinion. Yeah, that that that's that's
an excellent point and you know another point that I that I've
seen here representing Veterans is if a veteran has AA
compensation and pension examination for the
Hypertension or really any condition. But in this context,
Hypertension, the examiner may very well on service connection
on a direct basis or maybe even a presumptive basis, but often
times what I see is, they don't consider secondary service
connection as a theory and so they're not offering an
opinion. On that and so Veterans if that, if that is,
in fact the case in a particular veteran's case, they
should push back on that. They should make sure that you know
a VA examiner is considering that theory and any evidence
related to that theory is considered and you know the
failure to do so should be something that maybe a veteran
looks to appeal or asks for a new examination to consider
that evidence and and those theories of service connection
right. Mike I think the important takeaway here is that
in most cases you're going to have to have that medical
opinion either by a VA examiner or your own doctor saying that
there's a link but this other evidence. Like the medical
records and the medical articles can provide a good way
to prove to the VA that you should get that opinion and
might provide if if you get a bad opinion from a VA examiner
or I should say a negative opinion. the medical articles
and the medical records might contradict the examiner
rationale for the unfavorable opinion and provide a basis for
appeal. Yeah. Well, I think that actually does it for this
edition of CCK Live. Thank you for joining us as always and
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