How to Service Connect Sleep Apnea secondary to PTSD. Symptoms of sinusitis often include: Chronic sinusitis can also cause nasal polyps, deviated nasal septum, and recurring respiratory tract infections. Service connection links your present disability and your active military service. Congestive heart failure occurs when the heart cannot pump blood efficiently, causing a buildup of fluid in the lungs and other tissues. Additionally, sleep apnea may worsen existing coronary artery disease. If the VA grants service connection for both conditions, they will only assign whichever has the higher rating. In addition to being a secondary condition to ischemic heart disease, arrhythmias can also be caused by other conditions such as hypertension, diabetes, and obesity. Yes, Sleep Apnea is a VA disability and its rated under diagnostic code 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed). Veterans with Ischemic Heart Disease are nearly three times as likely to develop congestive heart failure as those without. This is because, while asleep, the body may not clear the veterans esophagus as it would when the veteran is awake, thereby exacerbating the veterans GERD. denied? Obstructive sleep apnea (OSA) is characterized by recurrent complete and partial upper airway obstructive events, resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation. A 50% rating would be given if treatment was ineffective or you were unable to use therapies due to another condition. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease. CCK Recognized for Donations to American Veterans Disabled For Life Memorial, CCK Successfully Argues for a Precedential Decision About Protected Work Environment, A Day in the Life of a Paralegal (Claims Advocate) at CCK. Phoenix, AZ: One Renaissance Tower, Two North Center Avenue, 18th & 19th Floor, Phoenix, AZ 85004 This process may be repeated over and over again during the night. See 67 FR 54394. By using this information, you understand that there is no attorney-client relationship created by you reading or using the information contained on this website or in this newsletter, article, or blog. Typically, sleep apnea symptoms are at their worst during REM Sleep due to the bodys naturally-occurring reduced muscle tone in the bodys airway. We know the pain of feeling stuck, frustrated, and alone, and we want to make this process as easy and painless as possible for you. Signup to never miss a beat with special offers, blog updates, exclusive trainings, and more delivered right to your inbox! For a limited time, you can book a free, no-obligation VA Claim Discovery Call with one of our experts. Did you know there are more than 40+ conditions that can be medically linked to cause or aggravate sleep apnea? You're not alone. WebCorrelation between coronary artery disease and obstructive sleep apnea syndrome and analysis of risk factors Correlation between coronary artery disease and obstructive sleep apnea syndrome and analysis of risk factors Exp Ther Med. Heres a quick litmus test: If you snore during sleep, are tired during the day (maybe you take frequent naps), and stop/start breathing while sleeping (gasping for air), chances are you might have Sleep Apnea. Proper detection and treatment of sleep apnea might This is called a split-night sleep study. A current diagnosis of sleep apnea, as confirmed by a sleep study; An in-service event, injury, or illness; and. The General Rating Formula for heart conditions ranges from 10% to 100% with breaks at 10%, 30%, 60% and 100%. Agent Orange is a herbicide used by the U.S. military during the Vietnam War. sleep apnea and that must be confirmed by a sleep study (its okay if this If your heart is healthy, it can pump enough blood to meet the increased demand. at 4, 906. persona 5 character models. The disability compensation depends on the disability rating. While the symptoms of heart failure can seem to come out of nowhere, the condition is often the result of another underlying cardiovascular problem. A veterans final VA disability rating for Sleep Apnea depends upon the frequency, severity, and duration of symptoms, meaning, the more severe your symptoms, the higher the VA rating for Sleep Apnea. Loved ones like family or close friends could also be a good help in sharing how your sleep has changed. R. at 7. For instance, which pages you go to most. All clinician information blocks at the bottom of the DBQs must be completed and the form signed and dated by the clinician completing the DBQ. Secret hack: You can also order a sleep study Similar to other heart conditions secondary to ischemic heart disease, the VA wont assign separate ratings. The VA refers to mixed sleep apnea as a combination of the obstructive and central forms of the condition. WebIn the recent years intensive research has revealed numerous negative consequences of obstructive sleep apnea (OSA) for the cardiovascular system. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. Its estimated that patients with sleep apnea are 2-4 times more likely to develop heart arrhythmias (abnormal heart rhythms) than people without this condition. Heres the brutal truth about VA disability claims: We use cookies to ensure that we give you the best experience on our website. High Blood Pressure Secondary to Obstructive Sleep Apnea: What Veterans Should Know Are you suffering from obstructive sleep apnea syndrome and hypertension? Many veterans suffer from various sleep conditions due to their military service, to include Sleep Apneaa sleep disorder whereby breathing repeatedly stops and starts during sleep (apneic episodes). While appellate litigation proceeded, the connection on direct or secondary bases because it did not qualify as a disease or injury. Thousands of other Veterans in our Community are here for you. The information these cookies collect will not personally identify you, and they cannot track your browsing activity on other websites. Good news, there is a better way and theres a laundry list of possible sleep apnea secondary conditions. As your heart rate and blood pressure increase, your doctor will monitor your hearts electrical activity and blood flow. Estimate your 2023 VA Rating & Compensation for FREE! To receive benefits, you must first prove that there is a service connection. Earlier studies estimated the prevalence of OSA in heart failure with reduced EF to be 12-15%, while the prevalence of central sleep apnea (CSA) was between 37-38%. If accepted into our ELITE membership program, youll get free up-front access and permission to use $13,119 worth of proprietary VA claim resources, including access to our network of independent medical professionals for medical examinations, disability evaluations, and credible Medical Nexus Letters, which could help you get a HIGHER VA rating in LESS time. Need an Independent Medical Opinion (IMO) to help service-connect your sleep apnea VA claim? If you are the surviving spouse of a disabled veteran who has passed away, youre eligible Average Disability Payment Agent Orange Ischemic Heart Disease, VA Secondary Conditions to Ischemic Heart Disease, Sleep Apnea Secondary to Ischemic Heart Disease, Heart Failure Secondary to Ischemic Heart Disease, Arrhythmias Secondary to Ischemic Heart Disease, Cardiomyopathies Secondary to Ischemic Heart Disease, Valvular Heart Disease Secondary to Ischemic Heart Disease. Since 2016, VA Claims Insider has helped thousands of Veterans just like you get the VA rating and compensation they deserve in less time. This VA dependents Today, Brian Reese the VA Claims Insider reveals the Top 8 VA Benefits for Surviving Spouse this year. However there are several rules that must be followed in order for this to occur: If the VA does propose a reduction of rating, then the veteran can submit an argument against it. After receiving an honorable discharge in 2018, Trisha worked as a growth marketer and utilizes her analytic skills to help others accomplish their business goals. If accepted into our ELITE membership program, youll get free up-front access and permission to use $13,119 worth of proprietary VA claim resources, including access to our network of independent medical professionals for medical examinations, disability evaluations, and credible Medical Nexus Letters, which could help you get a HIGHER VA rating in LESS time. However, in February 2022, VA proposed changes that would reclassify sleep apnea ratings to 0 percent, 10 percent, 30 percent, or 50 percent, with 100 percent for sleep apnea seeming even harder to qualify for. According to the Mayo Clinic, Sleep Apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts.. Its FREE to get started, so click Go Elite Now below to complete our 3-step intake process. The Department of Veterans Affairs (VA) proposes to amend the section of the VA Schedule for Rating Disabilities (VASRD or Rating Schedule) that addresses the cardiovascular system. Research has found that veterans who have chronic tinnitus also prevalently experience sleep apnea. Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Although all of these symptoms contribute to the interaction betweensleep apnea and PTSD, the main culprits seem to be sleep deprivation and chronic stress. WebNexus Letters for GERD, Coronary Artery Disease, & Fatty Liver Disease. Loud Snoring. Los Angeles, CA: 10880 Wilshire Blvd., Ste 1101, Los Angeles, CA 90025 For a limited time, you can book a free, no-obligation VA Claim Discovery Call with one of our experts. 2019 Eventually, this can lead to fluid retention throughout the body (particularly around the lungs).*. If your VA claim was denied, we may be able to assist you. Gasping For Air. study. you were on active duty, and furthermore, you probably didnt even know what Additionally, the more severe a veterans PTSD is, the more severe their sleep apnea can become. Another type of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. sleep apnea was during you service. Contact the VA-accredited veterans disability attorneys and claims agents at CCK today at 800-544-9144. Disability terminology chart. The second part can be satisfied with a veterans existing service-connected disability rated at 0 percent or higher. WebThis is called hypopnea (decreased breathing) or apnea (meaning no breathing). Generally, there are three types of sleep apnea: Oftentimes, the symptoms of the three types of sleep apnea can overlap, making diagnosis more difficult. Because the medical research is slim to You might also like the following Sleep Apnea Blog posts: Top 3 Most Common VA Sleep Apnea Secondary Conditions, List of 40+ Possible Sleep Apnea Secondary Conditions. People with tinnitus may hear phantom noises, such as: Tinnitus is one of the most frequently claimed conditions for service connection. Research from 2018 estimates that obstructive sleep apnea affects 34% of men and 17% of women in the general population but 40% of men and 60% of women with cardiovascular disease. By understanding the VA secondary conditions associated with ischemic heart disease, veterans can take steps to prevent further complications and improve their overall health. This blockage is caused when the back throat muscles relax, impairing the airflow. The rating criteria are as follows: 60% diastolic pressure predominantly 130 or more Washington, D.C.: 1776 I Street, NW, 9th Floor, Washington, D.C 20006 Treatment options include lifestyle modification, medications, implantable devices, and surgery. As such, a veteran with anxiety and depression faces a higher risk of sleep apnea. For secondary service connection to sleep apnea, veterans will need: When filing a claim for secondary service connection, veterans can use the same form as primary service connection (VA Form 21-526EZ). This website adheres to the W3Cs AA Accessibility guidelines. shampoo for damaged hair. Believe it or not, buddy statements can be helpful in proving sleep apnea claims if you can find vets who you served with and heard you snoring, or can talk about the issues that led to the sleep apnea. Many veterans attempt to service-connect sleep apnea as a primary disability condition and cant seem to figure our why the VA keeps denying your sleep apnea claim. be resistance among military clinics worldwide from ordering-up sleep studies The most trusted name in education-based resources for Veterans. These secondary conditions can significantly impact a patients quality of life and, in some cases, can be life-threatening. These cookies are also used to let affiliates know if you came to one of our websites from an affiliate and if your visit resulted in the use or purchase of a product or service from us, including details of the product or service purchased. Additionally, sleep apnea may worsen existing coronary artery disease. Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can affect people who have experienced or witnessed trauma, such as a distressing or shocking event. Not everyone who snores has sleep apnea, but many who have sleep apnea do snore regularly and loudly. Sleep Apnea, Obesity, and Heart Disease As a part of the VAs duty to assist veterans in obtaining evidence to help prove their claim, the VA has a duty to assist veterans in scheduling the examination for a sleep study and helping them realize the VA disability claim that they are entitled to. Your Sleep Apnea VA Rating A Guide to Getting a VA Disability Rating for Sleep Apnea, Top 10 Questions About Military Sexual Trauma (MST), A post shared by VA Claims Insider (@vaclaimsinsider). 1 Adults with OSA not only have an increased risk of developing comorbid CVD but also have worse outcomes related to CVD. Brian Reeseis a VA benefits expert, author of the #1 Amazon Bestseller You Deserve It: The Definitive Guide to Getting the Veteran Benefits Youve Earned, andfounder of VA Claims InsiderThe Most Trusted Name in Education-Based Resources for Veterans.. While it is often possible to control hypertension through lifestyle changes and medication, some people with hypertension also develop ischemic heart disease, which occurs when the arteries that supply blood to the heart muscle become blocked or narrowed. Claire Szewczyk is a Digital Content Coordinator for Hill & Ponton, PA in Florida. For example, maybe your Sleep Apnea so severe, that you have difficulty working and lose productivity throughout the day due to frequent napping. Heres the brutal truth about VA disability claims: Veterans exposed to Agent Orange during the Vietnam War. Prior to the exam, the examiner will review the veterans c-file so they are familiar with the veterans case. As such, the two conditions have been linked and veterans can receive secondary service connection for sinusitis linked to sleep apnea. #3. If treatment for sleep apnea provides only limited alleviation, you will only receive ten percent of your maximum compensation, even if a CPAP machine is required. You Deserve It: The Definitive Guide to Getting the Veteran Benefits Youve Earned, 9 Secrets Strategies for Winning Your VA Disability Claim. you viewed to avoid repetition. Brian Reeseis a VA benefits expert, author of the #1 Amazon Bestseller You Deserve It: The Definitive Guide to Getting the Veteran Benefits Youve Earned, andfounder of VA Claims InsiderThe Most Trusted Name in Education-Based Resources for Veterans.. Pittsburgh, PA: 201 Penn Center Boulevard, Suite 400, Pittsburgh, PA, 15235 Evidence (echocardiogram, multigated acquisition scan, MRI, etc.) In some cases, implantable cardioverter-defibrillators may be recommended to help prevent sudden cardiac death. Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim (FDC)so you can increase your rating fast!If youve filed your VA disability claim and have been denied or have received a low ratingor youre unsure how to get startedreach out to us! Signup to never miss a beat with special offers, blog updates, exclusive trainings, and more delivered right to your inbox! Nexus Letters for GERD, Coronary Artery Disease, & Fatty Liver Disease. Knowing what to look for and how to manage these conditions can help you stay healthy and live a full life. These changes may lead to clogged arteries and poor heart muscle function. As such, veterans who are service-connected for PTSD are eligible for secondary service connection for their sleep apnea. OSA largely results from a disruption in the normal breathing process. For years, the elephant in the room in the VA Schedule for Rating Disabilities has been sleep apnea. Congestive heart failure is a common complication of ischemic heart disease. Note: Millions of Philips CPAP Machines have been recalled due to toxic chemical seeping into mask and unknowingly being inhaled by sleep apnea patients. Cincinnati, OH: 300 E Business Way, Suite 200, Summit Woods Corporate Center, Cincinnati, OH, 45241 If you have been diagnosed with ischemic heart disease (IHD), its important to be aware of the other conditions that can occur. One type of heart disease is valvular heart disease, which occurs when one or more of the hearts valves are damaged. The second part can be satisfied with a Some of the most common secondary conditions include sleep apnea, heart failure, arrhythmias, cardiomyopathies, and valvular heart disease. Trouble sleeping caused by shortness of breath, coughing, or wheezing, A whistling or wheezing sound when exhaling, Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu, Re-experiencing the trauma through recurrent memories, flashbacks, and nightmares, Avoidance of people, places, and activities that are reminders of the trauma, Increased arousal such as difficulty sleeping and concentrating, Difficulty maintaining relationships with others, Thick, discolored discharge from the nose, Drainage down the back of the throat (postnasal drainage), Nasal obstruction or congestion, causing difficulty breathing through your nose, Pain, tenderness, and swelling around your eyes, cheeks, nose, or forehead. Sleep apnea increases the risk of heart failure by 140% and the risk of coronary heart disease by 30%. Study Impact: Our findings reveal a close relationship between the atherosclerosis-related burden measured by the coronary artery calcium score and the severity of sleep apnea that persisted after adjusting for confounding variables related to the risk of coronary artery disease. With an audible gasp, breathing starts again. Current evidence has shown that OSA initiates and exacerbates coronary atherosclerosis and is closely related to poor outcomes in patients As such, veterans who are service connected for tinnitus may be eligible for secondary service connection for sleep apnea, and vice-versa. In order to determine whether you should be referred for a sleep study, a doctor will first perform a physical exam, ask about symptoms, and collect your personal and family history. Veterans, do you think you might have Sleep Apnea? If so, how often and how long are your naps? we represent clients nationwide. If your obstructive sleep apnea VA claim, or other sleep apnea claim, was originally denied, you may be able to appeal the rating and receive VA disability compensation. Asymptomatic sleep apnea would not be compensated under the tentative regulation. How to Get a 100 Percent VA Rating (if deserved)! A 2023 Guide to VA Disability Rates & Pay Schedules, Individual Unemployability Rating Calculator, List of Blue Water Navy Ships Exposed to Agent Orange (Interactive Vietnam Map), Social Security Disability Benefits Guide, sleep apnea as a secondary service connected condition to PTSD, Calculate Your Potential Compensation Now. I am service connected for severe obstructive sleep apnea (OSA). These cookies allow the website to remember choices you make to give you better functionality and personal features. In order to establish direct service connection for sleep apnea, a claimant must show that they have: A veteran can also establish service connection for sleep apnea on asecondarybasis. After veterans file a claim for secondary service connection, VA may request that the veteran undergo a Compensation and Pension (C&P) exam. Positive Airway Pressure Treatment and Depression in Adults with Coronary Artery Disease and Nonsleepy Obstructive Sleep Apnea. Yes, Sleep Apnea is a VA disability and its rated under diagnostic code 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed). She was a former US Airforce civilian employee, who worked at Hill Air Force Base, in Layton, UT as a flight testing administrator. You're not alone. It indicates, "Click to perform a search". 26,27 More recent studies have found an even higher prevalence of both CSA and OSA in heart failure patients. She enjoys working with the Veteran population and keeping them up to date with information they need the most. An ischemic heart exam, commonly called a stress test, can provide your doctor with important information about your heart health. Brian is a Distinguished Graduate of Management from theUnited States Air Force Academy, Colorado Springs, CO and he holds an MBA from Oklahoma State Universitys Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class). nexus letter from a qualified medical professional. One of the main risk factors for sleep apnea is obesity, which other conditions like ischemic heart disease can also cause. Were seeing veterans coming back from Iraq, Afghanistan, and the southwest Asia theater of war with severe sleep issues, which can oftentimesbe linked to PTSD. Some of these symptoms include sleep deprivation, insomnia, hyperarousal, and daytime sleepiness. All Rights Reserved. Over time, plaque can harden and narrow the arteries, making blood flow difficult. VA may deny a sleep apnea claim based on different aspects, whether theres not enough medical evidence of sleep apnea or perhaps no logical connection between your military service and your current sleep apnea. The VA rates ischemic heart disease under the General Rating Formula for Heart Conditions with a range from 10% to 100%. The most common VA rating for Sleep Apnea is 50%, which requires the use of a breathing assistance device such as Continuous Positive Airway Pressure (CPAP) machine. A person must have a polysomnogram, either in a sleep lab or at home, in order to be diagnosed with sleep apnea. Op. This sleep-disordered breathing leads to poor sleep quality and is a risk factor for the poor quality of life. Examples of chronic disease include: arthritis, diabetes or hypertension. They are a leading cause of heart failure and death worldwide and are one of the common secondary conditions in veterans with ischemic heart disease. Contact Us Box 449, Deland, FL 32721, Orlando, FL: 605 E. Robinson Street Suite 635, Orlando, FL 32801 A C&P exam for Sleep Apnea might involve a physical examination and review of your medical history and severity of symptoms over time. Some of the following conditions can be secondary to sleep apnea, while others may be the primary condition to which sleep apnea is secondary. Service connection on a secondary basis requires Brooklyn, NY: 300 Cadman Plaza West, One Pierrepont Plaza, 12th Floor, Brooklyn, NY, 11201 A ton According to medical research, military veterans are FOUR TIMES (4x) more likely to have sleep apnea than the normal civilian population, a truly staggering number. These cookies are necessary for the website to function and cannot be switched off in our systems. interim link to secondary service connection due to weight gain (obesity). So, heres the opinion of VA Claims Insider: If you did NOT have a sleep study while on active duty and you did NOT get a diagnosis of sleep apnea on active duty, you should attempt to service connect your sleep apnea VA claim secondary to another service-connected disability rated at 0 percent or higher. This guide will provide an overview of the most common conditions secondary to ischemic heart disease. Its also important to document whether you have a breathing machine, such as a CPAP or BiPAP, as this is the most common difference between the 30% and 50% VA rating for Sleep Apnea. Chicago, IL: 332 S. Michigan Avenue, Floors 8 and 9, Chicago, IL 60604 While there is no cure for the condition, you can manage it through lifestyle changes and medical treatment. Sinusitis is a condition where a persons sinuses become swollen and inflamed for three months or longer, despite treatment. Exploring the Connection Between Sleep Apnea and Cardiovascular Disease. Providers Overview Location Reviews Providers If the VA grants service connection for both conditions, they will only assign whichever has the higher rating. Many veterans have or develop Sleep Apnea and common signs and symptoms include: If you suffer from any of these symptoms, its highly recommended to see a doctor right away. Because the chamber must relax in order to fill with blood between contractions, this stiffness means that an inadequate amount of blood is available to pump to the rest of the body. Veterans exposed to Agent Orange during the Vietnam War are at an increased risk for developing ischemic heart disease, and many receive disability benefits as a result. She has also spent several years working with the Department of Veterans Affairs audiology programs in Salt Lake City, UT and Pocatello, ID. People with sleep apnea are more likely to have irregular results on liver function tests, and their livers are more likely to show signs of scarring, known as nonalcoholic fatty liver disease. I have diagnoses post-service for GERD, Coronary Artery Disease (CAD), and non-alcoholic fatty liver disease. If you continue to use this site we will assume that you are happy with it. rocky top hearts australian shepherds This means that a veteran has an already service-connected disability that caused the veteran to have sleep apnea. A polysomnogram at a sleep center might be preferred if you have heart or lung disease, risk factors for central sleep apnea or a history of other sleep disorders. The lungs arent getting fresh air. How to Get a VA Rating for Sleep Apnea Secondary to Anxiety (The Insiders Guide), Can I Get a VA Rating for Sleep Apnea Secondary to Depression? Sometimes, certain lifestyle changes can help to minimize the symptoms of sleep apnea, such as losing weight or quitting smoking. Sleep apnea can cause various health problems, including heart disease. By using our website, you agree to the use of certain cookies. These exams are usually performed by a VA examiner or a VA-contracted third-party medical professional. It is intended that the DBQs will be completed by the Veteran's health care provider. The chemical has been linked to various health problems, including cancer, congenital disabilities, and ischemic heart disease. Pursuant to Diagnostic Code 6847, VA disability ratings for Sleep Apnea are as follows: Sleep Apnea is rated under diagnostic code 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed): 6847, Sleep Apnea Syndromes (Obstructive, Central, Mixed): Many veterans with Sleep Apnea, especially those who were diagnosed long after leaving the military, might still be eligible if medical evidence shows your Sleep Apnea is proximately due to or aggravated by another service-connected disability such as musculoskeletal conditions and/or mental health conditions. The most trusted name in education-based resources for Veterans. Several conditions may qualify for disability compensation, including heart disease. This type of exam is meant to assess the cause and the severity of the veterans condition, as well as the connection to the primary service-connected disability. Several conditions can occur as a result of ischemic heart disease. This means you do NOT currently have the VA disability rating and compensation YOU deserve, and you could be missing out on thousands of dollars of tax-free compensation and benefits each month. As blood backs up into the blood vessels, the body starts to retain fluid in the abdomen and lower body. VA Form 21-686c, also known as the VA form to add dependents or the Declaration of Status of Dependents, is a form for you to provide information to the VA about your dependents. Current evidence has shown that OSA initiates and exacerbates coronary atherosclerosis and is closely related to poor outcomes in patients You can increase the chances of successfully demonstrating a service connection by completing the three parts of the Caluza triangle: It can also be important to document and disclose your Severity of Symptoms in terms of their frequency, severity, and duration. must be satisfied for sleep apnea secondary conditions to prove secondary Over time, hypertension can lead to coronary heart disease, heart failure, stroke, and kidney failure. I am service connected for severe obstructive sleep apnea (OSA). Authors Get a Free Case Evaluation, The Link between Sleep Apnea and Hypertension, VA Disability Ratings for Insomnia and Sleep Disturbances, Sleep Apnea Secondary Connection to PTSD VA Disability, Other Medical Conditions Sleep Apnea is Connected With, VA Proposes Changes to Sleep Apnea Ratings, Common Sleep Apnea and Sleep Problems Symptoms in Veterans, VA CPAP Machines for Sleep Apnea Treatment, Establishing Service Connection For Sleep Apnea, C&P Exam for Sleep Apnea and Sleep Studies.