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(cell phone 301-651-6392)

To: All veterans


Date: 26 Sept 2014
Topic: Sleep Apnea
Independent Veteran Medical Opinion (IMO)
And Veteran medical nexus opinion based on
Veterans Medical Records

Pages: cover only

From:
Craig N. Bash, M.D.
Neuro-Radiologist
www.veteransmedadvisor.com

4938 Hampden lane Bethesda, MD 20814


Phone: (301) 767-9525 Fax: (301) 951-9106
E-Mail: drbash@doctor.com

Sleep Apnea.
This is common condition as we age, in fact, anybody over 50 should be tested if they have any sleep
complaints, snoring or a spouse that says they stop breathing at night. The disease is categorized into two
basic groups as either central or obstructive. Additionally, a mixed version also occurs. Some lung disease
can also contribute to sleep apnea thus this disease has many multifactorial causes.
The Central version often is due to central nervous systems problems (stroke, functional brain disease,
cervical spine disease).
The Obstructive type occurs when the nose/mouth, para-nasal sinuses, pharynx or lungs obstructs the flow
air into the lungs, which can be associated with snoring.
TESTING:
1. It is important to get a sleep study both with and without a CPAP trial. (A two night study is better than a
split-night study)
2. Nasal x-ray and/or CT scan might be useful along with a physical exam
Many Veterans have sleep apnea secondary to cervical spine problems and/or diabetes, which occur often in
VA patients. Sleep apnea can also cause its own set of secondary conditions such as weight gain/diabetes,
cardiac and stroke diseases.
As stated in the VA watch dog write-up VA will not grant sleep apnea on lay statements alone it requires a
well organized medical opinion along with testing. This rating is currently under review with the VA
currently and thus the codes might become more restrictive.
SUGGESTION:
1. A well-trained Physician who is familiar with the primary and secondary aspects of sleep apnea to include
sleep testing should evaluate all sleepy veterans. Then a comprehensive report Independent Veteran Medical
Opinion =IMO/Veteran medical nexus opinion) should be obtained so that VA service related coding can be
accomplished.
2. All veterans should apply for a claim for sleep apnea ASAP as new VA codes are likely forthcoming
Craig N. Bash M.D., M.B.A. Associate professor--Cell 240-506-1556 Veteran Medical Opinion
Veteran medical nexus opinion based on Veterans Medical Records opinion based on Veterans medical
records drbash@doctor.com

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