Question: I was diagnosed with sleep apnea in 2011. I didn't know snoring really loud was a condition until the girl I was seeing, couldn't stand sleeping next to me. So I went in to see a doctor and a sleep study was performed. The results were that I have Obstructive Sleep Apnea. In 2006 I was diagnosed with hypertension and since then, I've been diagnosed with CHF and dilated cardiomyopathy in 2012. I've done the research referring to http://www.sleepapnea.org/learn/sleep-apnea.html. This particular page relates untreated sleep apnea to hypertension and I believe, I've had sleep apnea for years that has gone undiagnosed because of these facts; - I was diagnosed with hypogonadism in 2000, which I've been being prescribed Testosterone Replacement Therapy since 2000, as well. - The testosterone injections has caused me to gain a lot of weight. I was 160 lbs before I began treatment for my hypogonadism and throughout the years, I have continuously gained weight to where my weight is at 280 on average. IAW my medical records, my doctors state that I have high hips, making my waistline an easy 40 inches plus on average. - I was being prescribed 400 mg/ 2 weeks for 10 years before my doctors decided I was taking too much and decided to lower my dosage to 200 mg/2 weeks. - During treatment on TRT, I've had a heart attack, been diagnosed with insomnia, depression, PTSD, sleep apnea, CHF, Hypertension and Dilated Cardiomyopathy, amongst just a few of my conditions. - I am still being treated for all of these conditions & I wear a CPAP when I sleep at night. *My question is, can I have a doctor type a statement relating my sleep apnea to my hypertension? I am requesting this for VA Compensation Benefits. I feel that the VA Hospital works hand in hand with the VA Regional Office, so its hard to get any of my requests met without feeling like I'm asking them to go out of their way to assist me. If you believe my sleep apnea began while in service, do you believe it began before I was diagnosed with hypertension? I have more evidence to send if you can provide me with an email. I have tried sending you my complete medical history related to my service, but it is too large to upload. If you have any suggestions on how I can send it to you, I will be happy to do so. Thank you. I would also like to know your opinion about my heart conditions....Do you believe that they all stemmed from the time frame in my medical records, from the evidence you have and may have gone undiagnosed?

Is it possible for me to reverse my health problems through diet and moderate exercise?

I have gained so much weight because of testosterone injections and because of hypogonadism.. Is bariatric surgery my only option?

Do you think my OSA developed in the time frame indicated in the records I have provided to you?

If I cannot afford bariatric surgery, what are my other options?

Will you be willing to fill out a questionaire regarding my conditions? I am having trouble getting Veteran's Affairs to approve my disability and continue further treatment because they are stating my sleep apnea did not begin in the time frame of the records for which you have reviewed and given me your professional opinion on. The link to the questionaire can be found at http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp . I am also going to upload it for you as well. I can upload my most recent medical records from within the past 2 years if this will help you with completing the questionaire.

It's okay, I understand. I believe that the high dosage of testosterone replacement therapy led to my weight gain, and that plus issues with anxiety and depression caused my issue with sleep apnea, which went untreated for many years, leading up to CHF and dilated cardiomyopathy. All I really needed was a doctors statement backing me up, which is what you have given me. I can go ahead and schedule an appointment for a second opinion with another doctor and bring our discussion along with your credentials as back up for the answers for which I am seeking. Can you just do me one last favor regarding this issue and note the time frame as to when you believe my sleep apnea began in accordance with the records for which I have provided you?

I am looking for an answer from the time range of 2003 to 2007 if you believe that's when it began, because that is when I started to have symptoms that i can recall. I'm sure you are right that it developed when doctors knew so little about it, that's why I feel as though it went undiagnosed and untreated, leading to my hypertension, which was diagnosed in 2005. There is a gap between 2007 and 2011 which is why they are denying further treatment, but as I said, I believe the issue began between 2003-2007 due to the symptoms in my medical record. I will not be able to schedule for a 2nd opinion until next week which will be later, but I am looking for more than one opinion which I am sure the opinions will be the same, which will work in my favor.

In 1999, I joined the military weighing 160 lbs. I began TRT in September of 2000 at 400 mg every 2 weeks, which was a high dosage according to my blood tests, but STILL was prescribed the same dosage throughout the years to follow. From 2001 - 2002, I was having issues with depression, which is common in my genes. I was also on high doses of TRT which i believe added to my dysthemic disorder as I recall it being named. In March 0f 2002 I witnessed a catastrophic event that caused me to have some issues with adjusting to normal everyday occurrences, for which i had minor problems with prior to that. After that, my pulse rate was recorded at high rates IAW my records. Ever since the catastrophic event which i witnessed, my quality of sleep started to decline in which I had issues with falling asleep at night, even after working intense long hours during the day. I had issues with snoring and continued to gain weight as the years progressed, which I believe was a result of the high doses of testosterone. I began to have major respiratory issues in 2003, which included pneumonia, and bronchitis. As time further progressed, I was diagnosed with GERD in 2005, gastroenteritis, and anxiety. Furthermore, in 2006 this led to me being treated for all of the previous issues mentioned,esophageal reflux,UTI, Sinusitus maxillary, insomnia and insomnia, plus issues with edema, which I felt I had the entire time anyways. At that time i was having issues with daytime sleepiness. I would show up late for work because I was so exhausted in the morning, I could not drive to work, snoring, and daytime fatigue. When I was at work, I would sneak out to my truck and take long naps, until my co-workers would come wake me up when they needed me, when things got too busy. My supervisors made it clear to me that they had an issue with me going to the doctor for treatment, because they believed I was trying to get out of work, so I rarely sought treatment. In 2007, I decided to discharge from the military, because i was having issues with my supervisors about my tardiness to work and always being too tired to work. After May 2007 when i discharged from service, I was never treated, but had issues with snoring and would stop breathing in my sleep for years, before one day in 2011, my new girlfriend at the time, suggested I see a doctor for the symptoms which you have named, because she believed I had this issue with sleep apnea, in which she was correct. She probably saved my life, because I would have never sought treatment, for my snoring being a health issue. When I discharged from service in 2007, I weighed approx, 280 lbs. That's 120 gain in 7.25 years from when I joined in December 1999 at 160 lbs. From about 2002 - now, I've had issues with concentration. It's gotten so bad, even with treatment, I have had to drop out of school because I have a hard time comprehending what is being taught and what I am reading in books. Is this the explanation you are seeking?

Thank you very much for answering my question quite clearly. I have done my research IAW my medical records and with reputable online sources, and now with your definite response I appreciate your honesty and will definitely refer back to you for further inquiry. I have another issue to discuss that concerns my father for the same issue. I will go ahead and rate you for this discussion, then refer back to you for the issue concerning my father. Thank you for your honest, professional opinion. Good luck to you in life and in your career. Best regards, XXXXXXX XXXXXXX