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This document is an independent medical opinion analyzing the relationship between service-connected PTSD and Obstructive Sleep Apnea (OSA) for a veteran, supporting the claim with clinical findings and relevant research.
Year:
[Year]
Region / City:
[City]
Theme:
Medical Opinion
Document Type:
Independent Medical Opinion
Organization / Institution:
[Medical Facility Name]
Author:
Dr. Grant Thomas
Target Audience:
Healthcare providers, VA personnel
Period of validity:
N/A
Approval Date:
N/A
Date of Changes:
N/A
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Year:
2017–2021
Medical field:
Sleep medicine
Condition:
Moderate to severe obstructive sleep apnea
Intervention:
Hypoglossal nerve stimulation
Procedure codes:
64582, 64583, 64584
Type of document:
Evidence review and policy summary
Reviewing bodies:
NICE; VbBS; HERC
Last review date:
November 2021
Study types included:
Systematic review; randomized controlled trial; prospective and retrospective case series
Number of studies:
7
Total patients:
326
Geographic context:
United Kingdom; United States
Regulatory context:
Clinical governance and payer policy assessment
Year:
2017
Region / City:
United States
Topic:
Obstructive Sleep Apnea, Commercial Motor Vehicle Drivers, Medical Certification
Document Type:
Medical Examination Recommendation
Organization:
Federal Motor Carrier Safety Administration (FMCSA)
Author:
FMCSA
Target Audience:
Medical professionals, commercial motor vehicle drivers
Effective Period:
2017 and ongoing
Approval Date:
2017
Revision Date:
None
Note:
Date
Topic:
Medical Opinion
Document Type:
Independent Medical Opinion
Author:
[Physician’s Name]
Target Audience:
Veterans Affairs (VA) Review Boards, Healthcare Providers
Note:
Year
Theme:
Obstructive sleep apnea, Pediatric otolaryngology
Document Type:
Research study
Context:
A research study on physical examination techniques for evaluating tonsil, adenoid, and pharyngeal grading in children with obstructive sleep apnea.
Authors:
David J. Stevens; Sarah L. Appleton; Andrew D. Vincent; Yohannes A. Melaku; Sean A. Martin; Tiffany K. Gill; Catherine L. Hill; Andrew Vakulin; Gary A. Wittert; Robert J. Adams
Document Type:
Supplementary material to a research article
Subject:
Obstructive sleep apnea, nocturnal hypoxemia, grip strength, muscle mass, fat mass
Population:
Community-dwelling middle-aged and older men
Study Design:
Observational study with linear regression analyses
Data Collection Methods:
In-home polysomnography; questionnaires; blood analysis; dual-energy X-ray absorptiometry
Variables Examined:
Age; income; alcohol consumption; smoking; dietary patterns; physical activity; diabetes; hypertension; arthritis; cancer history; cardiovascular disease; depression; muscle mass; fat mass; testosterone; inflammation
Statistical Methods:
Univariate and adjusted linear regression models
Sleep Assessment Device:
Embletta X100 (Embla Systems, Colorado)
Outcome Measures:
Dominant and non-dominant hand grip strength; lean mass; fat mass
Supplement Sections:
Supplementary S1 (regression adjustments and univariate associations); Supplementary S2 (non-respiratory sleep metrics and body composition associations)
Year:
2008–2014
Region / Institution:
HERC, Regence BCBS, SIGN
Subject:
Obstructive Sleep Apnea, Tongue Base Surgery
Document Type:
Clinical Guidelines and Evidence Review
Procedure Codes:
CPT 41512, Excluded Services Guidelines E1–E2
Techniques:
Tongue Base Suspension, Submucosal Ablation
Evidence Sources:
Kezirian 06, Farrar 08, TEC Review 07, Regence BCBS 08
Patient Indications:
Adults with OSA intolerant to CPAP or oral appliances
Outcome Measures:
AHI improvement, Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire
Policy Status:
Experimental, Non-Coverage Recommendations, Medically Necessary under certain criteria
Related Guidelines:
Guideline Notes 172–173, Excluded Services Guidelines 1–2
Surgical Risks:
Not specified in document
Year:
2026
Region / City:
Not specified
Subject:
Obstructive Sleep Apnea Treatment
Document Type:
Clinical Correspondence
Institution:
Dental Sleep Medicine Clinic
Author:
Treating Dentist / Sleep Medicine Specialist
Intended Audience:
Referring Physician
Patient Age / DOB:
As indicated in document
Therapy Initiated:
Oral Appliance Therapy (OAT)
Additional Recommendations:
Weight management, positional therapy, nasal patency improvement
Standards Followed:
American Academy of Dental Sleep Medicine guidelines
Year:
2026
Region / city:
Global
Theme:
Sleep apnea, Dry eye disease, Meta-analysis
Document type:
Systematic review, Meta-analysis
Organization:
Not specified
Author:
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al.
Target audience:
Researchers, Medical professionals
Period of validity:
Not specified
Approval date:
Not specified
Date of amendments:
Not specified
Year:
2026
Location:
Hotel Nikko, San Francisco, CA, USA
Topic:
Sleep Apnea, Snoring, Sleep Disorders
Document Type:
Educational Conference Program
Organizing Institutions:
University of California, San Francisco Department of Otolaryngology-Head and Neck Surgery; Penn Center for Sleep Disorders, University of Pennsylvania
Authors / Faculty:
Andrew N Goldberg, MD; Eric J Kezirian, MD; Richard J Schwab, MD; Jolie L Chang, MD; David M Claman, MD; plus additional UCSF and external faculty
Intended Audience:
Healthcare professionals including physicians, nurses, and physician assistants
Accreditation:
AMA PRA Category 1 Credits™, ANCC Contact Hours, AAPA Category 1 CME Credits, Interprofessional Continuing Education (IPCE)
Educational Objectives:
Review new developments in diagnosis, management, and treatment of sleep apnea and snoring; evaluate medical and surgical interventions; assess patient outcomes and technology impact
Commercial Support:
Eli Lilly, Neurocare, Inc, Reflux Gourmet, Sleep Res Inc
Exhibitors:
Aerin Medical, Apnimed, Avadel, Axsome Therapeutics, Cadwell, Clevemed, Cryosa, DayBreak, Eli Lilly, Ensodata, Fisher & Paykel, Harmony Bioscience, Inspire, Jazz Pharma, Livanova, Moona Health, Neilmed, Nox Medical, Nyxoah, Onera, Philips, Ron Andrews Medical Company, Serene Sleep, Sleep Res, Vertex Pharmaceuticals, Zoll Itamar
Course Chairs:
Andrew N. Goldberg, MD; Jolie L. Chang, MD; David M. Claman, MD; Eric J. Kezirian, MD; Richard J. Schwab, MD
Year:
2013
Region / City:
United States
Topic:
PTSD Screening
Document Type:
Measurement instrument
Organization:
Department of Veterans Affairs
Author:
F. W. Weathers, B. T. Litz, T. M. Keane, P. A. Palmieri, B. P. Marx, P. P. Schnurr
Target Audience:
Clinicians, researchers
Period of validity:
Ongoing
Approval Date:
2013
Modification Date:
Not specified
Year:
2024
Region / City:
Wales
Topic:
PTSD treatment guidelines
Document type:
Algorithm
Organization / Institution:
Traumatic Stress Wales
Author:
Dr. Mathew D Hoskins, Professor Jonathan I Bisson
Target Audience:
Healthcare professionals
Period of validity:
Ongoing
Approval date:
June 2024
Date of changes:
June 2024
Change Date:
February 3, 2016
Jurisdiction:
United States
Subject Area:
Veterans benefits law
Topic:
Service connection for posttraumatic stress disorder
Document Type:
Administrative guidance manual section
Issuing Body:
Department of Veterans Affairs
Legal References:
38 CFR 3.304(f); 38 CFR 4.125; 38 U.S.C. 1154(b); M21-1 Adjudication Procedures Manual
Covered Populations:
Veterans
Scope:
Development and adjudication of PTSD service connection claims
Source Type:
Government administrative guidance
Year:
2015
Region / city:
United States
Topic:
Posttraumatic Stress Disorder (PTSD), Service Connection
Document type:
Legal / Regulatory Guide
Organization:
Department of Veterans Affairs (VA)
Author:
Not specified
Target audience:
Veterans and VA administrators
Effective period:
From April 15, 2015
Approval date:
April 15, 2015
Date of changes:
Not specified
Year:
2022
Region / city:
United States
Topic:
Posttraumatic Stress Disorder (PTSD), Military Sexual Trauma (MST), Veterans Affairs
Document Type:
Internal procedure guidelines
Organization:
Department of Veterans Affairs (VA)
Author:
VA MRRC
Target Audience:
VA personnel, Veteran Service Representatives (VSRs), MRRC staff
Period of Effect:
Ongoing
Approval Date:
August 10, 2022
Modification Date:
Not specified
Year:
2024
Region / City:
USA
Topic:
Trauma, PTSD, Addiction
Document Type:
Research/Clinical Overview
Organization:
Treatment Innovations
Author:
Lisa Najavits, PhD
Target Audience:
Clinicians, Therapists, Researchers
Period of Activity:
Ongoing
Approval Date:
N/A
Modification Date:
N/A
Year:
2008, 2010, 1977, 2013, 1995, 2013, 2008, 2005, 2006, 2013, 1979, 1985, 2013, 2008, 1988, 1996, 2005, 2010, 2014, 2008, 2012, 2010
Country:
Israel, USA, Taiwan
Mind/Body practices:
Hypnotherapy, Transcendental Meditation, MBSR, Progressive Muscle Relaxation, Mantram Meditation, Relaxation Techniques, Tai Chi, Acupuncture, Partner Massage Therapy, Imagery Rehearsal
Population:
Veterans, Military
Study Design:
RCT, Observational
Outcomes:
PTSD symptoms, depression, anxiety, stress reactions, sleep quality, anger, smoking abstinence, quality of life, craving for substance
Measures:
CAPS, IES, BDI, BSI, PCL, Visual Subjective Sleep Quality Questionnaire, PTSD scales, Perceived Stress Scale, Minnesota Nicotine Withdrawal Scale, various questionnaires
Measurement points:
Baseline, Post-treatment, Follow-up (1 month, 3 months, 6 months, 12 months)
Number of subjects:
8-286
Comparison group:
Control groups, no intervention, or other treatments
Year:
2024
Region / City:
USA
Topic:
PTSD, Substance Abuse, Treatment
Document Type:
Clinical Guidelines
Organization:
Treatment Innovations
Author:
Lisa Najavits, PhD
Target Audience:
Healthcare professionals, therapists, clinicians
Period of Application:
Ongoing
Approval Date:
1/1/24
Modification Date:
N/A
Treatment Approach:
Cognitive-behavioral therapy, Coping skills training, Exposure therapy
Key Symptoms:
Intrusion, Avoidance, Negative thoughts, Arousal
Co-occurring Disorders:
PTSD, Substance-related disorders
Gender Disparities:
Higher PTSD rates in women, higher substance abuse in men
Substance Use:
Cocaine, opioids
Treatment Focus:
Dual treatment for PTSD and substance abuse
Cultural Sensitivity:
Tailoring treatment to cultural context
Recovery Model:
Abstinence or harm reduction
Evidence Base:
Over 45 published research articles
Contextual Description:
Clinical guideline for treating PTSD and substance abuse using the Seeking Safety model, emphasizing integrated treatment for both disorders.
Year:
2019–2021
Region / Location:
United States
Topic:
Psychiatric Genetics, PTSD
Document Type:
Research Summary / Scientific Review
Institution:
Rosalind Franklin University of Medicine and Science
Author:
Monika A. Waszczuk
Target Audience:
Researchers and clinicians in psychiatry and genetics
Study Cohorts:
Psychiatric Genomics Consortium (PGC), Million Veterans Program (MVP)
Methods:
Genome-Wide Association Studies, Dimensional Phenotypic Analysis
Phenotypes Studied:
PTSD symptoms, trauma exposure, related psychiatric conditions
Sample Size:
30,000–250,000 participants across studies
Findings:
Identification of multiple genetic loci associated with PTSD and trauma-related traits
Endophenotypes:
Dimensional measures of symptom severity, lifetime trauma exposure
Relevance:
Genetic architecture of PTSD and transdiagnostic loci in psychiatric disorders
Data Collection Tools:
Clinician-Administered PTSD Scale (CAPS), PTSD Checklist (PCL)
Publication Date:
2021
Description:
Scientific article presenting GWAS findings on PTSD and trauma, emphasizing dimensional phenotypic approaches to reveal genetic loci associated with symptom severity and trauma exposure.
Year:
2016
Region / City:
Greater Manchester, UK
Subject:
Mental Health, Trauma, PTSD, Emergency Services
Document Type:
Journal Article
Institution:
University of Salford, Bucks New University
Authors:
Elaine Beaumont MSc, Mark Durkin MSc, Sue McAndrew PhD, Colin Martin PhD
Target Audience:
Fire Service Personnel, Mental Health Professionals
Period of Study:
Not specified (pre- and post-therapy measures)
Date Published Online:
29 November 2016
Volume / Issue:
Volume 9, e34
DOI:
https://doi.org/10.1017/S1754470X16000209
Contextual Description:
Peer-reviewed journal article presenting a study on the effects of combining compassion focused therapy with trauma-focused cognitive behavioural therapy for firefighters experiencing PTSD, anxiety, depression, and low self-compassion.
Year:
N/A
Region / City:
N/A
Subject:
PTSD, Mental Health Training
Document Type:
Training Material
Institution:
National IAPT
Author:
N/A
Target Audience:
Healthcare Professionals, Mental Health Practitioners
Period of Validity:
N/A
Approval Date:
N/A
Date of Changes:
N/A