u/tacostonight

I recently had a cardiac workup for palpitations that i believe are anxiety related.

My stress test was completley normal. My holter completely normal. My echo however, showed a 3.4 aortic root and a 4.2 ascending aorta. Everything, and i mean everything else in the echo said normal.

I am a 49 year old male. Height is 6'3, weight is 269 pounds ( i was at 295 last year), blood pressure 115/80.

I've read everything from , get a thoracic surgeon, to don't worry it's normal. Like most things in life, i think the truth is in the middle somewhere. I have absolutely crippling health anxiety anyways, so none of this helps. I have obsessed over it all.

Anyways, cardiologist that ordered the echo calls and says "we'll re-test again on an echo in a year, seems close enough to normal for your age". I have two insurances, so i sent the test over to my pcp and he says "you need immediate follow up imaging, i am referring you to a cardiologist".

What i'd like to do, is make sure I ask for what is considered reasonable for follow ups or care. Any tips?

Been having palpitations off an on so did a cardio workup.

Ascending aorta 4.2cm.

I’m a 49 year old male. 6’3 , 265 pounds.

I have read that I’ll need surgery eventually and it’s not an easy surgery. Also freaked out my chest is just gonna pop.

Interpretation Summary
Ascending aorta measures 4.2cm
Left ventricular size, thickness and function are normal
LV ejection Fraction = 60-65%.
Global longitudinal strain is calculated at -16.0% which is mildly abnormal.
Tissue doppler sampling consistent with 'Normal diastolic function.'
Right atrium is mildly dilated.
Right ventricle is mildly dilated.
Right ventricular systolic function is normal.
No tricuspid regurgitation was present, hence, RV/PA systolic pressure can not be estimated.

I was denied a claim. the dbq was submitted the day before the denial. The c&p examiner cited non-existant material, i scoured the sourced material and the names of the authors and dates, produced no articles. She didn't provide the proper citing so they may exist but not for me to reference. Asked AI to look for them and everything they found had nothing to do with her cited materials.

Claimed my condition could not be aggravated by claim, but claimed a certain drug was known to aggravate the condition. She stated she reviewed my records , all 22 years worth of them. If she had, she'd seen i was on the very medication she listed.

Then proceeded to generalize my condition without review. "episodic", "temporary". The va's own c&p on those conditions were "permanent and chronic".

Just a heads up, you are your own best advocate. The rater, never addressed my nexus letter that was uploaded 2 weeks prior to this decision and relied solely on a last minute, factually incorrect, and improperly cited dbq.

Whether you are awarded a claim or not, always get your records. Just do an foia request , only for the c&p exams. They've only taken a couple days for mine each time.

Quick history .

Claim submitted in march as aggravation. got denied on causation. Submitted supplemental with some more treatment records and a claim letter asking to review this as aggravation. did an ace, denied again, c&p exam didn't address aggravation again. Submitted supplemental again with more records, denied on june 5th , this time, with no new and relevant info.

So, i had my physician write a nexus. named the document Dr. x medical opinion. Submitted this on july 10th, nothing showed up. My may supplemental still said "we recieved your claim on date in may". I had the denial from the 25th of June, though.

So, i called the 800 number. The rep said my may supplemental was open still, i said i have the denial. I then said, i uploaded and submitted a new supplemental on july 10th with a nexus as well and i want all this new stuff to be there. She said, I can send a notification to review the july submission.

WTF is going on with this? i got a denial, it let me open a new supplemental, yet the one that was denied was still open.

Having a fun, grindy, mindless game mode is something gachas have needed for a while. the arpg elements, loot, and tiny tina borderlands vibe , has been such a breath of fresh air.

i hope they continue thinking outside the box for content.

My wife and I are thinking of retiring early and moving to italy.

My income is roughly 5k a month in pension. We'll have approximately 550k usd to spend on a property. looking for mostly move in ready or historical with as close to move in ready.

Wife is 2nd generation italian. not sure if that still helps at all with citizenship or not. I don't care really about that. we are planning a couple trips to areas recommended as a first step to see how we like it but have no idea which area to start in.

I'd like to ask realistically ask on what we are looking for to see if it can be done. We'd like a detached house, farm / outside the cities. However, we'd like to be within an hour of the coast and 20ish minutes to medical facilities (hospital).

If it's doable, what areas would you suggest?

a couple months ago i filed a tmj, trigeminal neuralgia, and secondary osa claim. I had a c&p for the tmj and a few days later got a claim letter.

tmj complete, trigeminal neuralgia deferred, osa denied (supplemental).

The claim bounced around from preparing decision letter to rating back and forth after. Supplemental never moved beyond "recieved" . figured it was just because one was deferred. I got a c&p for trigeminal neuralgia last week and it's scheduled.

this morning i woke up and my claim is in the preparing final decision letter. I look and see,

"We received this file for a closed evidence request: Exam Request - Temporomandibular Joint Dysfunction (TMJ/TMD)"

Received on July 4, 2026

I had a claim letter yesterday. Tmj approved, sleep apnea denied.

It went from preparing letter back to rating for a couple days, which was weird. I got the decision letter yesterday and am ready to do another supplemental on apnea . I log in and the claim is back at rating. Site issues?

I originally put a claim in, back in march. It was a secondary condition with aggravation as the argument. The denial came back only addressing "causation".

I created a supplemental specifically requesting the aggravation claim and that the original denial didn't address what was claimed.

I got another denial today. The supplemental still shows last updated june 5th (when i filed, either website is lagging or claim isn't finished , no idea) and the denial didn't even reference an ace exam that was sent out for it.

A claimant may file a supplemental claim by submitting or identifying new and relevant evidence. (38 CFR 3.2501)

Relevant evidence means evidence that tends to prove or disprove a matter at issue in a claim. (38 CFR 3.2501) The evidence from Orlando VA Medical Center submitted in connection with the current claim does not constitute relevant evidence because it does not prove or disprove a matter at issue within your claim.

A review of your claims folder shows that the claimed condition was last denied by rating dated May 28, 2026. Service connection was denied because we did not find a link between your medical condition and military service. (38 CFR 3.303)

We received your medical evidence which discusses the symptoms of your medical condition. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. The evidence does not show an event, disease or injury in service. (38 CFR 3.303, 38 CFR 3.304)

The evidence submitted in connection with the current claim, does not constitute relevant evidence because it does not prove or disprove a matter at issue within your claim (why it was previously denied). We did not find a link between your medical condition and military service. (38 CFR 3.303) The evidence does not show that the prior decision should have been different nor does it support a change in our prior decision. Therefore, we are confirming the previous denial of this claim.

the orlando va medical center document was the supporting aggravation documentation. i am not sure i am sending this to the va right or what but they are not answering the aggravation question at all.

My claim has gone from rating to preparing decision letter at least 10 times in the past 2 days, back and forth. Is this common? any insight into what might be going on?

I filed a claim for TMJ. It was documented after a orthognatic surgery in the service, it's been documented the 20 years i've been out. VSO urged me to file it, had a c&p with leidos this morning.

I got there and rang the bell on the bus door. They didn't verify my identity, didn't look at my ID, ask my date of birth, nothing. basically, "are you john?", "yes", okay this way.

I read up on how the VA is supposed to do these TMJ exams and what matters.

Into the exam. I tell her how my jaw hurts with very little movement, my diet restrictions, history, and she seems really nice so far.

She asks if i have any other questions. I say, yes, are you going to measure? She says, "you can open your mouth enough". I said, i can open it, and it's sore even small motions left and right, and opening wide is painful, clenching is painful. She says , "okay, but you can open it enough". "i can tell you have normal mouth opening". buh by, thanks for your service.

I am going to assume, i'll get service connected at 0%.

My question is , leidos has half assed three of my claims now. Can i request a different contractor? Is there anything I can do to outline some of the objective issues i had like identity validation, and what not? The examiner was just like the rest of these leidos ones and that is personal experience, i know, but the track record with this contractor i feel like i am not getting a fair claim.

My vso filed a claim of sleep apnea secondary to cluster headaches. While there is some literature, and my va appt's to tie the two in together i had low expectations.

The claim has dragged on for a while (three months) and over a month ago the dbq's were submitted for it (i did a records request). The c&p examiner stated:

The Veteran's sleep apnea onset in 2025 occurs more than two decades following service and the initial onset of cluster headaches, which weighs against a proximate causal relationship. Additionally, the Veteran has multiple well-established post-service risk factors for obstructive sleep apnea, including obesity (BMI >30) and hypertension, both of which are strongly supported in medical literature as primary contributors to airway collapsibility and sleep apnea pathogenesis (Young et al., 2022). The presence of long-standing snoring and progressive sleep-related symptoms further supports a typical natural history of obstructive sleep apnea unrelated to a neurologic headache disorder. Furthermore, cluster headaches, while severe and disabling during episodes, are not known to produce chronic structural or neuromuscular changes in the upper airway that would predispose to obstructive sleep apnea.

This examiner was a psychologist who went against my neurologist's views, but whatever.

The question is, the examiner stated they read my records. In my records, in the service, it showed that my BMI went up around the time I started getting cluster headaches (I was sent to spin class), my labs showed increased levels that could and would probably cause hypoxia. Based on the examiner's argument, this was likely an undiagnosed issue from back in 2004 (if they read my records like they stated). The reason i would like to pursue this further is because the cpap has dramatically reduced my cluster headache frequency at night. When this denial comes in, do i claim this differently since the examiner didn't even address aggravation (which is where all my records and documents point to)? Did my vso file this incorrectly? Or do i just move on, be grateful that i have some relief at night and move on?

I filed an initial claim through the vso. It was a condition that was aggrivated by another condition.

The claim has been going on for 80 days with DBQs submitted over a month ago. I submitted a records request and got the c&p results (i didn't even attend).

The examiner basically shit on me for 3/4 the exam (again i didn't attend) and kept pointing out that despite literature supporting a connection, x condition doesn't cause y condition.

I don't know if the VSO submitted this wrong, or what, but all of the evidence I submitted (22 years' worth) is all about aggravation, including my personal statement. Now this examiner states they reviewed all this. No where in my evidence did i state a causation factor.

So, do raters / examiners actually look at both of these factors or should i have filed this different from the start?

kinda stinks because the cpap has actually been therapeutic. whether my clusters cause congestion that triggers apnea or something else. i know that using the cpap has reduced my nocturnal attacks noticeably. anyways, here's the reasoning in case any of you are curious.

4C. Rationale: [ Medical Opinion / sleep apneat ] The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of cluster headaches. Rationale is; The Veteran's electronic claims file, including service treatment records from ///, post-service medical records, and the Veteran's lay statements, has been thoroughly reviewed in its entirety . The Veteran carries a diagnosis of cluster headache (644.019) with onset in approximately August 2003 during active service following a complicated wisdom tooth extraction with left-sided socket infection, with persistent unilateral headache symptoms characterized by autonomic features including lacrimation, nasal drainage, and periorbital pressure. The Veteran also carries a diagnosis of obstructive sleep apnea (G47.33) diagnosed in March 2025, following a positive sleep study, with symptoms including chronic snoring, restless sleep, daytime somnolence, and fatigue requiring CPAP therapy. Additional comorbid conditions include obesity (BMI >30), generalized anxiety disorder, and hypertension, all of which are independently recognized risk factors for sleep-disordered breathing From a pathophysiologic standpoint, cluster headaches are classified as a primary trigeminal autonomic cephalalgia involving hypothalamic activation, trigeminovascular system stimulation, and parasympathetic outflow, resulting in unilateral head pain with cranial autonomic symptoms. In contrast, obstructive sleep apnea is a mechanical and neuromuscular disorder characterized by recurrent upper airway collapse during sleep, driven by anatomical airway narrowing, impaired neuromuscular tone, and contributory factors such as obesity and craniofacial structure (Malhotra & White, 2022). While there is some documented clinical association between headache disorders and sleep disturbances, current medical literature does not establish a direct causal relationship whereby cluster headaches induce or structurally contribute to the airway obstruction required for the development of obstructive sleep apnea (Kapur et al., 2023). The mechanisms of these two conditions are distinct, with no shared primary pathologic pathway sufficient to establish causation.

The Veteran's sleep apnea onset in 2025 occurs more than two decades following service and the initial onset of cluster headaches, which weighs against a proximate causal relationship. Additionally, the Veteran has multiple well-established post-service risk factors for obstructive sleep apnea, including obesity (BMI >30) and hypertension, both of which are strongly supported in medical literature as primary contributors to airway collapsibility and sleep apnea pathogenesis (Young et al., 2022). The presence of long-standing snoring and progressive sleep-related symptoms further supports a typical natural history of obstructive sleep apnea unrelated to a neurologic headache disorder. Furthermore, cluster headaches, while severe and disabling during episodes, are not known to produce chronic structural or neuromuscular changes in the upper airway that would predispose to obstructive sleep apnea.

Based on the totality of the medical evidence, accepted medical principles, temporal relationship, and the presence of significant alternative risk factors, it is less likely than not that the Veteran's obstructive sleep apnea is proximately due to or the result of the service-connected cluster headaches. The Veteran's sleep apnea is more consistent with a condition arising from post-service risk factors, including obesity and cardiometabolic contributors, with no sufficient pathophysiologic or causal nexus linking it to cluster headache disorder.

here's the kicker. i never claimed my clusters caused apnea. i claimed my clusters aggrivate it.

I had 4 dbq’s submitted on Va.gov over a month ago. The claim has gotten me a couple c&p’s and a few ace exams (I did not even attend). Claim itself is approaching 90 days.

My osa is a bit of an odd case but the claim is just idling there with dbq’s all done.

How long did your osa secondary take out of curiosity?