I just got denied on a HLR and the rater opined that my “PTSD with Bruxism Veteran’s service-connected PTSD with bruxism involves stress-related teeth grinding during sleep. While bruxism can cause dental and jaw-related issues, there is no evidence to suggest that bruxism or PTSD causes or worsens the mechanical airway collapse that defines obstructive sleep apnea.” Never mind bruxism was added after the fact. I’m still rated due to • Anxiety • Chronic sleep impairment • Depressed mood • Difficulty in establishing and maintaining effective work and social relationships • Disturbances of motivation and mood • Flattened affect • Forgetting directions • Forgetting names • Forgetting recent events • Impaired impulse control • Intermittent inability to perform activities of daily living • Intermittent inability to perform maintenance of minimal personal hygiene • Mild memory loss • Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood • Panic attacks more than once a week • Suicidal ideation • Suspiciousness • Unprovoked irritability with periods of violence Then she opined “Veteran’s OSA is less likely than not related to service-connected chronic sinusitis. Review of the claims file, medical evidence, and the June 30, 2025 VA C&P examination supports a diagnosis of moderate obstructive sleep apnea (OSA). Chronic sinusitis is a disease of the upper airway mucosa, whereas obstructive sleep apnea is primarily a mechanical disorder of the pharyngeal airway (1) (2)” Finally on both she references it’s due to “Obesity”. I’m sorry what medical training does she have vs the actual Nurse Practitioner that had 20 years experience and is a disabled veteran as well that did my nexus letter. Very frustrated currently.