* Damage to the brain from a TBI (Traumatic Brain Injury). The BEST Path to Proving Sleep Apnea is Service Connected. Pittsburgh, PA: 201 Penn Center Boulevard, Suite 400, Pittsburgh, PA, 15235 Winning a VA Sleep Apnea is much harder. * SeveralDesert Storm, OIF, and OEF Clients have hadTraumatic Brain Injuries whichinterfere with how their Nervous System works, and as a result, have a different kind of Sleep Apnea (oversimplified, where the brains signals to breathe dont make it through to the lungs).
Getting Veterans (VA) Disability for Sleep Apnea | CCK Law Hear from fellow Veterans just like you, with many of our Veteran Success Managers having gone through our programs. Elizabeth M. Walsh appeals the Board's denial of service connection for hypertension and sleep apnea. Those are the ingredients. Sometimes claims are appealed and remanded several times, which can cause a claim to drag on for years. Veterans with deviated septums can have clear cases for a secondary sleep apnea claim. Unfortunately, VA does not always apply the law correctly. Winning a VA claim to service connect sleep apnea is hard. Take advantage of a FREE VA Claim Discovery Call with an experienced Team Member. I understand you want your VA claim to be done as quickly as possible. and Coronavirus. How to File a Claim on VA.gov (step-by-step)! In fact, winning your VA sleep apnea claim can feel like you just led your team to victory in the World Cup. Whats the VAs Problem with Sleep Apnea? No current medical diagnosis (within the last 12 months), or improper diagnosis, #3. The rate was a staggering 22%. Were Veterans helping Veterans Worldwide, and since 2016 weve helped 10,000+ Veterans just like you INCREASE their VA disability rating! Which primary disabilities make the best claims for secondary service connection of sleep apnea? I was diagnosed with OSA 10 years after separation. However, most of the time, sleep apnea is a secondary claim. without his BI-PAP MACHINE,one up from CPAP,which i have. The VA has also given me a 0% disability for service connected IPF (Idiopathic Pulmonary Fibrosis . * 5- Star Lay and Medical Evidence that show you your VA Sleep Apnea disabilityaffects your dailylife. And I found that MOST Veterans with Sleep Apnea claims and appealsfit into 1 of 4 common scenarios. I stated on my retirement physical that I sometimes have trouble sleeping at night. I have had cardiomegly X-rays while on active duty. Veterans can also prove service connection for sleep apnea by showing that their sleep apnea began in service using service medical records, or by providing a nexus opinion from a medical professional that links their current diagnosis of sleep apnea to signs or symptoms they experienced in service. See id. Some Veterans are taking it a little further and going to the VA with this: I have had problems breathing and sleeping since I was stationed near burn-pits in Iraq and now I have sleep apnea. 4 0 obj Are you a veteran who suffers from sleep apnea? endobj Philadelphia, PA: 1 International Plaza, Suite 550, Philadelphia, PA, 19113 Making the Sausage: Heres what you need to know about new VA Claims regulations. This is because the fact is that many veterans suffer from PTSDand sleep problems are a common symptom of PTSD. You do not have to be prescribed a CPAP machine to be service-connected for sleep apnea. I read hundreds of cases. Living with Chronic Fatigue Syndrome can have a huge impact on a persons life and those around them. History of studies and lab work showing the doctor ruled out other possible conditions that may be causing the same symptoms, Nonexudativepharyngitis (swelling of the back of the throat with no mucus), Tender/palpable lymph nodes (neck or underarms), Fatigue lasting longer than 24 hours after exercise, Neuropsychological symptoms (burning, numbness, tingling sensation, sensitivity). Once diagnosed the more difficult step is required, which is proving the service-connection for sleep apnea. Second example.lets say the veteran has service connection for PTSD. So, if you developed sleep apnea while in service and still carry that diagnosis, you should be granted service connection. What the doctor may do is multiple laboratorytests to rule out some other underlying cause. Sleep apnea is a medically complex disorder. I met with my expert who offered opinion on my behalf and she was amazed by the decision, but not surprise by the level in which the VA are denying veterans SP claims. Everyone I came in contact with there was very nice. Scenario 3: The Veteran has a diagnosis of Sleep Apnea in the Military Service Records, or during the period of service. For instance, often sleep apnea presents itself in those who have been suffering from PTSD. Even without a definitive cause of the disorder there are noted risk factors including being between the ages of 40-50, difficulty managing stress, and women are more commonly diagnosed (possibly because they report symptoms more often). Learn more about us, Veterans Disability Claim Seattle, WA: 506 2nd Ave,Suite 1400,Seattle, WA 98104. Required fields are marked *. There are three types, obstructive, central, and mixed. While youmay have been a loud snorer or had other sleep difficulties in service that are normally associated with sleep apnea, if you are like most service members you probablydid not undergo a sleep study and get a formal diagnosis before your discharge from service. Learn how your comment data is processed. Box 449, Deland, FL 32721, Orlando, FL: 605 E. Robinson Street Suite 635, Orlando, FL 32801 Thats what you REALLY need you need the RECIPE for proving that sleep apnea is service connected. entitlement to service connection for nerve damage to the bilateral lower extremities, to include as due to Gulf War illness, and, if so, whether the claim should be granted. As a matter of fact, it may be easier to substantiate with medical records that the sleep apnea symptoms started after the diagnosis of diabetes. Want More Information about VA Sleep Apnea? You're not alone. The question raised in this case is whether this "intermediate step" is limited to . How to Connect Sleep Apnea to Military Service.
Is Sleep Apnea a Disability? A Guide for Veterans Thinking and memory issues such as not able to think quickly, difficulty remembering things, and unable to pay attention to details. You will need to follow one of the paths to service connection, which will likely require lay evidence and expert medical evidence. One of the most straightforward ways to achieve service connection of a particular disease or disability is to show that you had that disease or disability while in service. There are 3 things that the human body cannot live or function without: Blood/Oxygen, Food/Water and Sleep. 2 0 obj Ann Margaret really took the time to explain things to me. Estimate your 2023 VA Rating & Compensation for FREE! Direct service connection for sleep apnea may be granted for veterans who can show that their sleep apnea began in service using service medical records, and by providing a nexus opinion from a qualified medical professional that links sleep apnea to events or exposures in service.
Is Sleep Apnea Could Be a Service-Connected VA Disability? I have tried to connect OSA secondary to chronic sinusitis which has also been denied. Most people with CFS seem to have an impaired immune system which is thought to possibly be the cause of having CFS. Theres so much information, so many Veterans, and so much delay that it sometimes feels like this battle will never end. Have sleep apnea, AO esposed, 65 in VN; being treated for mild PTSD for one & 1/2yrs. If your situation is not like the one above, remember that this is only oneof the ways you may be able to win VA disability for sleep apnea. In the U.S. it has been acknowledged that more education needs to be provided to doctors and nurses to give them the skills to detect CFS sooner for the well being of the patient. As a fellow disabled Veteran this is shameful and Im on a mission to change it. If you want to learn how to implement these strategies to get the VA benefits you deserve, click here to speak with a VA claim expert for free. Your airway narrows and closes, leading to pauses in the breathing cycle. uuid:7e8f97fd-fbb3-41de-a1ee-403277269d1a That said, the key here is making the connection from service to diagnosis. Thanks to additions to the VA presumptive list, you may be able to presumptively service-connect rhinitis, sinusitis, rhinosinusitis or asthma if you served in particular theaters during specified time periods. Physical therapy can be given to help maintain and improve mobility. 3. Left untreated, sleep apnea can lead to cardiovascular diseases (high blood pressure, heart failure, arrhythmias, stroke), diabetes, depression, and headaches, among others. However, if you use one, it does provide you with a higher rating. A 2023 Guide to VA Disability Rates & Pay Schedules, Individual Unemployability Rating Calculator, List of Blue Water Navy Ships Exposed to Agent Orange (Interactive Vietnam Map), Social Security Disability Benefits Guide, Systemic Exertion Intolerance Disease (SEID), Presumption of Service Connection for Chronic Diseases, Common Symptoms of Chronic Fatigue Syndrome.
Service-Connected Sleep Apnea VA Claim | Strategic Veteran In our experience, an upper respiratory disability is one of the easiest choices for claiming OSA secondary to another service-connected disability. I disagree. Making the Sausage: Heres what you need to know about new VA Claims regulations. Your VA Sleep Apnea Claim, Ill give you the recipe for each of those 4 scenarios. (6.[,P)BLd?8e:}]eS8Sx|
XvKdEP,Zbl65k8 x!KSToHjbrC. Tucson, AZ: One South Church Avenue, 12th Floor, Tucson, AZ, 85701 This may be even easier for you now because of a new VA new rule as of August 2, 2021. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright 2016 - VeteransLawBlog.org - All Rights Reserved | Terms & Conditions | Legal Disclaimer, The Veterans Law Blog is NOT a law firm. caused or made worse by your active duty military service OR. Along with the record of the potential cause must also be a proven medical link between sleep apnea and the occurrence. Copyright 2023 VA Claims Insider, LLC. FREE tips for Veterans to stay How to Hire an Attorney For Your VA Claim or Appeal. Complimentary therapies such as meditation, gentle massage, deep breathing, or relaxation therapies may be beneficial to help reduce symptoms. In our experience, most VA disability claims are won or lost based on medical evidence. In our experience, OSA denials are almost always due to one or more of these five gaps: Fortunately, there are simple strategies you can employ to address these factorseven if the VA has already denied your VA claim for sleep apnea. Instead, the leading cause of sleep apnea is weight gain. How to Get a 100 Percent VA Rating (if deserved)! 4 Common Scenariosfor Proving Sleep Apnea is Service Connected. hTOo0| If you are lucky, you start breathing again. I dont know if Im authorize a second run at the DRO or go straight to BVA. Lesson #4: More VeteransShould be Able toService ConnectSleep Apnea. If youre stuck, frustrated, underrated, and currently rated between 0%-90%, VA Claims Insider Elite is for you! 2023-03-04T21:20:56-05:00 It's almost as much work - and it can often take as much dedication. Our firm was founded in 1986 in Orlando, Florida. While proving service-connection for sleep apnea claim accepted is no longer as difficult as it once was, it still is wise to not take your chances and get it right the first time.
My emphysema is connected. 1 0 obj Without a CPAP machine, the VA assigns a 30% rating. And then in three months, I got a response back, and it was a favorable response, and that just, that just blew me away. Also see our post What is a Service-Connected Disability? endstream document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. The transmission of an email request for information does not create an attorney client relationship. Was your obstructive sleep apnea (OSA) VA claim denied? I want you to think about the BEST Path to proving Sleep Apnea is Service Connected. Brian is a Distinguished Graduate of Management from theUnited States Air Force Academy, Colorado Springs, CO and he holds an MBA from Oklahoma State Universitys Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class). CFS is also known asSystemic Exertion Intolerance Disease (SEID)and Myalgic Encephalomyelitis (ME) is characterized by extreme fatigue without explanation from any other underlying condition. Its an essential piece of evidence. *A good medical understanding of the unique CAUSE/ORIGIN (what doctors call etiology) of YOUR sleep apnea. See our tips on how to obtain a credible nexus letter, Both sinusitis and rhinitis are linked to sleep apnea, Emerging research indicates a strong association between PTSD and sleep apnea, You Deserve It: The Definitive Guide to Getting the Veteran Benefits Youve Earned, 9 Secrets Strategies for Winning Your VA Disability Claim, Disrupted breathing in which a persons respiration can become labored or even stop for up to a minute at a time, Limited attention span or difficulty thinking clearly, Snoring, including snoring that is especially loud and involves gasping, choking, or snorting that may cause a person to briefly wake up, #1. As a fellow disabled Veteran this is shameful and Im on a mission to change it. VA denied it again (2nd) in late 2016 No treatment in service, VA totally ignoring evidence submitted. Worsening of symptoms while sitting upright or standing, known as Orthostatic Intolerance. Dear Veteran, Heres the brutal truth about VA disability claims: According to our data, 8/10 (80%) of veterans reading this message right now are underrated by the VA. Many conditions that are service related can cause obesity, like diabetes (and diabetes medications), depression, and injuries that result in lack of mobility. As the patient, this can be a stressful time, which is why it is so important to tell your doctor all the symptoms you have even if they seem silly or strange. These temporary breathing disruptions or lapses can occur from dozens to hundreds of times per night. Deland, FL: 1607 South State Road 15A Suite 12 Deland, FL 32720, Satellite Offices There is no cure for Chronic Fatigue syndrome but medications can be prescribed to help with depression along with physical therapy. Digestion issues like IBS (irritable bowel syndrome). Save my name, email, and website in this browser for the next time I comment. I believe the two are connected. * Can I service connect sleep apnea without a sleep study in service? If youve filed your VA disability claim and have been denied or have received a low ratingor youre unsure how to get startedreach out to us! If there is a way for us to improve our claims to get more granted for Vets with "GWI", rest assured, you will find it on the Veterans Law Blog. OY&/Ov{"3 tz0{r
F~2AhtAMR|ED8l .~h7564Ri;:4UY)')dXxrDWm b4RmeCF$ZelpKT+ise$._DSah#Yxm CPGtef%gMvHPMO_'QXfk3xk9R-bxUqJ4rzWhixgi7-]ng)T2i:P z"/oCw.8{N
A\c\FOl>jlh@7p ZB{hp!=Uds~$?4Af%E)L:va4Hc_?qaH }q?OFI>4 7Q3
For a limited time, you can book a free, no-obligation VA Claim Discovery Call with one of our experts. (In many cases, amedical expert report or opinion may be crucial to success). NOT GOING TO GIVE UP, I filed a FOIA for a copy VA experts opinion in preparation for another NOD, this time Im requesting a formal face to face meeting with DRO. Concerningly, it is also one of the conditions most rejected by the VA, as the vast majority are regularly turned down. In this guide, we'll explore how to get a VA Rating for Insomnia even if youve already filed or been denied benefits in the past. While we still have our home base in Florida, We offer free resources and expertise to empower all Veterans. 2023-03-04T21:20:56-05:00 Even with that little bit of extra information, almost allVeterans are still being denied service connection for sleep apnea. We also connect veterans with independent medical professionals in our referral network for medical examinations, disability evaluations, and credible independent medical opinions and nexus statements (medical nexus letters) for a wide range of disability conditions. Weve supported more than 15,000 veterans to win their claims and increase their ratings. We know the pain of feeling stuck, frustrated, and alone, and we want to make this process as easy and painless as possible for you. The criteria for entitlement to service connection for sleep apnea, to include as secondary to PTSD with major depressive disorder, are not met. Emerging research indicates a strong association between PTSD and sleep apnea.The link between sleep apnea and PTSD is likely due to the fact that many factors that aggravate PTSD also aggravate sleep apneaincluding sleep deprivation, insomnia, hyperarousal, and daytime sleepiness. It only took three months. How to Hire an Attorney For Your VA Claim or Appeal. Many Veterans suffering from emotional distress overeat and lack the motivation to work out. The VA Claims Medical Team specializes in this, sign up here to take the first step in your VA claim! Do I Need a CPAP Machine to be Service-Connected? I talked to several doctors and sleep experts. Proving Sleep Apnea is Service Connected its the one thing I hear more about from Veterans than any other topic. If you need a lawyer, fill out a contact form at the law firm of Attig Steel: https://www.attigsteel.com/contact-us/. Veterans are assigned a 0, 30, 50, or 100 percent rating depending on the severity . Because of my PTSD meds and sleep apnea I have gained considerable weight as well as an underactive thyroid. I want you to think about the BEST path to proving that sleep apnea is service connected, and the BESTway to get the VA sleep apnea disability rating you are entitled to. Your voice is important especially when it comes to your own health care. Also sinusitis, rhinitis, hypertension. I only have 50 days to file NOD, or file a BVA appeal within 1 year. New Rule allows Presumptive Service Connection for Veterans particulate matter (burn pit) claims. <>/Parent 3 0 R/Type/Page/Contents 8 0 R/Tabs/S/Resources<>/ProcSet[/PDF/Text]/Font<>>>/MediaBox[0 0 612 792]/Rotate 0>> Thats what Veteran Lee G. did Lees VA claim changed when he read my Sleep Apnea book: Chris gave me the knowledge to file a claim for Sleep Apnea. Even if youve been denied before, its not too late! Please call for an appointment before visiting: Mail Processing Center: P.O. In September 1978, she was granted service connection for bilateral chondromalacia, a breakdown of cartilage in the knee joint that causes pain when bones . NOW ITS YOUR TURN. In my book Put it to Rest! 8 0 obj PTSD can cause insulin resistance (fasting Blood sugar results above 100 prove you have insulin resistance) and insulin resistance causes sleep apnea. Its over 165 pages long, and took 9 months of research. Your email address will not be published. endobj Regulation Update: VA Ratings for Kidney Disease and Renal Dysfunction. If you need a lawyer, fill out a contact form at the law firm of Attig Steel: https://www.attigsteel.com/contact-us/. The problem is that many disabilities that arise in service are not actually diagnosed in service. z`tsd#Ex>@"A"M@+5;$ 2020 Strategic Veteran All Rights Reserved. Common signs of sleep apnea include: Loud and frequent snoring Silent pauses in breathing Choking or gasping Daytime sleepiness Insomnia Unproductive sleep Morning headaches If you are interested in avoiding unnecessary delay in your claim and want to do everything you can to maximize your chances of success, it is probably a good idea for you to consult with an accredited veterans disability attorney. Without a CPAP machine, the VA assigns a 30% rating. For a limited time, you can book a free, no-obligation VA Claim Discovery Call with one of our experts. BVA Decision
VA Disability Ratings for Hypertension and Sleep Apnea Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim (FDC)so you can increase your rating faster! A medical nexus (i.e., link) between their sleep apnea and the in-service event, injury, or illness; Once service connection is awarded, sleep apnea is then rated under 38 CFR 4.97, Diagnostic Code 6847 - Sleep Apnea Syndromes (obstructive, central, mixed). There are special rules regarding how a Sleep Apnea disability claim is treated by the VA. It's harder to get than it used to be, and there are more regulations. You will then need an expert medical opinion that shows these symptoms back then in service were probably sleep apnea even though you had not been diagnosed at the time. <>stream I am service connected for chronic sinusitis with a 30% rating.
Heres the brutal truth about VA disability claims: The proper medical explanation of the origin of the veterans sleep apnea, Lay AND Medical detailing of the symptoms experienced from sleep apnea affecting the veteran since the onset of the condition in the service until the present day. Medical opinions will be CRUCIAL, as these are not NECESSARY connections. Source: Department of Veteran Affairs Regional Office New Orleans, LA. So, if you developed sleep apnea while in service and still carry that diagnosis, you should be granted service connection. Not only does the VA provide compensation, but once you receive a service-connection for it, it provides a way to get other disabilities to service-connected. If you use a CPAP machine, then this should warrant a 50% rating. You may eventually get there on your own, but it may be after a series of decisions by the Regional Office and Board of Veterans Appeals. 38 0 obj
<>
endobj
Not presumptively. As this represents a total grant . Any advice on getting sleep apnea service connected? Were here for disabled veterans exploring eligibility for increased VA disability benefits and who wish to learn more about that process. If you are a veteran and have been struggling with sleep problems, you may wonder if a VA sleep study is the right solution. This illness can be hard to diagnose due to its seemingly unrelated symptoms, but do not let that discourage you. Im 50% connected with PTSD and currently have an appeal in for 100% on PTSD.
To prove that sleep apnea is service connected, the smart Veteran is going to have to connect the dots for them. How you mix them is the hard part. Jessica Rodriguez, Claims Advocate Updated: June 27, 2020. With lay evidence AND medical evidence. Scenario 4: The Veteran has one or more conditions service-connected, and is claiming that those conditions CAUSED the sleep apnea. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for sleep apnea, to include as secondary to the endstream Problems with sleep which include not being rested after sleep or difficulty staying and/or falling asleep. Sleep studies can be done to rule out Obstructive Sleep Apnea (OSA) or other sleep disorders preventing restful sleep. Dear Mr Attig: ,144x{,}T=7#|lk0s @0\0N Z,;QkH|L[, Template for processing Decision or Remand. In the year thatI spent researching theSleep ApneaField Manual, I learned that there are 39 medical conditions common among Veterans thatcan cause or aggravate sleep apnea. Its FREE to get started, so click Go Elite Now below to complete our 3-step intake process. 201 Bankhead Highway, Carrollton GA 30117770-285-1198. I filed to reopen my SA claim in 2016. I talked to several doctors about the causes and limitations of sleep apnea. Richmond, VA: 7400 Beaufont Springs Drive, Suite 300, Richmond, VA, 23225 If you have sleep apnea and sinusitis/rhinitis, your next step would be to get a doctors medical opinion supporting that your service-connected sinusitis/rhinitis caused or aggravates your sleep apnea. Theres lots of literature available to back it up. In April 2013, the RO reopened the sleep apnea claim, but denied service connection, and found no new and material evidence sufficient to reopen the tinnitus claim. But if your body cannot get sleep, you will die. Honestly, they are just saying it. Below is the schedule for rating disability for Chronic Fatigue Sundrome. We see that quite often with sleep apnea claims. While an OSA disability claim secondary to sinusitis/rhinitis is an easier path, veterans who are service-connected for PTSD (or other mental health conditions) are eligible for secondary service connection for their sleep apnea, and its possible to achieve an OSA disability claim secondary to PTSD with the right strategy and credible medical evidence. I talked to hundreds of Veterans and read their C-Files to see where they went wrong. First of all, lets explore a little about this common disability in veterans, so you understand the condition and why its important you pursue your claim and get the benefits you deserve. <>/Parent 3 0 R/Type/Page/Contents 4 0 R/Tabs/S/Resources<>/ProcSet[/PDF/Text]/Font<>>>/MediaBox[0 0 612 792]/Rotate 0>> While sleep apnea on its own can be difficult to connect, you have the option of connecting it to another condition already claimed. The VA uses two options for rating most sleep apnea claims. What the doctor is trying to do is check all possible outcomes for the symptoms to make sure a clear diagnosis can be given. Tender lymph nodes usually in the neck and underarms. If you or a loved one suffers from CFS do not be afraid to report symptoms to your doctor. HWnH}W#zx 8Fb$vhjKLdRCR6-kf$}9u/U(XVX= eX5e2by=t-V?l*_?,?C&{u&Q,E1[x3")KYdXD@Q2+x."]}0uLB!_ne\Ya)y,"k"Q>bV7mWnXQn
ZDE(WQ 8mSNMj;vwWoDL-y9mxC~`S3t|4[&
S/.TWGaxUtbw>Hk :LfNo`BYL2%*{6GuTP rzY9y+%Koa(+Ja.'Xg c}gn7 Ds?4S&}eLg\Qz}3l>tN`MA&DDz5:/v We would be happy to talk to you. Brian isalso the CEOofMilitary Disability Made Easy, which is the worlds largest free searchable database for all things related to DoD disability and VA disability claims and has served more than 4,600,000 military members and veterans since its founding in 2013. We can helpreach out so we can show you how. They denied injections the doctor recommended to ease my pain. When I turned my case over to Jason things turned around, QUICK. I recommend Perkins Law Firm. Its an entirely different thing to mix those ingredients so that they turn into a cake. Were Veterans, just like you, whove learned how to navigate within the VA system. Closely followed by PTSD, Hearing Loss, Tinnitus and TDIU. Result: Service connection for obstructive sleep apnea, secondary to service-connected GERD, with history of esophagitis and hematemesis, is granted. endstream
endobj
43 0 obj
<>stream
Anxiety and depression can interfere with sleep patterns. This disorder can also lead to more complications like depression, social isolation, lifestyle restrictions, and an increase in absences from work/school. Here are the ingredients to a properlydeveloped claim for sleep apnea: *A solid foundation of Lay and Medical Evidence showing when sleep apnea first began to present in the Veterans life. And that means you are going to have to think through your sleep apnea claim. Required fields are marked *. But remember the ultimate goal to win your VA disability compensation claim.
Allergies or sensitivities to foods, odors, chemicals, or noise. Once you are clear on the type of apnea, you should talk with your doctor further about what he or she thinks is the primary cause for it. Proving Service-Connection for Sleep Apnea. Also, to check for the cause of fatigue a doctor may do physical examinations such as an exercise stress test to check on the function of the heart and lungs. Even a previous diagnosis may not be accepted by the VA without a sleep study. Excessive daytime sleepiness is the most noticeable signal for those who live alone. The Veteran was granted entitlement to service connection for major depressive disorder in a May 2016 rating decision.