Fellow veterans, I have noticed there are a lot of military members and families here that have a lot of questions and need help.  While I am by no means an expert on the subject; I would like to keep this topic reserved for specifics links to regulations, instructions, and any other official information that will be useful.  I will reserve the first few posts for TRICARE, VA, Air Force, Army, Navy and Marines specific instructions and links.  Please post or send me a PM with any information (official only) that you feel will be helpful.  I feel that this will be a great way to support each other since there is a lot of information scattered out on this site and it would be a good idea to consolidate the facts in one thread.  Please let me know what you think and if you have any suggestions.  

Thank you for your time,

Frodo



Last edited by Frodo on Wed Apr 04, 2007 8:47 am; edited 1 time in total
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Successful Septoplasty and Turbinate Reduction surgery?saline irrigation...continuing cpap trial for pressure settings...

Reserved for US Air Force links, instructions, and information.

AFI 36-2110, Personnel, ASSIGNMENTS
AFI 41-210, Health Services, PATIENT ADMINISTRATION FUNCTIONS
AFP 47-103, VOLUME 2, Dental, DENTAL LABORATORY, TECHNOLOGY—FIXED AND SPECIAL PROSTHODONTICS
AFI 44-157, Medical Service, MEDICAL EVALUATION BOARDS (MEB) AND CONTINUED MILITARY SERVICE
AFI 48-123, Aerospace Medicine, MEDICAL EXAMINATIONS AND STANDARDS
AFI 48-123, VOLUME 1, Aerospace Medicine, MEDICAL EXAMINATIONS AND STANDARDS
VOLUME 1—GENERAL PROVISIONS
AFI 48-123 VOLUME 2, Aerospace Medicine, MEDICAL EXAMINATIONS AND STANDARDS, VOLUME 2-ACCESSION, RETENTION, AND ADMINISTRATION
AFI 48-123, VOLUME 3, Aerospace Medicine, MEDICAL EXAMINATIONS AND STANDARDS VOLUME 3-FLYING AND SPECIAL OPERATIONAL DUTY
AFI 48-123, VOLUME 4, Aerospace Medicine, MEDICAL EXAMINATIONS AND STANDARDS
VOLUME 4—SPECIAL STANDARDS AND REQUIREMENTS



Last edited by Frodo on Wed Apr 04, 2007 9:28 am; edited 1 time in total
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...zzz...zzz...zzz... ___...gasp...snort...cough...zzz...zzz...___....gasp...snort...cough...
Successful Septoplasty and Turbinate Reduction surgery?saline irrigation...continuing cpap trial for pressure settings...

Some usefull information for USAF vets with ALC "C".  Sorry for the long post but it might be of some help.  

UNCLAS

311310Z AUG 06

FROM: HQ AFPC RANDOLPH AFB TX//DPA//

TO: AL 8106

THIS MESSAGE IS FOR PUBLIC RELEASE

SUBJECT: ASSIGNMENT LIMITATION CODE (ALC) "C" STRATIFICATION IMPACT ON PERMANENT CHANGE OF STATION (PCS) ASSIGNMENTS AND TDY DEPLOYMENTS (NOT APPLICABLE TO THE AIR NATIONAL GUARD OR AIR FORCE RESERVE)

THIS MESSAGE IS IN FOUR PARTS.
  
PART I - GENERAL INFORMATION

1. IN MAR 06, THE MEDICAL COMMUNITY PUBLISHED AN INTERIM CHANGE (IC) TO AFI 41-210, PATIENT ADMINISTRATION FUNCTIONS, ANNOUNCING ASSIGNMENT LIMITATION CODE (ALC) "C," MEDICAL ASSIGNMENT LIMITATION STRATIFICATION.
THE INTENT OF THE STRATIFICATION WAS TO ALLOW AIRMEN TO SERVE ON EXTENDED ACTIVE DUTY TO THE FULLEST EXTENT POSSIBLE. ALC "C" AIRMEN ARE CURRENTLY BEING STRATIFIED INTO ONE OF THE FOLLOWING CATEGORIES:

C-1 - DEPLOYABLE/ASSIGNABLE TO GLOBAL DOD FIXED INSTALLATIONS WITH INTRINSIC MEDICAL TREATMENT FACILITIES (MTF).
  
C-2 - DEPLOYABLE/ASSIGNABLE TO CONUS INSTALLATIONS WITH INTRINSIC FIXED MTFS (TRICARE NETWORK AVAILABILITY ASSUMED).
  
C-3 - NON-DEPLOYABLE/ASSIGNMENT LIMITED TO SPECIFIC CONUS INSTALLATIONS BASED ON MEDICAL NEEDS.
  
FOR MORE DETAILS PERTAINING TO EACH CODE, REFER TO AFI 41-210 AT WWW.E-PUBLISHING.AF.MIL/PUBFILES/AF/41/AFI41-210/AFI41-210.PDF.

2. DEPENDING ON THE TYPE OF STRATIFICATION, AIRMEN MAY BECOME ELIGIBLE FOR OVERSEAS ASSIGNMENT CONSIDERATION AND/OR DEPLOYMENT IN SUPPORT OF OPERATIONAL ENDEAVORS. THE FOLLOWING INFORMATION ADDRESSES HOW THE ALC "C" STRATIFICATION WILL IMPACT PERMANENT CHANGE OF STATION (PCS) ASSIGNMENTS AND DEPLOYMENTS.


PART II - PCS ASSIGNMENTS:
  
1. EFFECTIVE 1 SEP 06, AFPC ASSIGNMENT OFFICERS/NCOS WILL CONSIDER AIRMEN WITH AN ALC "C" FOR PCS, PROVIDING THEY MEET ALL OTHER ELIGIBILITY CRITERIA. WE HIGHLY ENCOURAGE AIRMEN WITH AN ALC "C" TO UPDATE THEIR ASSIGNMENT PREFERENCES AS SUGGESTED IN THE JUN 06, AIR FORCE PRINT NEWS ARTICLE, ASSIGNMENT OPPORTUNITIES EXPAND FOR CODE C AIRMEN, LOCATED AT . ASSIGNMENT OFFICERS/NCOS WILL IDENTIFY MEMBERS WITH AN ALC "C" WHO ARE VULNERABLE FOR A PCS AS EITHER THE MOST ELIGIBLE VOLUNTEER OR NON-VOLUNTEER AND COORDINATE WITH AFPC/DPAMM (MEDICAL
STANDARDS) FOR STRATIFICATION PRIOR TO ASSIGNMENT CYCLES FOR ENLISTED AND DURING FOR OFFICERS. DPAMM WILL CONDUCT A REVIEW IN LIEU OF (RILO) MEDICAL EVALUATION BOARD (MEB) WITHIN 10 - 30 CALENDAR DAYS TO DETERMINE STRATIFICATION. DPAMM WILL ADVISE THE ASSIGNMENT OFFICER/NCO OF STRATIFICATION OUTCOME AND QUALIFICATION FOR THE PCS.

    A. IF THE AIRMAN IS QUALIFIED FOR PCS SELECTION BASED ON THE ALC "C" STRATIFICATION, THE ASSIGNMENT OFFICER/NCO WILL LOAD THE PCS IN MILPDS. THE PCS NOTIFICATION WILL THEN BE PROCESSED IAW AFI 36-2110, PARA 2.32.
    
    B. IF THE AIRMAN IS NOT QUALIFIED FOR PCS SELECTION BASED ON THE ALC "C" STRATIFICATION, THE ASSIGNMENT OFFICER/NCO WILL NOT LOAD THE PCS. IN THIS INSTANCE, NOTIFICATION OF A PCS WILL NEVER OCCUR BECAUSE THE AIRMAN WAS NOT SELECTED. AIRMAN WILL BE CONSIDERED FOR SUBSEQUENT PCS' FOR WHICH HE OR SHE IS QUALIFIED
    
    C. IF DPAMM IS UNABLE TO COMPLETE THE STRATIFICATION PRIOR TO COMMENCEMENT OF AN ASSIGNMENT CYCLE FOR ENLISTED OR DURING A CYCLE FOR OFFICERS, THE AIRMAN WILL BE BYPASSED UNTIL STRATIFICATION IS COMPLETE.
THE AIRMAN WILL BE PRIORITIZED AND CONSIDERED DURING THE SUBSEQUENT ASSIGNMENT CYCLE.

2. CURRENTLY, MILPDS RESTRICTS ALCS TO A ONE DIGIT, ALPHA CHARACTER FIELD. THEREFORE, IN THE INTERIM, THE ALC "C" WILL REMAIN AS AN OCCURRENCE IN MILPDS AND ANOTHER ALC OCCURRENCE WILL APPEAR AS X AND Y.
THIS ALLOWS AFPC/DPAMM TO PROPERLY IDENTIFY AND CODE AIRMEN WHO HAVE ALREADY BEEN STRATIFIED UNDER THE ALC "C" STRATIFICATION INITITIVE. A SYSTEM CHANGE TO MILPDS HAS ALREADY BEEN SUBMITTED TO INCORPORATE ADDITIONAL SYSTEM EDITS, BUT THE CHANGES WILL NOT BE AVAILABLE UNTIL THE NEXT MILPDS RELEASE; PROJECTED MARCH 07. ONCE MILPDS IS MODIFIED, STRATIFIED AIRMEN WILL RECEIVE ONLY ONE OF THE FOLLOWING ALCS IN MILPDS:
ALC X = C-1, ALC Y = C-2, ALC C = C-3.

3. IN THE FUTURE AND IN SOME CASES, WHEN AIRMEN ARE STRATIFIED WITH ONE OF THE ALCS MENTIONED ABOVE, ASSIGNMENT OFFICERS/NCOS WILL BE ABLE TO SELECT/LOAD PCS' WITHOUT PRIOR COORDINATION WITH AFPC/DPAMM.

PART III - DEPLOYMENTS

1. AIRMEN WILL ONLY BE SELECTED FOR DEPLOYMENT AFTER ALC "C"
STRATIFICATION IS COMPLETE. AIRMEN STRATIFIED WITH AN ALC X OR Y, WITH A DEPLOYMENT AVAILABLITY (DAV) CODE 41, MAY BE ABLE TO DEPLOY TO SOME LOCATIONS IF APPROVED BY APPROPRIATE WAIVER AUTHORITY. THESE AIRMEN MUST BE MEDICALLY CLEARED IMMEDIATELY FOR DEPLOYMENT, VERSUS WITHIN 30 DAYS OF PROJECTED DEPARTURE DATE (PDD) AS NORMALLY REQUIRED. INDIVIDUALS WITH AN ALC "C," AND DAV CODE 48, WILL NOT BE DEPLOYABLE.

2. THE PERSONNEL READINESS FUNCTION (PRF) WILL BE RESPONSIBLE FOR IDENTIFYING MEMBERS WITH AN ALC X OR Y SELECTED FOR DEPLOYMENT. PRFS WILL NOTIFY THE MEMBER'S UNIT DEPLOYMENT MANAGER (UDM) AND HAVE THEM CONTACT THE PHYSICAL EVALUATION BOARD LIASON OFFICER (PEBLO) AT THE LOCAL MEDICAL TREATMENT FACILITY (MTF) FOR EVALUATION.

3. THE PEBLO WILL SUBMIT A RILO TO AFPC/DPAMM. AFPC/DPAMM WILL REVIEW THE RILO AND ADVICE IF MEMBER CAN PROCESS/PROCEED TO THE TDY LOCATION ALONG WITH ANY ADDITIONAL INFORMATION, AS DEEMED NECESSARY.

PART IV - POINTS OF CONTACT:

1. ALC "C" STRATIFICATION PROCEDURES: E-MAIL:
AFPC.DPAMM@RANDOLPH.AF.MIL; DSN: 665-2246.

2. PCS ASSIGNMENTS: E-MAIL: AFPC.DPAPP@RANDOLPH.AF.MIL
DSN: 665-3815.

3. TDY DEPLOYMENTS: E-MAIL: AFPC.DPFROM@RANDOLPH.AF.MIL
DSN: 665-2246.


_________________
...zzz...zzz...zzz... ___...gasp...snort...cough...zzz...zzz...___....gasp...snort...cough...
Successful Septoplasty and Turbinate Reduction surgery?saline irrigation...continuing cpap trial for pressure settings...

Frodo wrote:

Fellow veterans, I have noticed there are a lot of military members and families here that have a lot of questions and need help.  While I am by no means an expert on the subject; I would like to keep this topic reserved for specifics links to regulations, instructions, and any other official information that will be useful.  I will reserve the first few posts for TRICARE, VA, Air Force, Army, Navy and Marines specific instructions and links.  Please post or send me a PM with any information (official only) that you feel will be helpful.  I feel that this will be a great way to support each other since there is a lot of information scattered out on this site and it would be a good idea to consolidate the facts in one thread.  Please let me know what you think and if you have any suggestions.  

Thank you for your time,

Frodo

I think a separate forum might be best as there are many discussions related to the issues. A sticky with FAQs might also help.

JohnP

Great idea John,  I will try and find out if that is possible.

Frodo


_________________
...zzz...zzz...zzz... ___...gasp...snort...cough...zzz...zzz...___....gasp...snort...cough...
Successful Septoplasty and Turbinate Reduction surgery?saline irrigation...continuing cpap trial for pressure settings...

It is difficult to reserve threads.  Sometimes it would be nice because occassionally someone will pop in with a concern so unrelated we are afraid it will be missed and not answered.  I'll run the sticky idea by the other moderators and forum administrators though.

The is such an important topic and there is clearly evidence that this information is needed.  Frodo, thanks for helping out our amazing military members who need every ounce of our support and we honor your service.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Thank you very much Vicki,

I was going to wait till I got home and send PMs to the Mods; I thought you all were sleeping :).  I think that it would be very helpful because there are so many regulations and they vary from each branch of the military.  Even though we have the same health problems as civilians, the military is a different world.  Medical care, insurance, doctors, paperwork and dealing with your boss are all different from location to location and especially overseas.   The other issue is most vets do not know their benefits and I would hate to see someone lose out on money or specific health care.  It seems that every vet has to research the information from scratch every time.  The more we can educate each other the better.  That way we will know the right questions to ask.  I know there are some military members deployed that should not be and if they new what questions to ask and had specific references, they would be getting the proper medical care they need.  Thank you again for your help,

Frodo

Thank you! Thank You! Thank You! for starting this thread.  I am going thru the VA to get my XPAP  (just prescribed Tuesday) and could really use some resources for finding out about the process.  

Kattitude

My Journey:

I was initially diagnosed with obstructive sleep apnea (OSA) and hypopnea about four years ago (2003) at the local VA medical center after having trouble with dozing off at work. I slept poorly to the point of dreading going to bed at night, took multiple naps every day without getting any real rest, snored and stopped breathing whenever I slept, generally felt miserable, was forgetful and had no long term memory, couldn't concentrate, had high blood pressure and put on a couple of hundred of extra pounds. It took nearly three months to get the initial sleep evaluation (Apnea Hypopnea Index (AHI) over 100) and another six months for my initial titration (pressure of 9 cm H2O). One week later (January 1, 2004), before I was able to get my first CPAP (Constant Positive Airway Pressure) machine I had a massive stroke (hemorrhagic, fortunately). My wife battled with the doctor to get my first CPAP, which the doctor was reluctant to start me on because of my recent stoke. With my wife’s insistence I went on the CPAP about 1 1/2 months after my stroke and I’ve been using it ever since.

Initially, the difference was amazing and I believe the CPAP helped tremendously with my recovery from the stroke, but I got to a certain point and I didn’t improve anymore. I lost over 100 pounds of weight and became significantly more active the first year. Even though there was improvement I struggled along until about three months ago when I again got to the point of having difficulty staying awake at work. I was getting only about 3 to 4 hours of pretty good sleep a night, but you can’t live for long on that little sleep. Although I was getting along, I had no reserve energy. A few extra trips to the basement was still exhausting.

I got a second sleep titration about two months ago (February 2007), with a result of the same pressure, but it took another month to get back in to see the doctor. At this second titration I got over 7 hours of deep, restful sleep! This was a first! I had never slept so long so well since…ever! The next day I learned the test machine was using a feature called C-Flex which lowers the pressure on exhalation making it much easier to breathe. On my initial titration in 2003 I slept only three hours.

By the time of my second titration, I had done a lot of research and had come to the conclusion that my problem was not that the therapy was failing but that it wasn’t as good as it could be. With the CPAP, I was dropping off to sleep nearly every night in a few minutes, but still awakened several times most nights not primarily from apneas (stopped breathing) or hypopneas (shallow breathing) but from either gasping for breath (not enough air) or from bloating (too much pressure). I learned that my difficulties were because my pressure requirements changed throughout the night, as do most people’s, and the machine I had ran only at a fixed pressure. In addition, because my CPAP was a constant pressure machine without a C-Flex type feature, I was exhausted the next morning from just exhaling against the pressure! This problem exhibits itself as  open mouth breathing  or  dry mouth  from breathing through the mouth (mostly out) and renders the CPAP therapy mostly ineffective.

The solution for the first two problems was the  Auto-Titrating  PAP or APAP machine. This machine attempts to keep the pressure as low as possible but increases pressure whenever it senses apneas, hypopneas, snoring or limited air flow.

The solution for the last problem is a function called  C-Flex  from Respironics or  EPR  (Expiratory Pressure Relief) from ResMed. This function senses the transition between inhaling and exhaling and reduces the pressure so you don’t have to work so hard at exhaling then increases on the transition back to inhaling. The different manufacturers implement this function differently and you may have to try different machines to get a system that works for you. Respironics uses a variable method depending on your breathing cycles and three setting levels while ResMed uses three fixed pressure settings of 1 to 3 cm H2O. Regardless of which method is used this feature is essential for comfortable therapy!  (Note: Only Respironics has this feature on their APAP system. The ResMed APAP does not. It’s available only on ResMed CPAPs.)

When I finally got in to see the doctor again and after discussing my problems and what I thought were their solutions, I asked the doctor to put in a prescription through Tricare for an APAP, and also to write a separate prescription for an APAP so I could rent/buy an APAP machine on my own while waiting for Tricare to come through. The doctor ended up submitting a prescription through Tricare for a standard CPAP with C-Flex because Tricare would balk at approving an APAP because they are  experimental  or  deluxe  or  diagnostic  systems. It’s taken over two weeks for the Tricare prescription to go through and I’ve had time to get an APAP (Respironics M series with heated humidifier and smart card), the corresponding software (Encore) and gather over two weeks of use data. The data showed exactly what I had told the doctor. Because of the data I collected and gave to the doctor with more argument about how much it was helping, the doctor re-wrote the prescription for an APAP! We’ll see how it goes through Tricare. The data showed that most of the time I actually required a pressure of only about 8 cm H2O, and that about 1/4 of the time, my pressure requirements would go up to 10 or 11 with peaks as high as 13. With the APAP, my AHI is now down around 0.5 to 2.5 every night with occasional peaks to a maximum of 8.0. I am currently taking a 1 to 2 hour nap every evening with the APAP, and then getting another 5 to 6 hours of sleep every night. I’m already seeing an improvement in energy and I’m having less trouble staying awake at work.

Initially my APAP was set for a pressure of 3 cm H2O above and below my titrated pressure of 9 (i.e., 6 to 12). In practice both were too low. I adjusted the lower to 7.5 and the upper to 12 and then to 13. I determined these pressures by examining the data output charts from the APAP. One problem with the APAP is if the band of operation is too narrow, you won’t get the benefit of its ability to adjust and if it’s too wide or too high, it will tend to  run away  increasing the pressure too much.

System cost:

Costs going through Tricare for military and retirees can vary. System cost for active duty personnel and their families can be little or nothing, but for retirees the systems can be expensive without supplemental or secondary insurance. Systems are available on the Internet for between $250 and $800 respectively for standard CPAP or APAP with heated humidifier, with BiPAP systems about double. (Through most insurance companies the price can be double or triple these amounts.) These systems are so inexpensive from Internet suppliers because they don’t do insurance or do limited insurance at increased prices. You may be able to buy these yourself for less than your co-pay, depending on your situation, and then work with your insurance company for re-imbursement. Before you can buy the system yourself, your doctor must write a prescription that specifies the type of system, CPAP, with EPR or C-Flex, auto PAP or APAP or auto-titrating PAP or CPAP and give the pressure or upper and lower pressures in the case of APAPs and you should always ask for a heated humidifier. Complete requirements for the prescription vary by supplier and are available on their WEB sites. After I got my doctor to write a separate prescription for an APAP machine, I ordered it from an Internet source and had it the next day.

Summary:

I hope this long narrative of my journey through the perils of seeking a good night’s sleep has added to your knowledge about this widespread ailment we’re all suffering from to varying degrees. I have only scratched or possibly gouged the surface. The Internet is full of information sources and blogs, too many to realistically peruse. A couple of the best to start on are www.wikipedia.com and www.thesleepsite.com. The first will give you a good foundation in the basics if you search for sleep apnea,  and the second is a sleep clinic in Columbus, Ohio, that’s packed with information about all types of sleep disorders. You’ll learn more in one session at these sites than in hours of surfing the WEB.

As you may have guessed I am partial to the APAP system with C-Flex but that’s the system that meets my needs. It may not be appropriate for everyone although I believe all systems will eventually go that way. You need to work with your doctor to evaluate your needs then decide how to proceed with therapy, but do it from a position of knowledge and understanding of your ailment and possible treatments. The added advantage of an APAP is that you’ll probably never have to go through another titration!

I started out three years ago ignorant of my problem and allowed the so called  experts  to tell me what I needed. Since then I have struggled and learned and taken control of my therapy.

The whole point here is that you must take control of your own therapy if it’s going to be successful. You must familiarize yourself with what systems are available and what your condition and needs are, drawing on any resources you can find and sucking the brains of any you encounter dry of all useful information. Above all don’t scrimp on your system and don’t let your doctor or insurance company scrimp. Your body and loved ones will thank you.

Runningbare



Last edited by runningbare on Sun Aug 26, 2007 12:34 am; edited 1 time in total

Kattitude wrote:

Thank you! Thank You! Thank You! for starting this thread.  I am going thru the VA to get my XPAP  (just prescribed Tuesday) and could really use some resources for finding out about the process.  

Kattitude

I don't know if you are active duty military or just a vet but I found some things different from what most non-VA people experience. for example, I told my VA primary care doctor that my wife had reported that I would stop breathing. He submitted a request for a test. Then a few weeks later I got a call from the test center associated with a non-VA local hospital. They did a split test, told me I had apnea and sent me home. They billed the VA I assume as I never saw any paperwork.

A few weeks later, I got a letter saying I had an appointment with the HOX (home oxygen) clinic back at the VA. There the technician(?) (never did ask her) provided me with the equipment and showed me how to ue it. She set up an appointment for 3 months later. This was, I believe, just so they could verify that I was really using it and that it was working. They looked at the results from the card and sent me home. Now I get an appointment annually I think (as I have been there a few times to get different masks and due to humidifier problem) and they look at the results. I have never seen a doctor for this since my initial primary care referral. Next time I go, I'll ask about whether a sleep doctor reviews the information.

On the good side, it appears they give you excellent equipment (Remstar Pro2 Cflex with humidifier) with choice of masks ranging from full face to pillow. If I don't like the mask, they will give me another so I have tried both nose only and two sizes of nasal pillows. No charge for the unit or for service (they just took back the old humidifier and handed me a new one). They also give me a handful of the disposable filters when I ask for them (I change them monthly) and I noticed she replaced the foam filter on my last visit.

Don't know what they would do if the unit was stolen (say at an airport).

John
12 years active service a long time ago (during the days of wooden ships and iron men) - non-retiree - 20% service connected disability

runningbare,

That was an excellent report!


_________________


Acronyms and Often Used Forum Phrases
Respironics? M-Series Auto w/ HH & C-Flex; Flexfit? Hybrid? Mask, Encore Pro 1.8i

JPEZZ,
Thanks John!  That gives me a better picture of what to expect.  I did finally get through to someone today who told me that they would contact me when the maching was in and I would go in for instructions/mask fitting/etc.  I'm curious, was your machine APAP or CPAP?

Thanks for your help!
Connie

Kattitude wrote:

JPEZZ,
Thanks John!  That gives me a better picture of what to expect.  I did finally get through to someone today who told me that they would contact me when the maching was in and I would go in for instructions/mask fitting/etc.  I'm curious, was your machine APAP or CPAP?

Thanks for your help!
Connie

CPAP

Good luck.

Oh! You can do me a favor. Ask about whether a sleep doctor has reviewed the information and what the qualifications are of the person doing the fitting, etc. I'd be interested in knowing.

John

Frodo,

My husband may have sleep apnea, but he is afraid he will be forced to retire early from the Air Guard. If you have any information on disability or anything we would appreciate it. He won't do a sleep study until he knows.

Thanks,

Dear Frodo,

This is a very good idea!  I've been with the VA for several years and never seem to get my questions answered.  How often will the VA replace my mask?  How about my generator?  I have a big bulky Respironics that weighs 15 tons.  I was told I'm  lucky to have one.  I guess they are right.