Question: I have a few things going wrong with my breathing: I have COPD; bibasilar atelectasis; hemidiaphragm paralysis; and sleep apnea.

I'm a Navy veteran and was exposed to asbestos for a few years in the late 1970's (as a boiler tech on a Navy ship that used asbestos for pipe insulation). I have found that my lung problems, coupled with back problems and other things that put me on morphine and oxycodone to manage pain prevent me from doing the research that has filled my time for the past 30 years. The morphine makes me stupid, the sleep apnea makes me sleepy, ... I have effectively been forced into retirement at age 62 (even though I has previously envisioned working in some capacity until I was at least 80).

I get treatment at the XXXXXXX VA health care system (which I should say is provided by doctors from the Massachusetts General Hospital, Mass Eye and Ear Clinic and BU, among other first class teaching hospitals). I believe they are doing all that can be done for me medically.

My question is about what caused all of this. I've asked the VA to increase my disability benefits (I get disability benefits for having been involved in an accident onboard the ship I was on way back then -- I ruptured my pectoralis major muscle in a boiler room accident).

Here are my questions:
Is it reasonable to say my COPD is caused by asbestos exposure? (I think this is highly probable; there are lots of hits here in google.scholar)

Is it reasonable to say the bibasilar atelectasis and hemidiaphragm paralysis are at least as likely to have been caused by asbestos exposure as anything else?

Is it reasonable to say the sleep apnea was caused by asbestos exposure (or by COPD, or something else that was related to asbestos exposure)?

I think you'll be able to see what I'm doing here. I have found literature that shows that the kind of mild centrilobular emphysema that I have may have been caused by asbestos exposure (even though I smoked cigarettes for 30 years at about 30 packs/year -- I quit about 10 years ago). I don't know why these other things have happened to me, but (particularly since I've been a "good boy" for all these years), I don't think they are completely unrelated; at least for the purpose of asking the VA to help pay my bills, I'd like them to blame all my pulmonary problems on asbestos exposure.

Is that reasonable?

Can we (you) say (truthfully) that COPD is a secondary condition to asbestos exposure?

Can we (you) say (truthfully) that bibasilar atelectasis / hemidiaphragm paralysis is a secondary condition to asbestos exposure?

Can we (you) say (truthfully) that sleep apnea is a secondary condition to asbestos exposure?

I think your statement that "sleep apnea is also not explained by asbestos exposure" is rather strong, considering the evidence, at least to the extent that the sleep apnea may be related to (secondary to) the COPD. An early report [1] found a high prevalence of sleep apnea–hypopnea syndrome in individuals with chronic obstructive pulmonary disease. This finding was considered biased because many of the participants were already suspected of having both sleep apnea–hypopnea syndrome and chronic obstructive pulmonary disease. Several other reports [2,3] have suggested that the prevalence of sleep apnea–hypopnea syndrome in individuals with chronic obstructive pulmonary disease is higher than would be expected in the general population. This finding is not without controversy [4]
However, more recent studies [5] suggest that there is evidence in COPD and OSAS of overlapping mechanisms relating to inflammation, oxidative stress, and leukocyte dysfunction. These overlapping mechanisms suggest a common cause of the diseases.


1. Guilleminault C, Cummiskey J, Motta J. Chronic obstructive airflow disease and sleep studies. Am Rev Respir Dis 1980;122:397–406


2. XXXXXXX TD, Rutherford R, Lue F, Moldofsky H, Grossman RF, Zamel N, Phillilpson EA. Role of diffuse airway obstruction in the hypercapnia of sleep apnea. Am Rev Respir Dis 1986;134:920–924


3. Chaouat A, Weitzenblum E, Krieger J, Ifoudza T, Oswald M, Kessler R. Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am Rev Respir Dis 1995;151:82–86


4. Bednarek, XXXXXXX XXXXXXX Plywaczewski, Luiza Jonczak, and XXXXXXX Zielinski. "There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome: a population study." Respiration; international review of thoracic diseases 72, no. 2 (2004): 142-149.

5. McNicholas, XXXXXXX T. "Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease." XXXXXXX journal of respiratory and critical care medicine 180, no. 8 (2009): 692-700.