It is a fact that insulin injections cause weight gain problems. Another fact is that, yes, some VA doctors will be very adamant as to the cause of the OSA. If you expect a VA doctor to write you a letter then you need to know how to ask for it. Don't be meek, but rather confident and assertive. Ask for what you want.
If your C&P was actually preformed by the local VAMC you can get the result after three business days from ebenefits or from ROI at the VAMC.
If your C&P was farmed out to be preformed by QTC your results will not be available to you until after the claim is decided.
The very first prerequisite for R-1 is to obtain a "O" rating. Read CFR 3.350 - 3.352 for eligibility rules.
You don't mention anything about SMC "S" that you should qualify for, and you might qualify for regular A&A, depending upon your individual circumstances.
Just my opinion but it looks to me like you could qualify for mild lower raticular group ratings of both arms (as they note several nerve groups affected) which would give you 20% per arm and add 10% on top of that for bilateral conditions. You may hit 100%. That being said, it would surprise me if they don't schedule you for an EMG. This test is a breeze if you have sensory issues.
Filing an Actual Appeal, Claiming a CUE is way different than Requesting an "Official Review for Possible CUE," of a recently decided Claim/Denial.
I was successful with mine, granted that doesn't mean you would be with yours. My lay opinion is, the Rater failed to properly take your IMO into consideration. The PA's opinion can not be held as equal to that of an MD Board Certified Surgeon. At the very least, you raising the issue, may get it another look, by a Sr Rater or actual DRO. Definitely worth a shot, sooner rather than later. You would still have your NOD waiting in the wings.
Nobody at the VA Rating Dept wants to be reversed on Appeal, looks bad and brings into question their competence.
I had a late 2014 C & P SA Increase with a Recent Pul Hypertension SX as Secondary to the SA. The C&P DR, VMC GP MD asked me why I was wasting his time, I'd been SA 50% since 10 and there wasn't grounds for an increase. I explained why I thought he was wrong, discussed 38 CFR 4 SA Ratings, he was adamant that I would not get an increase based on my SA & PH @ 0% SC. We agreed that we Disagreed. His negative SA Increase DBQ was in my MHV File the following week.
Received a continuation of my SA @ 50% 05/15, the Rater agreed with the C & P Dr. Gave no consideration to my "Sworn Affidavit" where I laid out the Medical Evidence and Discussed in great detail how I met the SA 100% Rating Requirements.
Just as I was getting ready to file my NOD requesting a DRO Hearing 01/03/2016, while printing a Copy of my VA IU Rating for the MI DAV Property Tax Exemption, I noticed an obvious ERROR on my DAV Confirmation page. Somehow, instead of 90% IU T & P, I was now Rated 100% SC Scheduler for SA, and Awarded SMC S (1) Scheduler Housebound. This was the result of a VA Phantom Sr Rater doing a "Quality Review" of my 05/15 Denial.
So there was no need for my NOD, but the Sr Rater got the Retro Date of 05/15 Wrong, filed the "EED CUE Review Request" 05/15, additional Retro Awarded 07/16.