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EODCMC

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Hi, I am a 30 year retired vet. I retired 13 years ago. I as recently diagnosed with "very severe" obstructive sleep apnea. The machine they gave me is preset on the highest output flow. My episode exceed 35 times an hour with some lasting more than 30 seconds. 

I was diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record. In fact, they wanted to operate on my uvula. There lies the rub. The operation could have ended my career so I didn't persue. Additionally, while on active duty I developed severe chronic sinusitis and allergic rhinitis and this also is documented in my service health record. I have been living with this and chalking it down to getting old.

Fast forward...I recently got a machine that they say I have to wear for the remainder of my life. I just learned that Tricare Prime does not pay for it all. So, I researched online and submitted a claim the E-benefits and it has been received and was under review until today when they changed this to "gathering of evidence" Development Letter Sent.

Does anyone know what this means? What do I have to look forward to concerning the process. I watch the news. It doesn't look good, right?

thanks in advance.

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For anyone following my post hoping to get a timeline cradle to grave. No change, as of today. I'm still in the 3rd phase Gathering Evidence "dust", requested documents overdue.

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4 hours ago, EODCMC said:

For anyone following my post hoping to get a timeline cradle to grave. No change, as of today. I'm still in the 3rd phase Gathering Evidence "dust", requested documents overdue.

You and King Tut, right, gathering dust?

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In brief, my FDC has two components, Obstructive Sleep Apnea and Sinusitus. The OSA is clearly service connected and the current diagnosis is clear and worsening. Both DXs active duty and recent recommend CPAP.

After further research, including information I've learned here, I feel the second component of Sinusitis may be short of compelling. The SC part is clear but the current DX may not.

My question for the more experienced advocates here is; if they come to the same conclusion as I, will the VA break out and provide a decision on the OSA or will they wait until they come to a conclusion on both before responding. Additionally, can they refuse both because only one component falls short?

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There was a slight change today. Still "Gathering Evidence" since May 14, but they drop the overdue part. Also, in the Documents Needed-From-You section, there is something where there never was anything prior: 

 
  • Request 1

    Due Date: Not Available Status:  No Longer Needed

    Request for folder scan/upload

     

    Im not sure what this means.

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Help Please. I received the attached notification for information request concerning my sleep apnea claim. They are requesting proof of combat. I never gave any indication of combat and I didn't know combat was required for a SC SA claim. Can anyone help me with my response and how I do it?

E-Benefits Doc Request 8-3-16.pdf

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