Denied Mixed Sleep Apnea Claim

[Draw808]

Currently have moderate Mixed Sleep Apnea (Central and Obstructive).Got denied for Service connection for Sleep apnea. Submitted NOD requesting DRO and added 5 buddy letters (included a statement from an E-7) who witnessed my apnea episodes while I was in service between 2012-2013. Also included two in-service complaints of trouble staying asleep and snoring (just in case VA never received them). Just wondering what do you think of my odds are at service connecting and any suggestion as well is much appreciated.

TIMELINE:

Military Service between Dec 2009 to Dec 2013.

sleep complaint - Jul2012

sleep complaint - Aug2013

Separated Dec2013

Filed VA claim for sleep apnea Feb 2014

Diagnosed by VA with Mixed Sleep Apnea - May 2015 (couldn't afford a couple thousand dollar sleep study myself so I couldnt get it diagnosed earlier)

Denied Service connection Sep 2015

Filed NOD requesting DRO Sep2015

[Gastone]

A very few Vet's, claim that at one time (No idea of when), VA was very liberal in awarding SA Claims on a Direct SC Basis. I've heard just the opposite from long time SA Clinicians at my VMC, they've constantly told me that getting a Direct or even for that matter SA Secondary rating is and has always been very difficult.

So, don't feel like the "Lone Ranger," with your SA denial. What type of DRO did you request? Have you tried to get a SA DBQ completed by your VA Sleep Specialist, most Vets I've talked to, seem to have a very difficult time pinning the VA Sleep Dr's down when requesting The SA DBQ. Getting a SA DBQ from a VA or Private PCP doesn't carry the same weight as one from a SA Specialist.

You already have the MSA DX from the VA. For the cost of an office call, less than $200.00, you could see a Private Board Certified Neurologist that specializes in SA. No guarantee that this Dr will agree with a Service Etiology for your needed Nexus, but worth a try.

Clinician Notes from either your VA Sleep Dr or the Private Neurologist, backing up the Service Connection as "More Likely than Not or at least as likely as not," would go a long way towards Sealing the Deal on your Appeal. And who couldn't use an additional 50% SA SC? Definitely worth the time, effort and $200.00 to a Private DR.

How about posting a redacted copy of your C & P SA DBQ and the Denial letter?

Semper Fi

[FormerMember]

Draw808

I think it's time someone gives you the briefing on how this works. Since 2010, VBA has forbidden VHA doctors of all stripes from offering any nexus letters that associate any current disease/injury with any disease/ injury in service. It ain't gonna happen. This is why there is a market for private doctors charging for nexus letters. You can dodge this where a doctor at a VAMC is an employee of an associated college medical center that works at VA. Examples are at the Univ. Of Oregon/Portland VAMC or Seattle VAMC with the Univ. of Washington. If you have private medical, you would pay the copay to go see one of these SA specialists and get tested privately. At that point you may be able to ask them to opine on the likelihood of a service connection using unequivocal language. Many will do this and many will not. In any case, in order to be probative with VA, it would have to include the info that the SA specialist had also reviewed your service medical records in coming to any conclusion and good reasons why it is service related. Simply saying Johnny Vet's SA is most likely related to his service without a long list of reasons why isn't going to put you in the $ column. Having a DRO review without one of theses magic pieces of paper isn't going to improve your chances of winning, either.

Five buddy letters is neat as long as they only say that they served with you, supply a DD 214 that proves it and limit the statement that you snored a lot in the barracks. They cannot testify that you have SA. They aren't doctors.   It makes no difference if you have an E-7 or SSgt. Jesus H. Christ was your squad leader.  That doesn't make the buddy letter more probative. Testifying you snored a lot doesn't equal a diagnosis of SA or OSA. It only means you snored a lot.  That's why you lost. 

Best of luck, sir. 

[Draw808]

6 hours ago, Gastone said:

A very few Vet's, claim that at one time (No idea of when), VA was very liberal in awarding SA Claims on a Direct SC Basis. I've heard just the opposite from long time SA Clinicians at my VMC, they've constantly told me that getting a Direct or even for that matter SA Secondary rating is and has always been very difficult.

So, don't feel like the "Lone Ranger," with your SA denial. What type of DRO did you request? Have you tried to get a SA DBQ completed by your VA Sleep Specialist, most Vets I've talked to, seem to have a very difficult time pinning the VA Sleep Dr's down when requesting The SA DBQ. Getting a SA DBQ from a VA or Private PCP doesn't carry the same weight as one from a SA Specialist.

You already have the MSA DX from the VA. For the cost of an office call, less than $200.00, you could see a Private Board Certified Neurologist that specializes in SA. No guarantee that this Dr will agree with a Service Etiology for your needed Nexus, but worth a try.

Clinician Notes from either your VA Sleep Dr or the Private Neurologist, backing up the Service Connection as "More Likely than Not or at least as likely as not," would go a long way towards Sealing the Deal on your Appeal. And who couldn't use an additional 50% SA SC? Definitely worth the time, effort and $200.00 to a Private DR.

How about posting a redacted copy of your C & P SA DBQ and the Denial letter?

Semper Fi

Thanks for the advice, I'll definitely get a private medical opinion. My denial letter is basically denying my service because it wasn't diagnosed in-service. From what I see is the VA doctor didn't put a medical opinion in the DBQ and the rater closed my claim without one. Also what i remember from the phone call where he did my DBQ is he was saying it isnt because of weight gain since you're same weight since service and your neck size is normal. Seemed like he was trying to use the usually deniers for sleep apnea and couldn't find one. 

My in-service complaints reflect exactly what my sleep study showed if you minus out the stop breathing part. Should I wait until the VA get a medical opinion to get a private medical opinion so I can shut down their BS logic with reasoning? I also just request a DRO de novo review before I head towards appeal.

Edited May 9, 2016 by Draw808

[Draw808]

1 hour ago, asknod said:

Draw808

I think it's time someone gives you the briefing on how this works. Since 2010, VBA has forbidden VHA doctors of all stripes from offering any nexus letters that associate any current disease/injury with any disease/ injury in service. It ain't gonna happen. This is why there is a market for private doctors charging for nexus letters. You can dodge this where a doctor at a VAMC is an employee of an associated college medical center that works at VA. Examples are at the Univ. Of Oregon/Portland VAMC or Seattle VAMC with the Univ. of Washington. If you have private medical, you would pay the copay to go see one of these SA specialists and get tested privately. At that point you may be able to ask them to opine on the likelihood of a service connection using unequivocal language. Many will do this and many will not. In any case, in order to be probative with VA, it would have to include the info that the SA specialist had also reviewed your service medical records in coming to any conclusion and good reasons why it is service related. Simply saying Johnny Vet's SA is most likely related to his service without a long list of reasons why isn't going to put you in the $ column. Having a DRO review without one of theses magic pieces of paper isn't going to improve your chances of winning, either.

Five buddy letters is neat as long as they only say that they served with you, supply a DD 214 that proves it and limit the statement that you snored a lot in the barracks. They cannot testify that you have SA. They aren't doctors.   It makes no difference if you have an E-7 or SSgt. Jesus H. Christ was your squad leader.  That doesn't make the buddy letter more probative. Testifying you snored a lot doesn't equal a diagnosis of SA or OSA. It only means you snored a lot.  That's why you lost. 

Best of luck, sir. 

Thanks for the advice Ill make sure my doctor nexus opinion has a very good rational opinion. The five buddy letters were submitted after my denial. From my wife's PEB board they relied heavily off of buddy letters from E-5s and above so I was just assuming it will with the VA. Also the buddy letters did say I snored a lot but also went into detail on how I stopped breathing constantly in my sleep.

Edited May 9, 2016 by Draw808

[Gastone]

The DRO Review, can be quick, so you better have the "New & Material MEDICAL Evidence," in the VA's hot hands, yesterday.

You risk getting your recent Denial continued, without ever having a face to face, not good. Do you actually have any "NEW' Medical evidence that clearly shows a Nexus of your MSA to Active Duty? I don't think "Buddy Letters" will do the trick, and if they were in your C-File already, none of that evidence counts as N & M Evidence.

A misstep deciding on a DRO Review rather than a Hearing could make your next stop 4+ years down the road with the BVA. Choose wisely.

Semper Fi

[Draw808]

Thanks again Gastone! I'll get on that ASAP. Even though I wasn't Dx with SA until a year and a month after separate does the fact I filed for it within 3 months help at all?