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Sleep Apnea - Appeal or New Claim

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John Royal

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Greetings everyone! 

Seeking advice on how best to proceed with my Sleep Apnea Claim. I retired in 2011 after 21 1/2 years of Naval service and I am currently SC at 40%. I need advice on whether to appeal my Sleep Apnea Denial (VA letter dated 3/9/12) or to file a new claim, since the 1 year to appeal has come and gone. In July of 2012, I received Progress Notes (VISTA Electronic Medical Documentation) that stated a diagnosis of Sleep Apnea diagnosed while on Active Duty with a plan for Sleep Services Consult. I assume the Progress Notes that I have came from my SMR, which I located where it said I had Mild Obstructive Sleep Apnea and it is confirmed from the Sleep Study performed (referred by VA to Civilian Provider) on 1/7/2011. I just had another Sleep Study (referred by VA to Civilian Provider) in April of 2016 and the results are that I have Moderate Obstructive Sleep Apnea and need a CPAP (which the VA will issue - soon I hope, as I have been dealing the effects of OSA for years now). I used eBenefits to get myself to the 40% level and wanted advice on whether I should submit an Appeal or New Claim using eBenefits or via a DAV/American Legion etc. 

 

Very Respectfully,

John Royal "JR" (USN Chief Petty Officer, Retired)

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John Royal......it took me no time at all to,get a CPAP issued.  My sleep study was completed on Dec. 1st.  I called Neurology on Dec. 2nd and asked when I could get my CPAP......they said come in the next morning and get it!  You have to take the bull by the horns to make it turn faster......if you wait on them good luck it could easily take 30-45 days.  I have learned that to make things happen with the VAMC you have to stay right on top of them otherwise you fall into the system of waiting until they come around for you.

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  • HadIt.com Elder

I agree with WayneTx here!

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@Gastone - I have started an SA FDC on your EBenefits. I am filing as Direct SC and I have my SMR stating mild OSA, the original study confirming that and the most recent sleep study showing that it has progressed to moderate OSA and the need for a CPAP.

@Wayne TX - Thanks for information! I will call the VA today to see what they tell me. Does the RX have to come from my VA PCM or can it come directly from the Provider that the VA sent me to?

JR

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A call is all you should need to do to get your machine..  The last thing any VAMC wants to do is have someone die by lagging behind on getting out the equipment immediately. Terrible PR.  If the call does not work favorably in a few days then call your Patient Advocate and let them know what you need.  They will jump on it and find out what is holding up the request and resolve.  I have found being in the VA system since 2001 that you have to take charge and demand that your needs get fast and prompt attention.  The last thing any VA employee wants is the VAMC Director Head Honcho on their case.

 

Edited by Wayne TX
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All,

After a few phone calls to the Choice Program yesterday, I finally got additional visits with the civilian provider. I will be seeing them this morning to get the final paperwork to submit to my VA PCM so that I can get a prescription for the CPAP.

JR  

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  • HadIt.com Elder

Thats great John R

Our Health should always come first.

Here is just a suggestion from me and I found it to be very useful

After you have your claim and evidence all in order and statements and facts to prove your case/claim.

Have it neatly arranged  in a way that are Numbered or filed Alphabetically/  see Number 4. or please see exhibit  A  as to what you need them to read and concentrate there thoughts on  so to speak  ...in some grave areas you may want to hi-lite some of the paragraph's 

 And Always go over it a few times before you hit that send button or mail it off...I find this helps me catch things that I need to change up, and with the C&P Examiners and the raters  they tend to catch every little dingy thing that they can to deny a veteran and no matter what we think, so when a veteran has all his/her ducks in a row  its very hard for them to come up with a Denial

A well organized claim is better to submit than a jump around type claim that throws the rater's thinking off 

Think of it as you are the rater...Well this veteran has everything in order and I agree with him/her

''Award granted''

However its not easy by all means but every little bit helps.

...........Buck

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