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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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thedeuce222

C&P Bad? Sleep apnea secondary to PTSD

Question

    Looking to get some advice on my current situation and the outcome of my C&P exam. I was seeking to do this claim by myself for sleep apnea as secondary to ptsd but it appears I will most likely fall short. Finding individuals who are well versed on the inner workings of the VA and claim process has been relatively hard for me.  Im not sure where to go or what to do so I will give yall a brief rundown to help clarify my situtation.

   I was medically discharged on June 6 2014 for Chronic PTSD with depressed mood and sleep impairment as well as TBI. I was put on TDRL until 02/23/2016 when I was approved for PDRL. In addition to PDRL I was approved and appointed a caregiver through the VA's program. The VA rated me at 50% for PTSD and 40% for TBI along with 20% for back and 10% for degenerative joint disease. Prior to discharge I was put through the ringer with therapists, psych doctors, two ptsd rehab programs. One rehab program lasted a couple months and the other was a couple weeks. Everytime I would bring up any sleep issues I had they were quick to associate it with PTSD and throw more pills at me. Since discharge my nightmares have increased coupled with waking up choking nad gasping for air. According to my caregiver there has been numerous occassions where I will wake up screaming ripping shit off the walks and trying to low crawl out the door as im gasping. I usually have no recollection of the events until she informs me the next day but I do remember the nightmares. My memory seems to be getting worse and worse each day and I always brought it up to the VA as well as the social workers that call. I'm assuming this may be associated with sleep apnea since i stop breathing 15 times an hour. Finally after a meeting with the caregivers nurses and my assigned caregiver they determined that I most likely suffer from sleep apnea and put me in for a referall. Dec 2016 I was put in for a sleep study and by january the study was done stating I had moderate sleep apnea and needed a cpap machine.

Moving forward I put my claim in after reading several articles, reports and forums posts from various other vets regarding sleep apnea as secondary to PTSD. At the time of my discharge I was not given any medical records and everything seemed to happen super quick. Ive since requested my medical records using the freedom of information act but it appears that takes 6-12 months to get anything back from.I attched my DBQ from the MEB process, sleep apnea findings and report, letter from my caregiver whom I knew prior to exiting the service and would witness the episodes as well as other documents supporting the sleep impaiment claim. The C&P reviewer kept harping on the fact that there was nothing in my file the stated I snored etc so it couldnt be service connected. She agreed after I mentioned there are various reputable reports done stating the link between the two and that one can aggravate the other. She agreed stating she had read some as well but then proceeded to state that PTSD does not cause sleep apnea. Seems like she was missing the whole point of my argument. As of May 28th I noticed my claim went to Pending Decision Approval with a completion date of 6/1-6/6. Im assuming this is expedited because of an incoming denial letter. Attached below is the DBQ pulled from my Blue Button. Your advice and input would be greatly appreciated even if its harsh criticism. Thank you!

Sleep Apnea
Disability Benefits Questionnaire
Name of patient/Veteran: XXXXXXXXXXXX
Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination
Request?
[X] Yes [ ] No
ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this
document:
[X] In-person examination
Evidence Review
---------------
Evidence reviewed (check all that apply):
[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS
1. Diagnosis
------------
Does the Veteran have or has he/she ever had sleep apnea?
[X] Yes [ ] No
[X] Obstructive
ICD code: g47.33 Date of diagnosis: 2017
2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
sleep
disorder condition (brief summary):
Veteran was diagnosed with obstructive sleep apnea in 2017. His sleep
study on 1/12/2017 showed mild obstructive sleep apnea with AHI of 14.4
events per hour.
He now has CPAP machine. He has some difficulty keeping the mask on
all
night. He reports that he has restorative sleep when the mask stays
on.
b. Is continuous medication required for control of a sleep disorder
condition?
[ ] Yes [X] No
c. Does the Veteran require the use of a breathing assistance device?
[ ] Yes [X] No
d. Does the Veteran require the use of a continuous positive airway pressure
(CPAP) machine?
[X] Yes [ ] No
3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms attributable
to sleep apnea?
[ ] Yes [X] No
4. Other pertinent physical findings, complications, conditions, signs,
symptoms and scars
-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to any conditions
listed in the Diagnosis Section above?
[ ] Yes [X] No
b. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
Section above?
[ ] Yes [X] No
c. Comments, if any:
No response provided.
5. Diagnostic testing
---------------------
a. Has a sleep study been performed?
[X] Yes [ ] No
If yes, does the Veteran have documented sleep disorder breathing?
[X] Yes [ ] No
Date of sleep study: 1/12/2017
Facility where sleep study performed, if known: Northport VAMC
Results:
mild obstructive sleep apnea
with AHI of 14.4 events per hour
b. Are there any other significant diagnostic test findings and/or results?
[ ] Yes [X] No
6. Functional impact
--------------------
Does the Veteran's sleep apnea impact his or her ability to work?
[X] Yes [ ] No
If yes, describe impact of the Veteran's sleep apnea, providing one
or
more examples:
he is tired during the day
7. Remarks, if any:
-------------------
MEDICAL OPINION REQUESTED: Direct service connection
Does the Veteran have a diagnosis of (a) SLEEP APNEA that is at least as
likely as not (50 percent or greater probability) incurred in or caused by
(the) SC PTSD during service?
It is less likely than not that the veteran's obstructive sleep apnea is
proximately due to PTSD. Obstructive sleep apnea is characterized by
recurrent
collapse of the upper airway during sleep resulting in substantially reduced
flow of air into the lungs despite ongoing breathing efforts. In this
veteran's
case, this is occurring an average of 14.4 times per hour. There is not
sufficient medical evidence to show that PTSD can cause collapse of the upper
airway.

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Case was closed today and it looks like I was denied. Where do I go from here? Should I seek legal representation from an attorney or a VSO as well as get an IMO letter?

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Wait for the Denial Letter, then give it a couple good reads to see what you're up against. A Denial isn't guaranteed but likely. Does it appear that the Rater reviewed all of what you thought was supporting medical evidence? Posting a redacted copy of the Denial Letter would help us greatly.

SA Secondary to PTSD is an uphill battle. If you haven't already done so, review BVA Decisions for 15, 16 and 17 for SA Secondary to PTSD Awards. How does your Secondary Claim stack-up?

You're already 80%, so a 50% SA would get you to 90% CSC, a relatively low Retro $$ payday currently. It could be difficult to find a "For Fee" VA Lawyer to take on your case. 20% of a possible $10K Award might not be enough.

You may or may not be able to rep yourself at the DRO Hearing Level Appeal but with the BVA, that's a different matter, VSO or a VA lawyer is a wise move. A VA Lawyer would want and advise you to skip the DRO and request the BVA immediately.

Either way, you're looking at a possible 4 to 6 yr wait Decision-wise, barring any BVA Remands.

Semper Fi

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I agree with Gastone.   You have to wait for the letter, and see what kind of denial VA cooked up  

This is likely a bogus denial and you need to appeal.  Berta may suggest you ask VA to cue themselves.,  But, in any case you need to file a NOD within a year of the alleged denial.    Here is why.

1.  Its correct that your exam is "negative evidence", where your doc stated that PTSD did not cause your sleep apnea.  However, there are at least 3 forms of service connection:  Direct, secondary, and presumptive.   VA must consider you for all these, its not your responsibility to sort out presumptives.   You can be service connected in any one of the three, you dont need all 3.    In your case, UNLESS you were diagnosed with sleep apnea prior to service, and you got it when you got out, then the "presumptive" here is you got it from service.  Its simple:  You are healthy when you went in the service..sick when you got out, so the military caused your sickness.  This is your case, assuming you have documentation of same.  

2.  There is no shortcut, you must get your medical records including your SMR's and see for yourself what you were diagnosed with prior to service and after service.  

3.  Its entirely possible, or even likely, that your SMR contain the evidence you need for your claim to succeed, as I posted above.  If so, there are 2 possibilities:

   a.  The VA had your records but top sheeted you and did not read them.  You simply need to appeal, and clearly cite your evidence.  Unfortuantely, the Veteran bears the burdens created when VA makes mistakes like not reading your file.  

   b.  The VA did not have all your records, there were some missing SMR's such as your in service diagnosis of sleep apnea or sleep disorders.  In this case you file a requrst to reopen under 38 cfr 3.156 c, and you should get benefits back to when you started the cpap machine.  

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Also, along with what Gastone said a rating for sleep apnea, along with your current ratings will get you to 90 percent but not to 100.  

The difference between a 90 percent rating and 100 percent is much more than one would think.  

A 90 percent for a single vet is 1748, while 100 percent is almost double that at 2915.  There are also many other benefits that 100 percent P and T vets get that others dont also.  

Persuing a claim for sleep apnea MAY not be your best route here.  For example, VA may have lowballed you on your ptsd rating, and you may be better off to get an increase elsewhere.  A big issue is, "Are you presently working?"

If you are unable to work then you should be able to get to either 100 percent or TDIU which amounts to the same thing, pretty much.  

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Just got home and read your replies. Firstly, I want to thank you all for your responses especially @broncovet and @Gastone for reaching out to me personally. I appreciate you taking the timeout of your day to address my question. Prior to filing I contacted a handful of VSO's in my area and they either responded with a rushed message that had nothing to do with my concerns or didn't return phone calls or emails. I have reached out to our Veteran Resource Center at my school in hopes of additional guidance coupled with your advice. I'm currently enrolled in college and finishing my degree which has been a struggle due to a piss poor memory. Ever since I got the cpap machine it has seem to be a bit better which I don't understand..

@broncovet I never thought about looking to see if i was low balled for any other claims. Common sense says I should have but I've been so damn busy with school and trying to stay afloat while The managing this shit lol. The fear of not being able to work haunts me to be honest and I would lose my mind if I wasn't able to. Once the denial letter arrives I will post a redacted copy of it for ya'll. It just seems odd that my claim was opened and closed within 20 days. Honestly felt like I had a sound argument but apparently I did not. I've submitted the documentation needed a few months ago to VARMC to get my medical records and they told me it can take anywhere from 6 months to a year to get them which seems bogus. I have years of therapy and treatment sitting in those files and I know they would have to be of some use in regards to my claim. Again, thank you for your advice. It really means a lot to me!

Claim Submitted: 05/10/2017

C&P: 05/23/2017

Claim Closed: 05/30/2017

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