Mark D Worthen PsyD

Maybe my answer  isn't necessary since Mark seems to have covered all the bases,,, but anyway here goes.
1. The va should have and in all likely hood allowed the contractor to review all of you rmedical records. The contractor should never be asking for copies from you, however, if it were my claim I would abide by the request. 
2. The contractor will be required to state that he/she has reviewed all the available medical records.
3. By you providing the information, you have saved the examiner from spending time looking for the documents in the medical file.
4. When ever I submit a claim, I submit all the medical records that pertain to the claim. This saves the VA from having to ask for them from the VA medical center or from private providers.  It makes the claim move a little faster, and this insures that you have provided all the available evidence for a review, even when they delay the claim asking for more evidence you can go into VA.gov and by checking a box tell them there are no more records and to make a decision on the claim.
5. And whenever I go to any C/P exam I provide all the medical records to the examiner in the form of a book, and tell them the records are for their review and that they should destroy them when they are done. I never put anything on them except my name so that my personal information is not compromised 
BTW you can submit the records directly to the va by going on line and logging into VA.gov, find the claim information and submit the records for the claim.  Or you can do like I do, spend $7.50 on average and send the records by mail with a return receipt request. I do all things by mail because I don't trust computers ( over 40 years expierence with comnputers) and I like receiving the return receipt as assurance the VA received the documents.  Ironically, sometimes I get the return certified  receipt days after the documents were received.
Best of luck with your claim

Good reply MarkD.  You know your stuff.

C-File Review
Question #3 on the VBA Contract Exam Audit Criteria is: “If required, does the report indicate a c-file (e-file) review was completed?”
I don’t know as much about other claim types, but for initial PTSD and other mental disorder claims, a c-file review is required. 
For review exams, the examiner needs to review any new, relevant documents since the previous claim decision. They can review the entire c-file if they wish, but it’s not required.
Make sure VBA has your medical records from private doctors & clinics
As a previous member said, the MDE contract companies connect electronically with VBA and VHA - that's how they obtain relevant records.
If you saw a non-VA doctor, i.e., not at a VA facility and not through VA community care, then (as most of you know) you should make sure VBA adds those records to your c-file. You can: 
(1) ask VBA to obtain the records (after you grant consent in writing - use VA FORM 21-4142)
(2) ask the doctor’s office or clinic to mail VBA the records; or 
(3) obtain the records yourself and upload or mail them to VBA. 
Upload Records to VA
https://www.va.gov/disability/upload-supporting-evidence/
Certified Mail + Return Receipt
Whenever you mail records to VBA, make sure to send them in a way that gives you proof that VBA received them. I prefer US Postal Service Certified Mail, Return Receipt because they have to sign for it, and people tend to treat Certified Mail more seriously. More info on the USPS website:
USPS: Return Receipt - The Basics USPS: Proof of Mailing & Delivery Mailing address - to send medical records to be added to your C-File:
Department of Veterans Affairs
Evidence Intake Center
PO BOX 4444
JANESVILLE WI 53547-4444
Exam Audit Criteria
The Contract Exam Audit Criteria can be found on pages 25-26 in this VAOIG publication:
Off. of Audits and Evaluations, Veterans Benefits Admin., Dep’t Veterans Affs., Contract Medical Exam Program Limitations Put Veterans at Risk for Inaccurate Claims Decisions, VA OIG 21-01237-127 (June 8, 2022). Community Provider Advice
The VA explains how community providers can submit their medical records to VA:
Community providers: How to submit medical documentation to VA [VAntage Point blog post, 8 Oct 2020]

Well a little happy to see that they Are looking at this private contractor stuff now.
I will still tell any veteran that has problems with these places to complaint to Whitehouse hotline.
The complaint is log an if they keep getting them things will change.
First the contract exam wasn't to be used on all claims it was for veterans who did live near a VA hospital.
Because they were complaining about the travel. Look it up.
Now these place are tell all veterans to travel 2 hr away for a exam.
That aint how it is to work.
But some feel disabled veterans need to find away to travel 2 hr away for a 30 min exam.
Not possible for most. I don't care if I can travel 2 hr I am not and told the VA just that.
I have VA hospital 15 min away that has treated me for over 20 years I had over 15 comp exam done at the hospital.
The hospital has a comp and pension department still so why does there contract doctor do the traveling if need be.
Pay them the milage. It ain't helping me.
Well my claims was send to the VA hospital took months but I wasn't doing it.
Now before everyone attack me.  I am.not saying refuse a exam. But you can refuse to travel.
I am a 25 year protected tdiu pt rating.
So yes I press buttons 

I just posted about how i won my OSA secondary to PTSD for aggravation (my CFile request after this will provide more light on exactly what the rater decided but that will take awhile to get).
But in short because my nightmares from PTSD cause me to rip off my mask and not have great sleep generally this exacerbates the OSA symptoms and effects.  I had two psych exams and two (NP & MD) records reviews to wade through to get it along with two IMO's from a MD and psychologist.

That looks like very sound advice, dajoker12.
I have not yet seen scientific evidence that PTSD causes obstructive sleep apnea (I have read all the articles you posted), but:
(1) scientific evidence and legal evidence are not the same; and
(2) it could be that there is such a causal relationship but research has simply not identified it yet. 
There is also the question of aggravation, as you (dajoker12) discuss in your post. I think aggravation is more likely than causation. There has not been much research on the aggravation question, but a sleep medicine physician might (and I know some do) conclude that there can be such a relationship, i.e., that PTSD aggravates (exacerbates) Obstructive Sleep Apnea.
I wrote an article (blog post) a while back about mental disorders that are secondary to service-connected medical disorders and I emphasized the importance of specifically asking VBA to consider secondary service connection, and I offered some suggested language for veterans service officers. In my experience, sometimes VBA did not ask a C&P examiner to consider the aggravation question and the examiner did not think of it either (even though they should). Consequently, veterans who might have received disability benefits for a secondary condition did not. That's why I believe it's important to clearly and specifically ask VBA to consider secondary service connection when you file the claim.
I adjusted the wording of suggested language for veterans service officers to consider to fit the current topic, i.e., the PTSD ==> Obstructive Sleep Apnea relationship. 
This is a claim for obstructive sleep apnea that is proximately due to, or aggravated by, the veteran's service-connected posttraumatic stress disorder (PTSD). Please note that the veteran asks the Veteran Benefits Administration to:
1) First consider if the veteran's obstructive sleep apnea is proximately due to, or a result of, the veteran's service-connected PTSD.
2) If not, the veteran then asks VBA to consider if the veteran's service-connected PTSD has aggravated (increased the severity of) the veteran's obstructive sleep apnea beyond its normal course or progression. Allen v. Brown, 7 Vet. App. 439 (1995); Aggravation of nonservice-connected disabilities, 38 C.F.R. § 3.310(b).

Note that you should ask a veterans service officer, VA-accredited claims agent, or veterans law attorney about how to phrase questions since they know more about the topic than I do. What I wrote above is simply a suggestion to consider. 
~ Mark

That looks like very sound advice, dajoker12.
I have not yet seen scientific evidence that PTSD causes obstructive sleep apnea (I have read all the articles you posted), but:
(1) scientific evidence and legal evidence are not the same; and
(2) it could be that there is such a causal relationship but research has simply not identified it yet. 
There is also the question of aggravation, as you (dajoker12) discuss in your post. I think aggravation is more likely than causation. There has not been much research on the aggravation question, but a sleep medicine physician might (and I know some do) conclude that there can be such a relationship, i.e., that PTSD aggravates (exacerbates) Obstructive Sleep Apnea.
I wrote an article (blog post) a while back about mental disorders that are secondary to service-connected medical disorders and I emphasized the importance of specifically asking VBA to consider secondary service connection, and I offered some suggested language for veterans service officers. In my experience, sometimes VBA did not ask a C&P examiner to consider the aggravation question and the examiner did not think of it either (even though they should). Consequently, veterans who might have received disability benefits for a secondary condition did not. That's why I believe it's important to clearly and specifically ask VBA to consider secondary service connection when you file the claim.
I adjusted the wording of suggested language for veterans service officers to consider to fit the current topic, i.e., the PTSD ==> Obstructive Sleep Apnea relationship. 
This is a claim for obstructive sleep apnea that is proximately due to, or aggravated by, the veteran's service-connected posttraumatic stress disorder (PTSD). Please note that the veteran asks the Veteran Benefits Administration to:
1) First consider if the veteran's obstructive sleep apnea is proximately due to, or a result of, the veteran's service-connected PTSD.
2) If not, the veteran then asks VBA to consider if the veteran's service-connected PTSD has aggravated (increased the severity of) the veteran's obstructive sleep apnea beyond its normal course or progression. Allen v. Brown, 7 Vet. App. 439 (1995); Aggravation of nonservice-connected disabilities, 38 C.F.R. § 3.310(b).

Note that you should ask a veterans service officer, VA-accredited claims agent, or veterans law attorney about how to phrase questions since they know more about the topic than I do. What I wrote above is simply a suggestion to consider. 
~ Mark

Moderator, you might want to Pin this somewhere, as this seems to be a recurring trend. 
I have given out this information to others, but I will post it here so that others can find it rather than searching through the forum.
First and foremost, claiming and getting sleep apnea secondary to PTSD or Mental disorder is not easy. I have personally seen more lost than won, however, it can be obtained and I myself have personally received it. 
If you had sleep apnea diagnosed while in active duty, it is usually a slam dunk........for the rest of those trying to get it, it could require a lot of work.  I suggest trying to get it both direct and secondary service connected.
It is easier to get sleep apnea as a direct service connection obviously, however, most Veterans do not get it diagnosed while in service. Best way to get that resolved is through buddy statements. I suggest getting 3-4 (I personally had 7-8) or more. Do not have them only say that they saw you snoring.......that is great and all, but that is not a symptom of sleep apnea.......it is incidental. They would need to say that they saw you gasping for air, choking, etc. Preferably roommates. If you were deployed, it would be easy to have many people saying that they saw/heard this as you would have more than likely been in an open bay setting at some point in time. You can also have your spouse write up a statement. This all needs to be during active duty periods of times and dates need to be included.  M21-1 reference III.iii.2.E.2.b "Types of Evidence VA May Use To Supplement or as a Substitute for STRs" allows for buddy statements to act as STRs for medical evidence.........if they are certified "buddy" statements or affidavits.............having them written on VA Form 21-4138 solves this issue as it has the appropriate verbiage written near the bottom. Under M21-1 reference III.iii.1.B.7.a and 38 CFR 3.200, it meets the certification criteria..........problem solved. From my experience, getting all of the buddy statements needed can take longer than you originally anticipate....plan ahead.
Now, for secondary criteria.
Have you ever been diagnosed with alcohol abuse (it is frequently written as "ETOH")? If so, has it been attributed to your mental disorder or did it exist prior to that and is it considered willful? If you have been diagnosed with alcohol abuse, and it is attributable to your mental disorder,  guess what, alcohol consumption is attributable to sleep apnea. 
would suggest that you start doing your own academic research. You might be able to locate peer-reviewed academic journal articles (those are the types of articles that you want to submit) through https://www.researchgate.net/. If not, another alternative is using a college database to search academic journals through. Ah, but you need to be a college student to use the database to search academic journals through. One might make an argument that you could register for classes at a local community college (you can even register online nowadays without even stepping foot on campus) and even register for "late start" classes, and have access to the aforementioned database immediately (hint hint, look in the academic journal Chest); one could easily find within a 60 minute search at least 5 appropriate and recent journal articles clearly establishing a link between specific mental disorders and sleep apnea; there is a clear link between PTSD, anxiety disorders, depression, and especially schizophrenia. One might make an argument that you could simply then disenroll from the classes that you enrolled in by the date specified in order to get a full refund, thereby being charged nothing. Save the academic journal articles as pdf files, and create a work cited page (bibliography) for them in APA format (google is your friend.)
You now have a choice...........
Submit your claim with the buddy statements, mental health notes from a private provider, and evidence that you have and go with either a VA exam or vendor exam (whichever is given) or you can get an IME and IMO from private providers. If go the latter route, I would schedule one with a sleep specialist, why, because sleep apnea is their specialty. Pulmonologists also fall within this scope as well, though I suspect that you will have better luck finding a sleep specialist believing there to be a link between mental disorders and sleep apnea. You will get a Sleep Apnea DBQ and an IMO. Make sure that you have your C - File first as an examiner is required to have access to it and state that they have seen it on the DBQ for it to acceptable proof to the VA.
I would also get one from your psychologists/psychiatrist (Make sure that they are a psychiatrist or a psychologist.....if a psychologist, they need to be PsyD or Ph.D., or under the observation of a Ph.D.). 
Make sure before you solicit those medical opinions, that you acquire "buddy statements" from 3-4 (or even more) people with whom you served. Roommates would be best, or people who slept in close proximity to you.........again, this is only if you believe that sleep apnea developed while you were in Active Duty service. Make sure that they are written on VA Form 21-4138. Make sure they say that they witnessed clear symptoms of sleep apnea i.e. gasping for air, choking sounds, moments where they visibly or auditorily could determine that you ceased breathing etc.
Remember, you will want the sleep specialist and the psych professional to have your academic journal articles and buddy statements.
Once you have all of them, solicit your medical opinions from the two aforementioned providers.
Ideally, you would love for the IMOs to say that they believe that you could be both direct service connected for sleep apnea or secondary due to mental disorder, possibly even say that the mental disorder and sleep apnea aggravate one another (which there is medical evidence to support.)
If you opt to go the route of getting the private IMO and IME, you will obviously submit those with your claim, and all medical records from private providers pertinent to sleep apnea and your mental health treatment, buddy statements, academic journal articles, and a nicely written statement written by yourself on a VA Form 21-4138 talking about the issue at hand and summarizing everything concisely. Mention everything that you are providing that you wont to be considered for the claim, and when the issue first manifested. 

I appreciate all the feedback!  Got my appointment set to see a primary care dr so i can start feeling better. I'll worry about the the disability later. Thanks again for the help. I'll try to keep everyone updated. 

Wow, this is a great thread. Nothing like the voices of experience to get a good sense of what's available in terms of an IMO/IME/Nexus Opinion. 
I don't know any of the physicians personally, but similar to what y'all have written, I have been impressed with Drs. Bash and Anise with regard to their breadth and depth of knowledge and ability to communicate effectively in writing. I have also enjoyed listening to Dr. Bash on the HadIt radio hour. 
I don't know as much about Dr. Ellis but I have read numerous positive reports here and on other forums. I have never read anything negative. 
Setting one's fees as an expert witness (which is how the federal courts refer to doctors like Ellis, Bash, & Anise) is interesting. I suspect a lot of it has to do with the stage of one's career, overall financial situation, and staff resources. If you're still in the midst of your career and you've got kids in college or grad/med school, then you should run your practice like a good small business and make some money. If you're approaching retirement and are financially secure then you might charge less as a community service. 
I am guessing, but Dr. Bash is probably following sound business principles for consultants of all kinds: If you have done good work, built up a solid reputation, and are swamped with referrals, you should raise your rates until you have a manageable number of referrals. Basic supply and demand in a free market economy (capitalism). 
Some people complain about such professionals, saying they are "too expensive". My usual response to such judgments is something like: "Well, if you want an economic system based on the principle, from each according to his ability, to each according to his needs, such a system has been proposed."

My guess would be that yours is not a difficult claim to adjudicate so they were able to get it (almost) finished faster than expected. Based on the info you shared, there's no way they'll reduce your rating. 
Regarding the term "moderate to severe", it's important to put it in perspective. 90% to 95% of the country is not suffering from two serious debilitating mental disorders at the same time.
Here's Dr. Mark's off-the-cuff, unscientific, for-illustrative-purposes only, 11-point "severity scale" that I just typed out as a "thought experiment" to give you a sense of where "moderate to severe" fits on the continuum.
Rating - Description
0 - No symptoms, no history of disorder.
2 - Mild symptoms but frequency, intensity, & duration insufficient for DSM-5 diagnosis of disorder.
4 - Mild symptoms that satisfy DSM-5 diagnosis for the disorder. Experiencing symptoms more often and with more intensity - harder for him to say "it's just a bad week" or similar. Wife said he seems dejected, less energy, motivation flags. He'll bounce back for days or even a week or two but that's becoming less often. Calling in sick to work more often. Supervisor said management has commented on his declined productivity.
6 - Moderate symptoms that cause noticeable and significant social and occupational impairment; frequent distress, dispirited; interpersonal relationships strained, even with her children; school functioning has clearly declined. Got a "C" in one course and two Incomplete grades. Decided to hold off on continuing college coursework, even though she is close to earning all credits for bachelor's degree.
8 - Moderate to Severe - frequent painful symptoms much of the time despite assiduously seeking treatment and following his doctors' advice; significant social & occupational dysfunction; probably will need to seek medical leave, reduce work hours, or may end up not being able to work. Psychiatrist has discussed options for "treatment-resistant depression", e.g., ECT (electroconvulsive therapy); the new ketamine-like medication; Lithium; Abilify; etc.; psychologist recommended VA's 6-week residential treatment program for PTSD in Sheridan, WY.
10 - Severe - very frequent, soul-crushing painful symptoms most of the time despite assiduously seeking treatment and following his doctors' advice; substantial suffering is obvious; significant social impairment, and no longer able to work, at least for the next several months or longer.
[The above is not an official, unofficial, actual, or real mental health scale. It's just a way to put symptom severity and functional impairment in perspective for illustrative purposes only.]

Just to make sure I understand correctly, you are currently receiving disability compensation for PTSD at the 70% level. Is that correct? 
If so, I am wondering if the letter asking you for more details on your stressors might be a mistake. Verifying stressors is something that happens before a veteran is service connected for PTSD. Once you are service connected why would they go back to the service connection question?
It's like them saying, "You are service connected for PTSD, so we want to confirm that you have PTSD." As Spock would say, "that does not compute." 

Congratulations SwiftSig! I admire your hard work, willingness to ask for help (which takes guts in my book), and discipline to do your part, like organizing everything per your service officer's suggestion. Not an easy task when you are, after all, having to cope with several disabilities and the added stress of the arduous claims process. 
And it is heartening to hear that 83% of the VA examiners you saw did their homework and treated you with the respect you deserve. Of course, 83% means there's room for improvement, but really that's not too bad for a huge bureaucracy like the VA, and considering that being a C&P examiner is one of the more difficult jobs at VHA. 
~ Mark
P.S. Lest anyone think I am an apologist for the VA, you should know (and many of you already know) that I am not shy about criticizing the Department of Veterans Affairs. Case in point is a 97-page "white paper", Psych C&P Exams Are Unfair to Veterans, which I submitted to the federal Advisory Committee on Disability Compensation and posted online for anyone to read (or scan, it is a bit dense ;-). 

Excellent points broncovet & JKWilliamsSr. 
I've studied mental health C&P exam issues intensively for 8 years, and I continue to learn important details by reading this forum. Y'all are awesome. 👍

This isn't a crucial point as I'm sure Dr. Valette is up to date on VBA regulations and policies. But just as an FYI for everyone, see this part of the M21-1:
M21-1 Adjudicative Procedures Manual, III.iv.3.D.2.c. Telehealth and Telemental Health Examinations 
...
A mental health DBQ submitted by a private provider and based on a telephone interview with a Veteran is not acceptable or actionable for rating purposes under any circumstances. VHA has determined that, in order to assess a Veteran’s mental health via telemental protocol, examiners must be able to see clearly, and fully appreciate all non-verbal cues, mannerisms, and manifestations displayed by the Veteran in a manner on par with an in-person examination.

I personally believe that a letter from your spouse or significant other is one of the most important pieces of evidence you can have inside your claim.  I believe that many examiners and raters do not consider them important and tend to dismiss them and give them no credibility.   However, on appeal it is something that seems to be a deciding factor in overturning  a poor rating decisions by the BVA. 
There are two important pieces to this letter that I believe is critical.
1.  Your spouse should only list symptoms they see.  They should never state in the letter a diagnosis.  If your letter has a diagnosis in it and your spouse is not qualified to render a diagnosis the rater will immediately ignore it.
2.  Your spouse should state how your disabilities impact your day to day living.  What things you could do in the past but cannot do now because of your disabilities.  No one is more qualified to stated how your daily life is impacted than your spouse.
I think anything else in the letter would be overkill but that is just one man's opinion. 

Buck, your DX is really  no one else's business.  As far as feeling less of a man please do not.  A lot of people who have not been to combat have PTSD, I am one of them.  I worked in the civilian world for over 35 years and I have seen some of the people who might judge you.  You would be surprised to see what I have seen in these people.  Their marriages are a wreck, some of them are alcoholics, and others have anxiety the same as we do.

You're not less of a man for having PTSD. You're more of a man for admitting your problems and facing them. No one else has walked in your shoes. No reason to feel guilt anymore Buck. Forget everyone else's opinions. You have no need for their approval.

As a C&P examiner, I took letters from spouses seriously. And, if a vet was accompanied by his or her spouse and asked me to speak with him or her, I would always do so as it often helped me to better understand the frequency, intensity, and duration of mental disorder symptoms and associated functional impairment. 
Unfortunately, VA does not require examiners to interview family members, and there are not any specific requirements for examiners about how to regard letters from family members. 
Nonetheless, letters from "lay witnesses" could help, even help a lot, and they're unlikely to hurt a veteran's claim.
Veterans law attorney Chris Attig recommends submitting lay witness statements as a "Declaration", which he explains in a blog post. Note that Mr. Attig calls it a "sworn declaration" whereas other legal websites, and the relevant U.S. Code, call it either an "unsworn declaration" or simply a "declaration". In my experience reading Mr. Attig's blog over the years, he offers well-written, important, accurate information for veterans and their representatives. I don't know Chris Attig personally, but I respect him and value his opinion.
Although they don't mention using a Declaration, the law firm Chisholm, Chisholm, & Kilpatrick has a good article, accompanied by a question & answer video titled, How to Use Lay Evidence for VA Disability Claims.
There's an easy-to-understand, informative article on the Martindale (legal publisher) website that discusses Declarations in general,  i.e, the article is not specific to veterans law: When to Swear and When to Declare: Affidavit or Declaration? by Matthew J. Bakota (21 May 2012).
Finally, here is the statute itself: 28 U.S. Code § 1746 - Unsworn declarations under penalty of per­jury. I'm not an attorney, but it looks pretty straightforward. If it were me I would write exactly what the law specifies at the bottom of a family member's letter, and ask them to date and sign it:
Note this part: "... under penalty of perjury ...." Chris Attig offers important advice in the blog post I mentioned above:
I hope all your exams go well SwiftSig!
~ Mark

My guess would be that yours is not a difficult claim to adjudicate so they were able to get it (almost) finished faster than expected. Based on the info you shared, there's no way they'll reduce your rating. 
Regarding the term "moderate to severe", it's important to put it in perspective. 90% to 95% of the country is not suffering from two serious debilitating mental disorders at the same time.
Here's Dr. Mark's off-the-cuff, unscientific, for-illustrative-purposes only, 11-point "severity scale" that I just typed out as a "thought experiment" to give you a sense of where "moderate to severe" fits on the continuum.
Rating - Description
0 - No symptoms, no history of disorder.
2 - Mild symptoms but frequency, intensity, & duration insufficient for DSM-5 diagnosis of disorder.
4 - Mild symptoms that satisfy DSM-5 diagnosis for the disorder. Experiencing symptoms more often and with more intensity - harder for him to say "it's just a bad week" or similar. Wife said he seems dejected, less energy, motivation flags. He'll bounce back for days or even a week or two but that's becoming less often. Calling in sick to work more often. Supervisor said management has commented on his declined productivity.
6 - Moderate symptoms that cause noticeable and significant social and occupational impairment; frequent distress, dispirited; interpersonal relationships strained, even with her children; school functioning has clearly declined. Got a "C" in one course and two Incomplete grades. Decided to hold off on continuing college coursework, even though she is close to earning all credits for bachelor's degree.
8 - Moderate to Severe - frequent painful symptoms much of the time despite assiduously seeking treatment and following his doctors' advice; significant social & occupational dysfunction; probably will need to seek medical leave, reduce work hours, or may end up not being able to work. Psychiatrist has discussed options for "treatment-resistant depression", e.g., ECT (electroconvulsive therapy); the new ketamine-like medication; Lithium; Abilify; etc.; psychologist recommended VA's 6-week residential treatment program for PTSD in Sheridan, WY.
10 - Severe - very frequent, soul-crushing painful symptoms most of the time despite assiduously seeking treatment and following his doctors' advice; substantial suffering is obvious; significant social impairment, and no longer able to work, at least for the next several months or longer.
[The above is not an official, unofficial, actual, or real mental health scale. It's just a way to put symptom severity and functional impairment in perspective for illustrative purposes only.]

In addition to the excellent advice you've received from your fellow vets, I'll briefly share from an examiner's perspective.
I learned from my friends who are veterans and from the many veterans I evaluated over the years that the "rules of the game" change dramatically when services members leave the military and enter the world of being a veteran.
In the military, seeing the doc for anything that's serious or chronic will likely hurt your career and you'll go from "Awesome member of the team" to "Potential liability". 
Then, when you enter the world of being a veteran all of a sudden everyone is exclaims, "What?! You haven't sought treatment? You gotta do that man."  I don't mean in any way to discount the advice you've received here--I totally agree with it. I'm simply highlighting the stark contrast between life in the military vs. life as a veteran. 
My main point is that decent C&P examiners know that there are many possible reasons why a veteran hasn't sought treatment before. 
When and if it seems appropriate (trust your gut) tell your examiners in a brief, matter-of-fact way (like you did here) why you put off treatment for so long. Don't belabor the point. 
Finally, as others have said, when you go for treatment appointments, try to put your disability claim out of your head. Ask yourself, "If I didn't have a pending claim, what would I say? How would I act?"
I've had severe allergies since I was a teenager and they're awful. People who don't have them really don't understand (unless they're medical folks.) But over the years my doctors have found treatments that work for me and now the allergies are a nuisance, but tolerable. Allergies are just one of the ailments you're dealing with, but my point is that treatment is often quite helpful.
All the best,
Mark

As a C&P examiner, I took letters from spouses seriously. And, if a vet was accompanied by his or her spouse and asked me to speak with him or her, I would always do so as it often helped me to better understand the frequency, intensity, and duration of mental disorder symptoms and associated functional impairment. 
Unfortunately, VA does not require examiners to interview family members, and there are not any specific requirements for examiners about how to regard letters from family members. 
Nonetheless, letters from "lay witnesses" could help, even help a lot, and they're unlikely to hurt a veteran's claim.
Veterans law attorney Chris Attig recommends submitting lay witness statements as a "Declaration", which he explains in a blog post. Note that Mr. Attig calls it a "sworn declaration" whereas other legal websites, and the relevant U.S. Code, call it either an "unsworn declaration" or simply a "declaration". In my experience reading Mr. Attig's blog over the years, he offers well-written, important, accurate information for veterans and their representatives. I don't know Chris Attig personally, but I respect him and value his opinion.
Although they don't mention using a Declaration, the law firm Chisholm, Chisholm, & Kilpatrick has a good article, accompanied by a question & answer video titled, How to Use Lay Evidence for VA Disability Claims.
There's an easy-to-understand, informative article on the Martindale (legal publisher) website that discusses Declarations in general,  i.e, the article is not specific to veterans law: When to Swear and When to Declare: Affidavit or Declaration? by Matthew J. Bakota (21 May 2012).
Finally, here is the statute itself: 28 U.S. Code § 1746 - Unsworn declarations under penalty of per­jury. I'm not an attorney, but it looks pretty straightforward. If it were me I would write exactly what the law specifies at the bottom of a family member's letter, and ask them to date and sign it:
Note this part: "... under penalty of perjury ...." Chris Attig offers important advice in the blog post I mentioned above:
I hope all your exams go well SwiftSig!
~ Mark

In addition to the excellent advice you've received from your fellow vets, I'll briefly share from an examiner's perspective.
I learned from my friends who are veterans and from the many veterans I evaluated over the years that the "rules of the game" change dramatically when services members leave the military and enter the world of being a veteran.
In the military, seeing the doc for anything that's serious or chronic will likely hurt your career and you'll go from "Awesome member of the team" to "Potential liability". 
Then, when you enter the world of being a veteran all of a sudden everyone is exclaims, "What?! You haven't sought treatment? You gotta do that man."  I don't mean in any way to discount the advice you've received here--I totally agree with it. I'm simply highlighting the stark contrast between life in the military vs. life as a veteran. 
My main point is that decent C&P examiners know that there are many possible reasons why a veteran hasn't sought treatment before. 
When and if it seems appropriate (trust your gut) tell your examiners in a brief, matter-of-fact way (like you did here) why you put off treatment for so long. Don't belabor the point. 
Finally, as others have said, when you go for treatment appointments, try to put your disability claim out of your head. Ask yourself, "If I didn't have a pending claim, what would I say? How would I act?"
I've had severe allergies since I was a teenager and they're awful. People who don't have them really don't understand (unless they're medical folks.) But over the years my doctors have found treatments that work for me and now the allergies are a nuisance, but tolerable. Allergies are just one of the ailments you're dealing with, but my point is that treatment is often quite helpful.
All the best,
Mark

My guess would be that yours is not a difficult claim to adjudicate so they were able to get it (almost) finished faster than expected. Based on the info you shared, there's no way they'll reduce your rating. 
Regarding the term "moderate to severe", it's important to put it in perspective. 90% to 95% of the country is not suffering from two serious debilitating mental disorders at the same time.
Here's Dr. Mark's off-the-cuff, unscientific, for-illustrative-purposes only, 11-point "severity scale" that I just typed out as a "thought experiment" to give you a sense of where "moderate to severe" fits on the continuum.
Rating - Description
0 - No symptoms, no history of disorder.
2 - Mild symptoms but frequency, intensity, & duration insufficient for DSM-5 diagnosis of disorder.
4 - Mild symptoms that satisfy DSM-5 diagnosis for the disorder. Experiencing symptoms more often and with more intensity - harder for him to say "it's just a bad week" or similar. Wife said he seems dejected, less energy, motivation flags. He'll bounce back for days or even a week or two but that's becoming less often. Calling in sick to work more often. Supervisor said management has commented on his declined productivity.
6 - Moderate symptoms that cause noticeable and significant social and occupational impairment; frequent distress, dispirited; interpersonal relationships strained, even with her children; school functioning has clearly declined. Got a "C" in one course and two Incomplete grades. Decided to hold off on continuing college coursework, even though she is close to earning all credits for bachelor's degree.
8 - Moderate to Severe - frequent painful symptoms much of the time despite assiduously seeking treatment and following his doctors' advice; significant social & occupational dysfunction; probably will need to seek medical leave, reduce work hours, or may end up not being able to work. Psychiatrist has discussed options for "treatment-resistant depression", e.g., ECT (electroconvulsive therapy); the new ketamine-like medication; Lithium; Abilify; etc.; psychologist recommended VA's 6-week residential treatment program for PTSD in Sheridan, WY.
10 - Severe - very frequent, soul-crushing painful symptoms most of the time despite assiduously seeking treatment and following his doctors' advice; substantial suffering is obvious; significant social impairment, and no longer able to work, at least for the next several months or longer.
[The above is not an official, unofficial, actual, or real mental health scale. It's just a way to put symptom severity and functional impairment in perspective for illustrative purposes only.]

Go get treatment!  As for getting benefits it sounds like you need to get current treatment and then apply for benefits. So something that has helped my claims are lay statements from friends, family, and yourself!  Also when you apply go through your medical records and get the evidence they will need to see to service connect you. Your claim will go much faster if you have everything vquest stated.