Marine1342

Gastone: Thank you for the clarification on the lawyer. Just wasn't sure if that was something that was needed now or later. But if and when I need it, I'll look up the legal help on it. No sense in losing retro if not needed. The OSA Claim timeline wise, the Letter of Decision Notification letter (dated September 14, 2016) stated that my claim was for sleep apnea was denied. So I have 1 year from that date to either NOD or Request for Reconsideration (with or without new evidence). Posted prior was the reasoning for the denial, who the C&P Examiner was and their credentials (Nurse Practitioner), as well as the evidence I submitted (my nexus letter by Dr. Anaise). Page 4 and Page 5 of this thread has the information (files attached) as well as a bit more explanation. In regards to requesting and "Official Consideration", I need to get in touch with a VSO, the one I was working with left, and the one that was recommended hasn't returned communication. It was recommended on this thread that I should look for a doctor (preferably that is board certified sleep) to hopefully concur with the Dr. Anaise nexus letter and get a second nexus letter, in order to help support my claim. And this is where it gets a bit hazy for me, and maybe you (or others) can clarify. In order to do an "Official Reconsideration" what form is to be used for this? Having a bit of trouble locating a board certified doctor, so wondering if either 1 other nexus letter (Ellis Clinic maybe?) or maybe even the nexus letter I have from Dr. Anaise is enough, for my particular case? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - The other part, I just want to confirm the accuracy of information. This is more for reference information on this thread, for those that are following this or might need to reference it later for themselves in regards to filing a claim that is denied and then options and knowledge:

Bumping this up. Been doing some research and I've read that if the claim gets denied on the first go around, that before you submit a NOD or go that route, that a Vet should hire a lawyer/attorney to help with the process. Given my situation, would you recommend I go this route? Maybe wait till after the request for reconsideration? Also, please see previous post for information accuracy, and let me know if it would need to be corrected.

Bit of an update (and to verify my learned knowledge is correct on this) to add information and clarity to this thread for those that read it. And please let me know if I am correct in what I wrote. If not, let me know so I can edit the information. Following the Notification letter denying a claim, the next options (excluding doing nothing) would be: - Request for Reconsideration (also called RFR or to re-open a claim) - Notice of Disagreement (NOD) "A request for reconsideration is nothing more than a reopened claim. You must have new evidence to support the request. You are essentially telling VA that you aren't disagreeing with the decision that was made based on the evidence VA had, but you want to submit some new evidence now that you think will change the decision. Like I said, it's just a reopened claim and since reopened claim generally get processed faster than NODs you can usually get a decision faster, and any decision that is based on new evidence submitted within the one year appeal period of the claim in question preserves any potential earlier effective date. The downside to requesting reconsideration instead of submitting a Notice of Disagreement is that if the decision isn't made within the one year appeal period you will have lost any chance to appeal the first decision if you don't get a favorable decision on the request for reconsideration. This is why as a VSO I rarely request reconsideration. I only do this when I am absolutely positive of the outcome of the claim and I'm not usually absolutely positive of the outcome." - Cruiser http://vets.yuku.com/reply/389598/Request-for-Reconsideration#.WBPD02zrtPZ The request for reconsideration, which normally is done at the Regional Office (RO) level, means that they will review your file again, based on new evidence that was submitted. Hence, they are re-opening your claim. A notice of disagreement, must be filed within 1 year of the decision date. You don't have to submit new evidence, but more evidence (good evidence in your favor of course) is always better. So if you got it, submit it either way. Downside to a NOD is that it does take longer than a regular decision, longer than a re-opened/RFR claim, but less than a BVA level claim. So my take on this, depending on how much time you have left on that 1 year NOD limit, and how sure you are of a favorable outcome, it might be faster to submit new evidence so that you get that RFR/re-open claim. If the RFR/re-open claim route is taken, you have 60 days (or is it 90?) to submit the new evidence in support of your claim. So balance of time is critical here. Don't wait to long that you risk the RFR overlapping the NOD limit, but also don't do it so early that you can't get your new evidence (IMO/IME, in-service book/statements etc.) completed and sent in time.

John: Every where I've read about sleep apnea and its relation to PTSD or TBI is the same, that its not concrete evidence but there is quite a bit of strong suggestion towards it. Similar to how there was a slow ramp-up with IED and TBI, and possibly how slow it was for the VA to make the connection with AO and its effects. Both (IED-TBI and AO-Effects) of which are still being disputed by the VA to a certain extent. I think the 'grace' option here is the fact that doctors don't need to be 100% certain, but just mostly certain. And you're right that no VA doctor will speculate on causes of OSA. I've asked and questioned, especially when they told me that obesity contributes to OSA. I'm 6', 165 lbs, with a size 14" neck. Not exactly obese....They would just skirt around the issues and questions. Luckily, we can talk with doctors outside the VA. Just gotta keep searching...

Just for visibility, my next steps should be: Look into possible CUE Look into requesting a regional level review officer. This might require filing a NOD. Look into board certified sleep dr. for IMO in support of original IMO. These secondary IMO's should be short and to the point, following James' sheet/guide. This is in hopes of avoiding the BVA process which can take 3-5 years.

I was surprised too that a NP did the review, and in comparison to other C&P reviews I've had, this one lacked the most notes... But I agree with you, that having myself present for the C&P exam did not make much sense, given that it was supposed to be a simple reading of the documents and review of test results. PTSD C&P requires questions and assessment for example. I'm going to email the VSO and work with him to get a NOD ready to submit, and discuss options and what the process we're looking at will be. And asking about having a reconsideration done at the regional level, to hopefully expedite the process... Did some poking around for information on a going the CUE route, prior to NOD (and I'll ask the VRO about this as well), but seems that a CUE really needs to be clear cut. And from what I've read, seems a bit more of a unique/difficult process, which looking at mine, I'm wondering if mine would even fall into the CUE category. I'll post on here what I find/discuss with the VRO. Thanks so much for guidance and clarification on this so far.

Noted. From what I'm reading from you guys and other posts, having a DRO (decision review officer) at the regional level (which happens to be 30 min. away from the VA hospital I go to) would be the quickest and best route to go. And most logical since we can choose that route, prior to going the BVA route (3-5 years) James: Thank you for the linear explanation of how the test/fact finding process works. Always had trouble trying to follow the process on who orders what, who does what.

Gastone: Case decided, I'm fracked, BVA hearing 3-5 years down the line...that's what I had figured. Never is quite easy the first time around. Medical credentials for the C&P Dr. was a nurse practitioner - certified, from my findings. Need to do some more research, but doesn't look like they were a medical doctor. The rater said that the IMO was evidence considered, but never mentioned it or anything. C&P doctor gave the definition of obstructive sleep apnea and then that was it. So maybe it was 'considered' How did you go about finding a MD board certified SA specialist? I've never had to go through specific doctor finding for myself or family members so this is news to me. Or at least where/how to look. And no, I did not submit for the ED SMC - K. Was focusing on this since it had more importance in comparison, I think.

James: Yeah...that is about half of it. Granted the other half was all the supporting document. It took me a while of reading (and re-reading) to understand what he was saying in the IMO. It was a lot for the rater to read, so I can see why they may have just passed the buck. Not saying they were right in doing that, but makes sense. From my findings, I figured it would be better to have more since they might end up saying well there is no supporting information on these statements made by the doctor etc. The qualifications of the C&P Examiner were that they are a NP (Nurse Practitioner). The signature stated FNPC, which google stated it means Family Nurse Practitioner - Certified. So the fact that I was not there, and that it was done by a nurse practitioners against a doctors statement, I feel like that has a significant weight in my benefit. In regards of having the C&P exam redone, you stated to ask that it be repeated with my being present. As in you, James, or me Cisco the vet present? With that being said, if I ask for a reconsideration at the regional level, would it make sense to ask for the C&P exam re-done? Does one impact the other? I'm going to circle back to that process and what it looks like, as soon as I address the other posts as well.

Thoughts?

Attached are the IMO, C&P Exam notes, and then the letter of notification I received from the VA. Actually never received it, so I asked my VSO for a copy. This is to be used for review and reference only. IMO.tif C&P Exam.tif Letter of Decision.tif

Berta (and Gastone): Thank you for the link and information for the TDIU/SSDI. That route would add another whole level of complexity, particularly the part of not being able to work. I need to look into it more, but thank you either way.

Gastone: I've learned and read that sleep apnea is not an easy path/route to go correct. Some of the best pockets of information I have found have been where Vets had their documents/findings/IMO's etc, lined up to be submitted or ready to have an exam done in order to submit the information. And I know that no Dr. can give a 100% certainty of a direct cause from one to the other. But due to the "Benefit of Doubt" it makes it doable. And really this "Benefit of Doubt" makes a lot of things doable, assuming information is presented to support two issues at a 50% or more, which is very appreciated. And going into this, I knew that it was going to be a tough battle. But I figured, with research and getting the information put together that supports my claim would help in the process. Not a guarantee, but whatever I can do help out the process to benefit me, I'll push for. The IMO was put together by Dr. David Anaise. I think it was a pretty well put together document, granted I've never seen one or had one done, so skews my perception a bit. Not sure what the privacy rules/requirements are, but I'm going to post the documents here (for reference only). The documents would be the IMO, and then the letter of notification that the VA sent, as well as the Rater document (pulled from MyHealtheVet). I think, that based on what I have, I'm not missing/lacking anything else, but wanted other people's eyes to double check. My information vs. what the VA said/submitted, I think that its pretty solid, and it should be granted. But there probably is a little bit of bias in that haha. Looking at paperwork and documents and information over and over puts such a mental strain. And it doesn't help that if feels like we only have 1 shot at claims with the VA.

See quote above. Bumping this for hopeful input on others

Well hot dog! Congrats on finally being recognized by the VA! Now you can fully enjoy your vacation and take a mental break!