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Marine1342

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Everything posted by Marine1342

  1. 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:
  2. Marine1342
    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.
  3. Marine1342
    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.
  4. Marine1342
    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...
  5. Marine1342
    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.
  6. Marine1342
    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.
  7. Marine1342
    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.
  8. Marine1342
    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.
  9. Marine1342
    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.
  10. Marine1342
    Thoughts?
  11. Marine1342
    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
  12. Marine1342
    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.
  13. Marine1342
    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.
  14. Marine1342
    See quote above. Bumping this for hopeful input on others
  15. Marine1342
    Well hot dog! Congrats on finally being recognized by the VA! Now you can fully enjoy your vacation and take a mental break!
  16. Marine1342
    James: The turn on feature is not 'instant'. Takes a couple of breathes for the machine to realize "hey, he's trying to breathe...better start" and then it kicks on. I use the nose pillow, and I personally don't like this breathe and have it turn on. Rather turn it on manually, simply because it feels really hard to breathe and not a fan of feeling restricted air. Have you tried adjusting and fitting the mask with the unit on at full pressure? Reason I ask, if you're test fitting with no pressure or the ramp-up feature then you might have a good setting for when its low, but as it picks up then the seal weakens/breaks due to 'weak' fitting. I was able to get the mask to fit mostly comfortable, but still had issues (again, side sleeper) with the mask shifting while I slept on my side (left side mostly). My pressure is actually relatively low too. I think I'm at 10 units of measure? Low enough that the ramp-up feature doesn't make a noticeable change, so I just turn it on and go. But even at that low pressure, I was having issues with the mask sleeping on the side. Sleep was less because of seal break issues every once in a while, but man the sleep was sooooo much better than what it was before. I tried it for 2 weeks before I switched to the nose pillow. The chin strap thing, no different than wearing a neck gaiter. Tight enough to not let your mouth dangle open, but you can still talk and open your mouth with it. But everyone's got unique needs. The features that the provider has access to, from what I've read and seen on the machine, is just the air pressure settings. That's the only 'medical' part of the unit. The other features on there are readings (how long you've used it over the past X number of days, sleep efficiency, AHI etc.) and minor settings for the user to change (ramp-up time, pre-heat etc.). I'll see if I can find some documentation on the face mask and better fitments. Glad to hear that your sleep is improved vs. prior usage! And a lot of this is trial and error since it is all unique to each person.
  17. Marine1342
    If the mask looses a seal when it hits full pressure, from my understanding you don't have a 'tight' enough fit. Have you considered/tried/been offered the alternative to the mask, a nose pillow? Reason I ask is because I was having issues with the face mask. Yes it gives you a better seal because its your nose and mouth, but since I tend to sleep on my side, the mask kept getting pushed off my face and then breaking the seal. Nose pillow was more comfortable, less straps around my face and head. They do recommend that you use a special strap to keep your mouth shut while you sleep. The nose pillow sits under your nose, very small. Not quite sure how to put an image into the response, but if you google "resmed cpap nose pillow" you'll see it. First couple images, that's the one I was issued. ResMed CPAP machine. Sorry its not a direct answer on your face mask question, but thought this might help some.
  18. Marine1342
    Buck: Didn't see your post before I posted, but yes I am SC for PTSD plus I have been issued the CPAP machine. And I use that every night. Not out of compliance and big brother checking in, but I can't stand the feeling of not sleeping with it. For once in 10 years, I actually feel like I slept. I actually wake up and feel awake. And that's why I figured it would be awarded. Nexus letter, SC for PTSD, CPAP with use. Now, I did not submit the documents for the sleep study and that whole thing, because it was all done at the VA medical center. The only 'private' medical paperwork was the Nexus letter statement.
  19. Marine1342
    So here is my view point/take on this situation. Part of me wants to make sure I’m thinking clearly and correctly on this, and the other part of me is asking/wondering what the next step or proper steps are. After taking a sleep study, I was diagnosed with OSA and issued a CPAP machine. In order to get OSA with CPAP service connected either it was documented in service, or has to be shown to be a secondary to a SC disability. In my case, I did not have it documented while in service. So my other option is to show a connection to a SC disability. I went and got an IMO that stated 50% or more that the sleep apnea is secondary to the SC PTSD, TBI, and tinnitus with documentation to support his statement. C&P exam stated that OSA was not secondary to PTSD, and then proceeded to give me the definition of OSA. The Notification Letter explanation is very short and states no evidence to support claim (uh..what about the 47 page IMO book?). I feel as if the C&P statement was simply thrown together to process things quickly, and the letter explanation was also very short. I have gotten letters before, all with a lot more detailed information. Again, seems like it was just thrown together to move on to the next case. It does list the evidence considered, so they did receive the documents from Dr. Anaise. So what am I missing that would cause this to be denied? Or is this SOP, until a NOD is made and then reevaluated in more detail to then compare/pit VA information against Veteran information? Maybe I don’t fully understand the ways of the VA process, and that is where my lack of knowledge has me stumped. The way I see it, I have “all the checks in the boxes” and yet….
  20. Marine1342
    I've always had to wait for the letter to come in the mail. The service reps didn't want to communicate that information to me over the phone or email. Understandable. I've also had it where the money hit my account with direct deposit before I got any letter in the mail. I think that both the funds (if applicable) and the letter are sent out at the same time, but clearly electronic stuff passes faster than a physical letter in the mail. May not always hold true though. It is also hard (for me at least) to calculate the percentage based on what is deposited due to back-pay and any partial pay, which is why for that % number I look online (eBenefits and MyHealtheVet). Fairly new system, the whole electronic thing, but when I first started with claims (2007) I didn't have access to those sites so it was just sit on your hands and wait. Can't even begin to imagine what it was like 20+ years ago...
  21. Marine1342
    After Preparation for Notification, it is then sent out to the Vet, assuming a second review was OK'd. Usually 5-10 business days depending on the mail and distance, from when it changes to Notification Sent. What I did (similar situation, was not home for the mail, granted it never ended coming. Guess it was lost...) but under eBennies, there is a section that reads "Disabilities" on the left hand column. If you click on that, it shows you your disability ratings. I used that to see if I was awarded or denied a claim. The other thing you can do is on MyHealtheVet, look at your medical documents, and look for the C&P reviews. Sometimes, the reviewer puts on there whether or not they think the condition is SC or not. Nerve wrecking waiting for the stuff to go through the system, and also to get the decision letter, especially when you're not home.... Please note, that the information updated online is not always instant, so give it some time. In my case, I was able to figure out what happened, well in advance of any paperwork in the mail. Granted it never arrived but still, I figured it out in 1 week from when it moved to Notification sent. The notification letter will state if you were awarded or denied, on what merit/grounds, and if you were awarded your claim, then you get a percentage, monthly pay amount, and a retro-date if applicable.
  22. Marine1342
    Paste without formatting CTRL + Right click gives you an option in the message response box to either Paste or Paste without formatting. This makes it so that just text is placed. HTH
  23. Marine1342
    Berta, Buck, and James, Thank you for your service and support for this country and it's people. And thank you for your continued service and support for those after you. And of course, for allowing others to pick your brains!
  24. Marine1342
    James: I have done a NOD and a De Novo review for the TBI and PTSD initially. This was when the criteria ratings were changing for TBI so there was a bit of confusion on all ends as to what was being looked at under what regulations. I'm not quite sure how the appeal/NOD/dispute C&P as inadequate exam works, particularly with the process of having a "new/proper exam and a reconsideration at the RO level". For clarification and confirmation purposes: When one requests a new/proper exam and reconsideration at the RO level, its not an appeal (NOD) in the sense that you want to be re-reviewed due to an error in the final processes (C&P and then RO decision and rating). An appeal would mean that you get placed in the appeals line, during which you would present new/more information to either add or clarify your case, which is then seen by a new DRO/RO (2-5 year process). This is under the assumption that you are still within the 1 year time limit of the (initial) decision. Is this correct? Almost 10 years of going through VA processes, and still learning new stuff with VA processes...gotta love it! Ultimately, if this is the route I need to take (second opinion from another Dr. agreeing with first Dr., and then submitting a request for new C&P exam with reconsideration at RO level), then I'll need to find more information on how this process works. (I'll be researching the forum's database) And also, thank you for the USVA101 link and especially the new information (to me) on the TDIU and SMC-S. More information to process and asses how that works. For ease of readability and flow, I don't want to steer away from the first point of viewpoints and assessment of the information I have (IMO, C&P exam information, and RO decision). I do want to touch back on that, as I do have some clarification questions, and if you have personally gone through that, what your experience and knowledge is one it. Not dismissing your knowledge and help at all, just want this thread to be as readable and easy to follow as possible, for others to take information from it.
  25. Marine1342
    To Buck: Thank you for your insight and information. I figured that going down the route of medication and its relation to PTSD and SA/OSA would require a validated statement (i.e. Dr. letter). The IMO I had done, stated something similar to this. Here is where my knowledge and experience is lacking. I do know/have read that wording is key as well as document/factual support. Unfortunately, I never bothered with going to get medically looked at for sleeping issues. I did complain about sleeping issues after my head injury, since that was the only physical injury I had. Never considered PTSD until I was going through therapy as a possible cause of issues. So having sleep apnea diagnosed/documented on AD medical documents is a no-go. Hence, why I am trying to go the route of the Dr. Opine IMO letter, which (per quote above) I thought that would be it.
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