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John Royal

Third Class Petty Officers
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  1. Like
    John Royal reacted to Gastone in Sleep Apnea - Appeal or New Claim   
    John, very few Vets, yours truly included, don't have our fingerprints all over our Claims Denials. We either relied foolishly on a VSO-Rep  to be as concerned, as we eventually became, or just plane old ignorance of VA Claims and a good dose of procrastination. All 3 are a recipe for a Denial.
    You mention your waiting, I trust you have at least started your SA FDC on your E-Ben site, to establish the New Claim File Date, right.
    Refresh my memory, are you filing for SA as a Direct SC or a Secondary? What is your Medical Nexus Evidence? Posting redacted copies would be helpful.
    Semper Fi
  2. Like
    John Royal got a reaction from FLTMEDOPS in Sleep Apnea - Appeal or New Claim   
    Gastone,
    As of today, I have not filed a claim, as I am still waiting for additional visit to Civilian Provider to wrap up the Sleep Study. I assume it will take the Prosthetics Department at the VA some time to issue me the CPAP machine. I am very diligent and communicate regularly with my PCM through My HealtheVet and hope that will help speed the process along in getting one issued. I missed the NOD, like a dummy, as I was busy with my new career and other things. I have the VA Form 3288 filed out and based from posts that I read on here, I phrased the request for my C-FIle as follows:
    INFORMATION REQUESTED BLOCK: I am requesting a complete unredacted copy of all of my claim files: papers, digital media, and all artifacts which are now contained in my Compensation and Pension claim folder.
    PURPOSE FOR WHICH INFORMATION IS TO BE USED BLOCK: I need to review my entire claim file.
    JR
  3. Like
    John Royal reacted to Gastone in Sleep Apnea - Appeal or New Claim   
    Are you saying, that as of today 06/02/2016, you have not Filed a New Claim for SA based on the recent 04/16 Sleep Study?  The reason would be?
    It appears that you missed the NOD Train on your previous Denials, or am I wrong? Did you ever file a NOD on anything?
    Forget about the Retro for right now, if you think you have compelling New & Material Medical Evidence that was or wasn't viewed by the prior Claims Raters, attach it all to your NEW FDC. Get the SA SC, just because you think or wish your SA will be SC'd, doesn't mean anything till you get the Award/Denial Letter.
    If you get the SA SC, then start researching for an EED Claim for the Large Retro $$.
    Semper Fi
  4. Like
    John Royal reacted to Andyman73 in Sleep Apnea - Appeal or New Claim   
    JR,
    I believe you have to mail the request to the claims intake center, or if you are close to your VAMC, you can have them scan it into the system on the spot. Maybe others will chime in to say yay or nay about the ebennies option for the C-file request. But it will show up as a claim, once it's in.
    That is how I requested mine, while at the VAMC for other reasons, just stopped in a the benefits counselor's office, filled out the form.  He date/time stamped it, scanned and uploaded it, and made a copy to mail off as well.  Then he gave me back the stamped original.
    Hmmm, if the SMR entry shows a DX, then it's there.  Sounds like they didn't want to even give you a 0% rating, since they knew it would leave the door wide open for increase in the future.
    Andy
    Semper Fi
  5. Like
    John Royal reacted to Andyman73 in Sleep Apnea - Appeal or New Claim   
    John Royal,
    Welcome to where the wild things are(aka; Hadit.com)!
    You will have to file a new claim, since the 1 year appeal/NOD window ran out on 03/09/13.  You were DXd on AD(!!!golden ticket!!!) with mild OSA.  Consider yourself blessed, 1 of 100. We other 99% were not DXd until after our AD time, and have a significant mountain to climb.
    With your DX from AD, and new sleep study showing worsening SA, and RX of Cpap, you can file a FDC.
    Like mentioned above, you need RX of Cpap to get a rating, which will be 50%.
    I think the only way you will be able to get any retro is to compare your most recent sleep study results with your AD sleep study results.  While they DXd you with mild SA, if the numbers are anywhere near the numbers of your new study, there may be an argument made that the original DX was downplayed. But if the numbers are too far apart, just count your blessings that you already have the nexus of the AD DX.
    Oh, by the way, what was the reason they denied your initial SA claim?  That will give us a clearer picture as to what's going on.  Also, if you don't have it, request your C-file ASAP!
    Semper Fi
  6. Like
    John Royal reacted to silverdollar22 in Sleep Apnea - Appeal or New Claim   
    You stated that you were denied in (VA letter dated 3/9/12).  Then said (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.)  This was after your denial and before you had been issued a C-PAP machine which is in the works still.  You cannot get rated without the use of a C-PAP machine.  If i'm not correct someone will chime in and correct me!!  Sorry i'm seeing a new claim in your future after you get your machine.  JMHO
  7. Like
    John Royal reacted to broncovet in Sleep Apnea - Appeal or New Claim   
    Even with what I just explained, sometimes your friendly VA employee or VSO will advise you to file a new claim.  Its unclear if they get a commision on that, Im sure they do, its just not "directly".  Its like the people who work at a car company...who tell you they "are not on commission".  Trust me, if they dont make their employer money and dont sell cars, or provide a service to their custormers, they will get fired, and lose "bonuses".  
  8. Like
    John Royal reacted to broncovet in Sleep Apnea - Appeal or New Claim   
    The answer to this is, "How much do you need money?"   Calculate how much you would lose by trashing your effective date not appealing.  Example:
    You applied in 2011, and, lets say you are successful and eventually get your benefits, the only difference there is the effective date, 2011 (appeal) or 2016 (new claim).  Thats 5 years of retro.  Lets further assume that you get your 50 percent increase from 40 to 70 percent.  Dont get me started on VA fuzzy math, I know these dont add up.  
    Im showing a single vet at 587 with 40%, but at 70% 1334, a difference of 747 per month.  747 times 60 months is $44,820 you will lose by reapplying and not appealing.  The question is can you afford to throw away 44k?   If you can, go ahead and file your nod, and donate most/all the money to tbird and hadit.  If, however, you need the money, then give tbird a smaller portion to help other vets and keep the rest for you and your family.  
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