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Thank you so much for the solid advice. I’ve heard the same thing about OSA being hard to prove. My IMOs not only referenced the diagnosis over and over they inserted the relevant records into my letter and then backed up the nexus with studies and excerpts from medical texts. So on paper I feel good. Of of course I submitted the raw records as well. I’ll upload a redacted copy tommorow it might be good for other members to see. I’ve certanly learned by following other members cases here. My IMO/nexus is over 60 pages so it’s a lot of redacting.

I'm working on a secondary OSA claim as well. I am also a organ transplant coordinator and have a pretty good medical education and fluency. First of all, I'd highly recommend you call Dr Anaise for a consult. He is a lung transplant surgeon of 30 years and a practicing attorney. He specializes in VA law and has a interest in sleep apnea. I have no interest in him personally, he did my IMO. Its killer. Of course my claim is pending so we will see in the end. He charged my 1500 for 3 conditions, but he was happy to do a consult and review my charts without charge. That being said, it seems that the current literature that I could pull showed a strong link with OSA aggravating DM2 not the other way a around. Here is a good study. Of course Dr Anaise my have other literature that is in your favor. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449487/

broncovet thanks for your reply! The Rhinitis is already SC at 10, They have found polyps which is the criteria for 30% so I'm going for an increase. I tried for OSA and HTN in service but it was declined. No diagnosis although documented symptoms. So instead I'm going for this. OSA secondary to Rhinitis. I have the DX, and 2 doctors saying that the Rhinitis (already SC) aggravates it (as likely as not). Sinusitis secondary to Rhinitis. I have the DX, and 2 doctors saying that the Rhinitis (already SC) causes it (as likely as not). HTN Secondary to OSA. I have the DX, and 2 doctors saying that the OSA (applying for SC) aggravates it (as likely as not). Sorry if I was rambling a little and not clear. I went with my own DBQs and 2 strong Nexus letters. I heard the VA is tightening up on OSA claims so I really wanted my ducks in a row.

Hi all, looking for feedback regarding my progress and chances, along with any other suggestions. I served in the Navy from 1999-2005, Honorable discharge as a nuclear mechanical on subs. Sadly, like many I rarely reported medical issues while I was in, didn't want to hurt the command with absences. If only I knew then right? In 2015 I filed put my first claim in, Rhinitis (this was well documented inservice) sleep apnea, i had symptoms inservice that were documented but never diagnosed and hypertension secondary to OSA. I thought I had a good package, I had buddy statements and an IMO from Dr Ellis. Well the VA disagreed. They granted SC Rhinitis at 10% and declined SC for OSA and HTN. I applied for a denovo review and they upheld the first rating. I then let my 1 year expire and things ended there. A few years later my sinuses were getting worse. I saw an ENT who diagnosed severe sinusitis a deviated septum and polyps. We tried steroids and antibiotics and then went with a pretty complex sinus surgery. Post op several rounds of steroids and still have polyps. I currently use daily steroid irrigation. That sucks. My OSA of course was diagnosed with a sleep study, it was rated as severe and I use a CPAP daily. I strongly feel that the fact that I can barley breath through my nose makes it a lot worse. The diagnosis on all of these are unarguable. Its the SC that will be the battle. HTN: I have pretty severe HTN, it is controlled with 3 meds daily. The literature is pretty clear that OSA worsens HTN. And for what its worth, I don't use the VA for health care. So my packet: I had hoped to try the DRC process as, I am very lucky to have the resources to build my own claim. I used Bethany who is a PA at Valor 4 Vets to do my DBQs for Rhinitis /Sinusitis, OSA and HTN. She also wrote IMOs for each with literature cited. The least as likely then not phrase is there for every condition. I'm happy to post if it will help anyone. I also wanted an IMO from a doc with a little stronger CV so I went with Dr Aniase, I know he's been talked about here and like others have said the service was great. Also he is a former lung transplant surgeon, who has focused a lot on OSA so I thought that was a good fit. He put together a solid 65 page letter with a lot of literature and medical rationale that OSA is make worse by Rhinitis and that HTN is made worse by OSA. He went on to say that sinusitis is only caused by rhinitis and pointed out the rationale for increased rhinitis. I of course had all of my private medical records. I took these to my local VFW service officer on 4/17. I had no problem doing the claim myself by a DRC claim has to be submitted by a VSO. She tried to discourage the DRC process as it shifts the responsibility to the Vet and the VSO. I get that but I already have everything and hopefully wont need additional exams as I have my DBQs. She relented and took all of my compiled paperwork to submit. Well shockingly while her cover letter asked it to be processed as a DRC, it wasn't uploaded to the DRC portal and is now showing as a regular pending claim. The OSA and HTN are re-opens. So I think i have a pretty bulletproof packet. What thoughts do you all have? Is there anything else I should do?