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Everything posted by doc25

  1. I stand corrected. The diagnosis doesn't need to state it, but it needs to be in the documentation. If you still believe that the phrase "medically necessary" doesn't need to be present? Let's consider the advisement of this veteran's law firm. The bad news is that this extra scrutiny by VA will be a trap for the unwary. If a veteran doesn’t have a statement from the doctor saying the CPAP is medically necessary, it is an invitation for VA to deny the claim now. https://veterans.perkinslawtalk.com/post/bad-secret-change-to-va-sleep-apnea/
  2. Screwed? Not so fast. Let's take into consideration: #1. There is a link that was made. #2. A specialist made the link. A pulmonologist opinion carries more weight than a General Practice Dr., Physician Assistant, or a Nurse Practitioner as a C&P examiner It doesn't hurt to ask your dr. to write it in the format that was mentioned. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- You seem to have met the Caluza elements for secondary connection, anyway. #1. You met the criteria for current diagnosis of Sleep Apnea. #2. You met the criteria for a service-connected disability. #3. A nexus of opinion was provided. Albeit, it does not contain the legal terminology. It does raise a significant amount of reasonable doubt in your favor. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- What we need to also look at is that: #1. You had a sleep study done. #2. The sleep study confirms you have sleep apnea. #3. A diagnosis for sleep apnea was made. The diagnosis also has to state you need a "medically necessary" CPAP Machine #4. You were issued a CPAP machine.
  3. [I'm guessing you are already service connected for Asthma? Is this correct? If yes, proceed and read below. If no, you will need to get Asthma service connected first.] Unfortunately, there is legal terminology that is required in a nexus of opinion. Your Dr. has to state one of these phrases for a favorable nexus. 1. "Due to" (100% probability) Ex. The veteran's claimed condition is due to the veteran's service-connected Asthma and the veteran's burn pit exposures in military service.. 2. "More likely than not" (Greater than 50% probability) Ex. The veteran's claimed condition is more likely than not, due to the veteran's service-connected Asthma and the veteran's burn pit exposures in military service. 3. "At least as likely as not" (Equal to or greater than 50% probability) Ex. The veteran's claimed condition is at least as likely as not, due to the veteran's service-connected Asthma and the veteran's burn pit exposures in military service. Here is a study below I attached that you can show your doctor and see if he'll use it to make the link in his rationale. Asthma_and_obstructive_sleep_apnea_More_than_an_as.pdf
  4. In order to get retropay for the earliest effective date/original date of your claim, you would need to find a Clear and Unmistakable Error or CUE. Your effective date, if granted this time around; will be the date you reopened the claim.
  5. There is some good news, but please start your own topic so we can point you in the right direction. I'll initiate some of that good news on here. #1. Don't beat yourself up over something that you did or didn't do. #2. All the other issues you are having can be secondary connected to Psoriatic Arthritis, once you get it service-connected. #3. Since the pain is severe enough that it is causing you to not get sleep that is called Insomnia; you can claim that secondary as well. Is this condition also causing you to have Depression? This can also be claimed, as secondary. The Insomnia and Depression will be combined because both are mental health disorders. I'll explain further once you create your own topic.
  6. Glad you are seeking help for PTSD. Are you currently diagnosed with PTSD? If not, at least you're getting the paper trail or medical evidence by seeking help. If you are diagnosed with PTSD this is how it is granted. #1. Current Diagnosis #2. In-service event/stressor #3. Nexus of opinion stating https://www.hillandponton.com/3-steps-to-presenting-a-strong-va-ptsd-claim/ Let's say you do get PTSD granted. It will be combined with the service-connected to Sleep Disorder/Anxiety. The PTSD being combined has to be considered for a possible increase in rating. If there is no change in your rating once combined, there are still secondary conditions to your mh disorders that get rated seperately; providing you an increase. For example: Obstructive Sleep Apnea secondary to Mental Health disorders is prevalent among the veteran community. It's been well-known for awhile, but the VA denies, denies, denies.
  7. The sleep disorder that is combined with anxiety should have said Insomnia/Anxiety. The VA rates Insomnia as a mental health disorder. Therefore, the sleep disorder is combined with Anxiety. https://www.hillandponton.com/va-disability-benefits-insomnia/
  8. My claim was denied also. That was my third time getting denied, so I got with a lawyer. I went with Chisholm & Chisholm Kilpatrick. Hill & Ponton is reputable also. CCK is doing it pro bono. If I get denied again, I don't owe them anything. But, if I get it granted they're asking for 30% from the retropay. I don't mind it because I'll see that money anyway after a few months.
  9. Do you have an unprotected disability, such as a mental health disorder? You will want to continue going to therapy at least every six months to establish that your disability has gotten worse or is unchanged from your current symptoms.
  10. We have a rigorous QA process when we clean and sterilize medical instruments at the VA Clinic I work at. We triple clean and triple check everything before we give it a green light. If it's not cleaned or sterilized properly, or there's any doubt, we send it back to be reprocessed all over again. It's people's lives we're dealing with. This is the standard VA-wide. Same should go with the VBA. The benefits are people's lives they're dealing with and it's imperative they get it right.
  11. I've had a theory for a few years now. And I could be wrong, but it occurred to me that there could be a possibility that once a certain number of claims get granted every FY. That quota initiates denials. It's just a hunch. Honestly, it would just be better off to tell us there's only a limited amount of $$$ for compensation & pension. Rather than string veterans along for months, years, and decades with daggum denials.
  12. It comes out to 92% actually. The additional 10% you mentioned would only get you to 93%. What are your SC conditions? and I'll research what secondary conditions that could be caused by your SC disabilities.
  13. Bone spurs in your lower back or another part of your body? If you are meaning bone spurs in your lower back the answer is yes. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bone-spurs.html
  14. Be sure the nexus of opinion states: The veteran's condition is "at least as likely as not" (equal to or greater than 50% probability) due to or the direct result of the veteran's service-connected MDD. Then a rationale must be provided. The rationale can be any medical literature that would make the link. It's already well-established that certain conditions can cause Sleep Apnea; particularly psychological disorders. MDD is one of them.
  15. You're lucky you had Headaches separately rated. Usually, they're just combined with TBI. You can request an increase if they've gotten worse.
  16. I just use this disability calculator: https://www.hillandponton.com/va-disability-calculator/
  17. This is gross incompetence by the PA. An orthopedic dr. is an expert in Orthopedics. PA's and Nurse Practitioner's do not have the same level of expertise as a specialist like an Orthopedic Dr. As far as the headaches go, heat stroke can have short-term AND long-term effects.
  18. For the Nexus of Opinion: Did the doctor state one of these legal statements? 1. " due to" (100% probability) 2. "More likely than not" (greater than 50% probability) 3. "At least as likely as not" (equal to or greater than 50% probability) That your Anxiety/PTSD is the direct result of MST. For your questions: #1. If you really need a timeline give it two weeks or more. #2. You will be asked questions about your in-service event/stressors, Social and Occupational impairment. Answer the questions as honestly as you can. DO NOT downplay what you experienced and DO NOT overexaggerate either. #3. If you feel you need to share your journey with us up to your discretion. We're here to support you in your continued journey and the claims process.
  19. True words Ms. Berta. I was looking at my C&P exam from 5-30-2017 and I found it intriguing that the examiner noted that I was diagnosed with Pes Planus on the same day. This infuriated me. I was diagnosed in-service 12/5/2006 and then again 9/2016 by two podiatrists. It occurred to me that he did not look at my c-file or VA e-folder.
  20. File a Notice of Disagreement. This will preserve the earliest effective date. Your dad has 1 year from the denial to appeal. They'll reopen a denied claim if you have "new and relevant" evidence that the VA did not have before. You'll want to do this under the Supplemental Claim Lane. You'll be afforded another C&P exam, if needed. A nexus of opinion, is what you'll really need, because it sounds like a Disability Benefits Questionnaire was filled out once and you had another one filled out again. Although you will have a "new" DBQ and it's "relevant" to the claim it will only reopen the claim, but will get denied because it will more likely than not; will have the same information. The nexus of opinion will add weight to your dad's A/A claim. If you do not have any "new and relevant" evidence you can appeal in the higher review lane. BEWARE: You can not use "new and relevant" evidence in this lane while it is in progress. It's in your dad's best interest to remain in the Supplemental Claim Lane or Appeal to the Board of Veteran's Appeals Lane. Can you post the denial letter? This will give us a better picture of what the RO used for evidence.Redact or Darken out any personal identifying information, such as SSN/Names/Date of Birth
  21. This article supports what you're experiencing in the absence of smell and taste. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051255/ Just smelling cigarette smoke could be that your olfactory nerves possibly may have been damaged either during your head trauma or surgery. My theory is that your brain is "remembering" only one smell. Being in the military we were all exposed to cigarette smoke; directly and indirectly. You've lost all sense of smell other than the cigarette smoke smell. What we smell, also affects our sense of taste.
  22. I picked up on the tone of his post,as well. It's a red flag for depression caused by this issue. I second that motion for Ward to get help. John Ward two fellow vets agree you need to get seen sooner rather than later for the depression you are experiencing. Please seek help as soon as you can.
  23. It's for the questionnaire only. That happened to me on my last claim and they did not ask for a Nexus. My claim ended up denied. I had asked the LHI examiner if a nexus would help my claim. His exact words were, as follows, "Yes. But the VA only asked me for the DBQ, not the Nexus. So, I can't write one in if they did not request for one." Although, MY claim was denied. It doesn't mean yours will.
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