doc25

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.

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.

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.

Total knee replacements are temporary ratings, but after one year are required to be reevaluated, from my understanding. So, you should be getting a follow up C&P exam letter sometime this year to be reevaluated. If you don't, then good for you.

No. Only one condition can be claimed. Now if Sleep Apnea is causing another secondary condition. That condition can be secondary to the Asthma and Sleep Apnea. Here are some secondary conditions that can be caused by Sleep Apnea. Sleep apnea may increase your risk of the following disorders: Asthma Atrial fibrillation Cancers, such as pancreatic, renal, and skin cancers Chronic kidney disease Cognitive and behavioral disorders, such as decreases in attention, vigilance, concentration, motor skills, and verbal and visuospatial memory, as well as dementia in older adults. In children, sleep apnea has been associated with learning disabilities. Diseases of the heart and blood vessels, such as atherosclerosis, heart attacks, heart failure, difficult-to-control high blood pressure, and stroke Eye disorders, such as glaucoma, dry eye, or keratoconus Metabolic disorders, including glucose intolerance and type 2 diabetes Pregnancy complications, including gestational diabetes and gestational high blood pressureexternal link, as well as having a baby with low birth weight Did you know that sleep apnea can cause inflammation and lead to complications? When blood oxygen levels drop due to obstructive sleep apnea, your body and brain trigger the “fight or flight” response. This increases your blood pressure and heart rate and wakes you from sleep so that your upper airway can open. These cycles of decreased and increased blood oxygen levels can cause inflammation that may contribute to atherosclerosis, the buildup of plaque in blood vessels, which can increase the risk of heart attack or stroke. Chronic inflammation can also damage the pancreas and lead to type 2 diabetes

You can submit any evidence during the claims process up until the day it is decided, if I'm not mistaken. Don't reopen to try direct service connection, unless there was a diagnosis in-service and you were given a CPAP in-service. APPEAL. APPEAL. APPEAL the secondary connection. You have a case for secondary connecting OSA to MDD. You want to preserve your earliest effective date to when you submitted the claim. As long as, you continue to prosecute the claim, you'll get more in retropay. Read the article I provided closely. A VA DOCTOR was on the panel doing the study linking OSA to Psychological Disorders.

I don't make up the rules man. This will better explain what I meant. VA Disability - Step 6: When the initial decision finds no "nexus" What is the "nexus" and why is it important? To get benefits, you must meet three tests. You need to show: eligibility by your military service, diagnosis of a "condition," and evidence that the condition started during your military service or, if your condition was preexisting, that it was aggravated by military service. This third test is the connection or "nexus" between what happened to you in the military and your current medical condition. Case in point: the back injury story In many cases this connection, or "nexus" may be tenuous at best. Let's consider, for example, a back injury. You may have hurt your back in some fashion while serving your country. That was in 1970 and you went on sick call. Your sore back was diagnosed as a "pulled muscle" or something similar. You were given some APC tablets and sent on your way to light duty for 3 days. The back became more painful so you were back on sick call a week later. This time an x-ray was ordered and you were given some stronger pain pills. Your light duty was increased to restricted duty for a month with orders of no lifting, no PT and so on. The military culture demands that we don't complain of our "minor" aches and pains. The team depends on each member being ready to complete the mission and the mission is all that counts. From day one we're trained that complaints of pain will bring about scorn from superiors. Fellow soldiers will know that they have to carry your load as well as their own. "Pain", we learn, "is weakness leaving your body." Pain is good. If J.B. Books [John Wayne character in the 1976 movie "The Shootist"] didn't complain about his back pain, why should you? So you toughed it out, used a lot of aspirin. While your back did improve, you always guarded it and were cautious that you didn't injure yourself again. Your civilian career wasn't as physical as the military. So during the years since your ETS you've had a chronic, low level back pain but it hasn't required much treatment...until now. In the last year you've had to seek more intensive medical care, and finally you had an MRI. The MRI study shows numerous issues with disks and nerves. You realize that your old service injury is here to haunt you. You file for service-connected disability compensation. You have a C & P exam. And about a year later you have a denial letter. The VA tells you that although you had complaints during your service, your condition today is new and unrelated to those old problems. Now what? How do I prove this "nexus"? The "nexus letter" is the key to winning your appeal. Nexus is defined as "the means of connection between things linked in series." Your next task is to seek an expert physician who will review your complete medical records. You'll ask him or her to write a letter stating their opinion that your condition today is related to your military service. Any physician who is qualified to write a "nexus" letter on your behalf may do so. While it is commonly believed that VA physicians aren't allowed to write such letters, that isn't true. VA physicians, as with many civilian physicians, simply don't like to write such letters. They may not be skilled at this task or may not have the tools at hand to write the letter. And typically they are so busy caring for a heavy load of patients that your issue isn't a priority. What does the letter look like? The nexus letter should follow a similar format to all letters that you use to communicate to VA. It should record only the facts and the doctor's conclusions. It may be addressed directly to you or "To Whom It May Concern." Also, see if the physician is willing to provide you with a current resume to attach to the letter; this will help to support the physician's expertise. View sample letter. Note the specific language in the opening and closing paragraphs. Less specific language may not meet the VA standard. The C & P Service Clinicians Guide gives the examining physician the exact phrasing to be used in the "nexus" statement. Here is the relevant section of the Guide: "When asked to give an opinion as to whether a condition is related to a specific incident during military service, the opinion should be expressed as follows: “is due to” (100% sure) “more likely than not” (greater than 50%) “at least as likely as not” (equal to or greater than 50%) “not at least as likely as not” (less than 50%) “is not due to” (0%) " The importance of using the language at # 1, 2, or 3 is apparent. Here is another sample letter. Again, note the "more likely than not" language in the "nexus" statement. Also, notice that the other medical information is pared down to the essential facts. Here is another note about this letter from it's author, Jim Strickland: "The only thing missing from this letter is an often-used statement to point out that there are no other known or apparent causes for the current condition. That might read like; "There is no known history of the veterans family having this condition..." or "The veteran has no other known history that would cause or contribute to this condition...". I only include that statement when the cause of the condition is less than apparent. I might use that to show that a cancer was more likely than not caused by exposure to Agent Orange and that the veteran had no family history or exposure to other carcinogenic chemicals that may be seen as a possible cause for the current condition. In this case there were 2 documented traumatic events that were the likely cause of the injury making any reference to other possible causes unnecessary." How do I get a doctor to support my claim? It's best to make a routine appointment and meet face-to-face with the doctor. Ask her directly to draft or sign the letter. Assuming that the physician agrees with your "nexus" claim, it is perfectly acceptable for you to draft the letter on her behalf. Then ask her to review and sign it, or edit and then sign, if she feels more comfortable with that. I advise you not to ask a nurse or clerk to perform the task of getting the physician's signature. These members of the care team often see themselves as "gatekeepers," to guard and protect the physician from tasks that will only take up more valuable time. They may believe that "rules" or "law" won't allow the physician to sign such a document and may refuse you access to the doctor. Most physicians will sign such a letter if it is brief, to the point and factual. What if I can't find a doctor who wants to do the letter? Some physicians are specialists who perform records reviews and/or Independent Medical Examinations and provide opinions. These doctors usually do a very good job with writing nexus letters, assuming that you can't get one some other way. These independent physicians can charge from about $1000.00 and up, depending on the extent of the services. You must pay that fee in advance with no guarantee that the physician will agree with your theory or that you will get benefits. The Independent Medical Exam doctor does not treat or prescribe and provides only a records review and report. Conclusion The importance of the nexus letter can't be overstated. In many situations the nexus letter from an expert is the only evidence that will tip the scales in your favor.

Request to speak to a patient advocate and explain the circumstances that an addendum needs to be made to the Dr. Note that established the sleep apnea diagnosis that : use of a medically necessary cpap machine is required.

This veterans law article will clarify what we mean https://veterans.perkinslawtalk.com/post/bad-secret-change-to-va-sleep-apnea/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783078/ Research this article. It links OSA to Fibromyalgia. The DBQ and nexus letter combined adds weight to the claim, but the nexus of opinion must contain the minimum threshold of "at least as likely as not" the claimed condition is due to or the result of the veteran's service connected Fibromyalgia. The research article can be added as the rationale. You're ahead of the curve with the diagnosis, sleep study; does any of the documentation state "medically necessary/required" CPAP?

Sawgunner is already SC for a back condition. He's trying to secondary connect MDD to SC Arthritis of the Spine and Intervertebral disc syndrome. The established fact is he was denied secondary connection.

The DBQ's are not sufficient evidence for a nexus of opinion. They are only good to give the rater a better picture of your symptoms. If you were not provided a C&P exam, this might fit in as "failure to apply the Duty to Assist". APPEAL this, because it's well known in the medical community that back conditions, especially chronic pain, can cause mental disorders. Read this: https://www.medicalnewstoday.com/articles/314493.php https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12479-8/fulltext https://www.practicalpainmanagement.com/resources/news-and-research/international-study-finds-back-pain-mental-health-closely-tied You can provide these articles as additional medical evidence. You don't have to be a medical professional to provide evidence of what's already been researched and linked by actual medical professionals.

Here is how my Sleep Apnea secondary to PTSD claim went: 1. Tried to direct service connect OSA. With no diagnosis in-service, but was diagnosed after service. Obvious denial 2. Tried secondary connection even though I had been diagnosed after service with Sleep Apnea and was service connected for PTSD. I had a "medically necessary" CPAP issued. Denied again. 3. I submitted a Sleep Apnea DBQ filled out by my pulmonologist and reopened OSA secondary to PTSD. I was afforded a C&P exam and the examiner provided a favorable nexus of opinion. Here is the study the examiner used to link Sleep Apnea to Mental Disorders.Psychiatric Disorders and Sleep Apnea article.pdf You could actually submit the article as additional medical evidence. [You are not competent to make a diagnosis or make medical assessments, but you are competent enough to provide medical studies, articles, etc.]

I recommend you number and underline each issue of the lay statement your ex provided. We both know those friggers aren't going to just read it without being pointed to what they need to read. For example: 1. Flat Feet 2. Ankles 3. Knees 4. Back 5 Sleep Apnea and Asthma You're fortunate that your ex is a nurse. That's as detailed as a statement can be.

Post what you have. REDACT OR DARKEN OUT any personal identifying information.

I think vets should also be compensated for doing the raters job...GS11 pay sounds like a good starting point. lol.

I'll take a look at it. Be sure to Redact or darken any identifying personal information.

Since you did not appeal the C-spine claim, you'll need to go the Supplemental Claim route to re-open. It appears you have "new and relevant" material. Highly probable is not sufficient enough language for VA law to grant a decision based on a private dr. stating this. Although it brings up a reasonable amount of doubt. The VA has to send you to a C&P exam to get the proper nexus, if your private dr. can't or won't correct this. Here is what is required for a granted decision- The veteran's claimed condition is: (either one of these three) 1. "due to" (100% probability) the claimed condition is the result of military service. 2."more likely than not" (greater than 50% probability) the claimed condition is the result of military service. 3. "at least as likely as not" (equal to or greater than 50% probability) the claimed condition is the result of military service. The other route to take IF this claim gets denied, is secondary connecting the C-SPINE condition to your service-connected back condition. Here's a quick hip pocket lesson on how the musculoskeletal system works: For the most part, every issue begins from the bottom; to the top. Our feet are the foundation of how we get around, then the ankles, knees, hips, lower back, mid back, neck, then head. See where I'm going with this? [ You can also claim secondary issues that are on the opposing side of where the service-connected disability is located at, but I can explain that later.] Since you have a back issue that is below your C-spine; your C-spine qualifies for secondary connection. These are just recommendations. Best wishes.

Good to friggin' go and congrats! Deferred is actually a good thing, it's not a denial. Basically, your claimed condition or conditions needed to be sent back for further development. All you need now is an additional 10% to get that 1 point to get 95%...which gets rounded up to 100%.

I got a C&P exam for sleep apnea secondary to PTSD. Here's how my case went: 1. First submission denied because they said there wasn't evidence in-service for Sleep Apnea. Which I wasn't trying to direct-service connect. I had sleep study confirming I was diagnosed after service. Didn't have CPAP at the time. So, duh it's going to get denied. 2. Re-opened with VA diagnosis of sleep apnea and I had a "medically necessary" CPAP at that time. Denied again. WTH? 3. Re-opened again, but the third time I had a Sleep Apnea DBQ..THEN...I was sent to the C&P exam and I received a favorable nexus of opinion. If you get denied and you weren't provided a C&P, then the VA failed to apply duty to assist. A BVA or CVAC judge would see that. Did your doc provide you with a nexus of opinion?? Saying it vs. documentation are two different things.

If you were being treated for PTSD, then there has to have been a diagnosis in-service for PTSD, otherwise you wouldn't have been treated for PTSD. Does that make sense? Post one of the medical records that shows your treatment and the first page of your chronological history of medical problems, if you have that chronological history.In addition post your 2006 denial letter so we can review it. ***REDACT/Darken out all personal identifying information.***

If you don't mind me asking, What are your current service-connected disabilities? Assign a VSO or VA agent to assist you in applying for TDIU if your SC disabilities are preventing you from working.

It took me three attempts at the Regional Office level before they secondary connected OSA to PTSD. (I think I read you have PTSD? You can go that route too.) The battle is well worth it. There are three criteria you have to meet to secondary connect OSA. #1. Must have a service-connected disability-Your Allergic Rhinitis #2. Must have a diagnosis for Sleep Apnea. You'll also need your dr. to document that a CPAP is "medically necessary". #3. Nexus of opinion stating the minimum threshold of "at least as likely as not" Sleep Apnea is due to or the result of your service-connected Allergic Rhinitis. Here is some medical literature to research: Allergic Rhinitis&Sleep Apnea.pdf https://www.ncbi.nlm.nih.gov/pubmed/15056401

You can try to get them listed seperately, but if they're grouped together, it's likely that they are secondary conditions. Secondary conditions get their own ratings anyway. You are very fortunate to have that many issues service connected AND secondary connected. All you really need to do is request increases, when the medical evidence clearly shows worsening of symptoms. Refer to the Gout ratings that I provided. Do you believe your gout symptoms have worsened over the past 3-6 months? Have you been seen at least twice or more a month for exacerbations of your gout?? I see you're 0% for Allergic Rhinitis. Code 6522: Allergic or vasomotor rhinitis is the swelling of the tissues lining the nasal passage because of allergies or other inhaled triggers like smoke, fumes, etc. This causes the nose to become stuffy and runny. If the rhinitis is fairly constant and there are growths forming in the tissues, it is rated 30%. If there are no growths in the tissues, but 50% of the nasal passages on both sides or 100% on one side is blocked, it is rated 10%. I'd see about getting Allergic Rhinitis increased to 10%. Have you been diagnosed with Sleep Apnea and require a "medically necessary" CPAP machince? You may be able to secondary service connect Sleep Apnea to Allergic rhinitis. Read this VA case for a better understanding of what I mean. https://www.va.gov/vetapp16/Files3/1618940.txt

Gout is a form of arthritis caused by high levels of uric acid in the body. Gout falls under diagnostic code 5017, but it is supposed to be rated under 5002 Atrophic Rheumatoid Arthritis. Gout must be rated seperately. 5017 Gout. The diseases under diagnostic codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002. 5002 Arthritis rheumatoid (atrophic) as an active process For residuals such as limitation of motion or ankylosis, favorable or unfavorable, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Note: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation. IBS and PFS involving the knee can't be seperated, BUT keep in mind that the opposite knee eventually will begin to cause you problems, on a secondary basis caused by your Left Knee. Your left knee can also cause hip and lower back problems, eventually, as well.