Dustoff1970

I recently underwent two separate ACE exams from Optum Serve (LHI) for revaluation of my 60% Agent Orange Nam heart disease and within two weeks or less the VARO notified me by regular mail decision that my 60% rating would continue unchanged.
Both records ACE exams conducted by NP examiners.  I suspect the VA raters wanted to reduce my BVA approved increase to 60% but no joy for the chicken chit raters.
 

Before VARO makes a decision on your first HA you can file additional information and/or evidence about second HA to the VARO using the VA form 21-4138 STATEMENT IN SUPPORT OF CLAIM and if you do not have this now old superseded form (I am told) you can use plain sheet of paper and type STATEMENT IN SUPPORT OF CLAIM at the top of page in larger bold type.  This has worked well for me many times since 1998 and most very recently in claims and appeals.
Be sure in your new correspondence you use the VARO reference numbers at top of their pages in reply to you and must include your name, C-file number and last 4 of your SSN plus date of birth on each and every page you send them.
Some one else may know the new form number that replaced 21-4138 if there is one.  I made many copies of the old blank 4138s and still use them if I can find them in my filing cabinet.
My comment is not legal advice as I am not a lawyer, paralegal or VSO.
 
 

Since you have apparently been diagnosed with OSA Apnea and presently suffer from it then you need to seek or continue treatment for the OSA while on active duty and make sure this is documented in your MSR medical records.
If you were issued a CPAP machine for OSA by private or VA doctor then continue to use it and/or ask for one at your active duty station medical clinic. It would be very helpful if the the military does another sleep study on you and issue you a CPAP.
It is very important for you to obtain like I did copies of your medical treatment notes, diagnosis at your active duty locations.  Friendly med clerks are your best friend.  Make extra copies of these records and hold them dear to your heart for future VA use just like I did in Nam and Japan in 1970.
During or after your active service you can file a new VA claim for direct service connection with the new evidence obtained and created on active duty.
Military medical records are like gold in the bank vault.  I know from experience.
My comment is not legal advice as I am not a paralegal, lawyer or VSO.

Sounds like you have a very good aggressive attorney and stay with him or her.  You have many options if BVA judge denies.  Unfortunately, it is common for many non-lawyer BVA judges not to know their *** from a hole in the ground but they all have staff attorneys that should know the law and regulations. Good luck