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bellrungboxer
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Posts posted by bellrungboxer
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I just got my letter for my 50% rating for the central sleep apnea secondary to my TBI in record time 2 week turnaround!
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Just wanted to put this post out there because it genuinely took me as a shock. Luckily, it shouldn't have a huge effect on me, but it really might for some.
So as most know, each state has different benefits given to vets with disabilities and most notably is that many states give property exemption for 100% P&T or TDIU vets. See link here for info:
https://www.military.com/benefits/veteran-state-benefits/state-veterans-benefits-directory.html
This is all fine and good, but I just applied for my exemption in my state only to learn that I would see no benefit from it until September 2021. The reason behind this is that our state is bass ackwards and pays property taxes in "arrears". So September 2020 and March 2021, I will actually be paying my 2019 property taxes, since my application will for some reason only begin for the 2020 property taxes that are to be paid September 2021 and March 2022.
Maybe this all makes sense to you all, and I hate to bite the hand that feeds, but I will be contacting as many state government officials that I can to try to get this changed so that it is effective upon application. I can afford to pay until September 2021, but what about someone who had to go on TDIU suddenly or for a widow of a vet that passed from a service connected injury?
So moral of the story is, check on all of your bennies because some of them may still be just out of reach.
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Hold up, I thought that DBQs via virtual C&P exam were what caused the removal of public facing DBQs
I won't scratch my head TOO hard.
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13 hours ago, pacmanx1 said:
Good post only wish it was in writing. Hopefully VA will put out a letter.
I'll give the White House VA Hotline a call today to see if they can email me a response.
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MAJOR FYI:
I just got off the phone with my county VA rep and we talked about the DBQ removal. They said that in a phone call today, the VBA had listened to the multiple complaints and the sudden removal without any guidance on current DBQ holders. So here's what they have been advised:
DBQs will be accepted and effective up until June 1st
I asked if we were still able to have new ones filled out, and they said that the VBA did not say they would be disqualified prior to June 1st. However, they advised to have them filled ASAP so that it was near to the sudden removal. They also said that many local VA reps may have some of the DBQs saved.
TLDR: GET DBQs FILLED OUT AND FILED BEFORE JUNE 1ST!!
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I took a deeper look into @JustGettingStarted 's post about the removal of the public use DBQ's and found the OIG's Investigation Report
QuoteThe OIG found that claims processors awarded benefits based on questionnaires completed by private providers located in a different state or country than where the veterans reside, without evidence that the examinations were completed in person. VBA’s internal controls over public-use questionnaires remain inadequate to prevent the use of telehealth disability benefits questionnaires. As a result, the team identified inaccurate benefit entitlement determinations for 41 of the 81 claims reviewed totaling approximately $613,000 in improper payments for claims completed from April 2017 through September 2018. Public-use disability questionnaires, including telehealth questionnaires, contain an inherent risk of fraud. While VBA has taken some steps to mitigate the risk, this review identified further internal control and procedural deficiencies regarding public-use disability benefits questionnaires. Interviews with VBA staff and managers revealed a reluctance to continue accepting public-use disability benefits questionnaires. This was due to the fraud risk in using the questionnaires, as well as to the difficulty in updating the forms to ensure they remain accurate and usable for benefit entitlement purposes. These factors raise questions about whether public use disability benefits questionnaires remain a viable tool for streamlining the veterans’ claims process.
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1 hour ago, pete992 said:
Since the fact that VA may not consider DBQs as evidence, I don't see a need for a veteran to have their physician fill these form out.
So I found the VA OIG Inspector's report on DBQs from 18-Feb-2020....the public facing DBQ's are indeed useless:
QuoteThe OIG found that claims processors awarded benefits based on questionnaires completed by private providers located in a different state or country than where the veterans reside, without evidence that the examinations were completed in person. VBA’s internal controls over public-use questionnaires remain inadequate to prevent the use of telehealth disability benefits questionnaires. As a result, the team identified inaccurate benefit entitlement determinations for 41 of the 81 claims reviewed totaling approximately $613,000 in improper payments for claims completed from April 2017 through September 2018. Public-use disability questionnaires, including telehealth questionnaires, contain an inherent risk of fraud. While VBA has taken some steps to mitigate the risk, this review identified further internal control and procedural deficiencies regarding public-use disability benefits questionnaires. Interviews with VBA staff and managers revealed a reluctance to continue accepting public-use disability benefits questionnaires. This was due to the fraud risk in using the questionnaires, as well as to the difficulty in updating the forms to ensure they remain accurate and usable for benefit entitlement purposes. These factors raise questions about whether public use disability benefits questionnaires remain a viable tool for streamlining the veterans’ claims process.
Source: https://www.va.gov/oig/pubs/VAOIG-19-07119-80.pdf
@pete992 thanks for challenging me to dig deeper...I advise everyone here to read at least the report summary
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3 hours ago, pete992 said:
DBQs from this date will no longer be accepted
Are we sure about that though? I mean, it can't hurt to have a doctor fill things out in the same method that they review the private contracted doctors exams, right? Maybe you wouldn't be able to submit it as an official DBQ, but as non-government patient treatment records. Just because it isn't an official form, doesn't mean it is disqualifying information, but then again nothing really surprises me anymore.
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50 minutes ago, Fat said:
In addition, he also stated if the air pressure is too high during the titration, it would give a false reading regarding CSA.
Yes that was absolutely my case. Mask leaks are also a culprit of this. My centrals skyrocketed on the AutoPAP at it's lowest setting. I felt like it was choking me and made me feel like I was hyperventilating because of the force I had to use to exhale against the pressure.
Luckily, this sleep doc at the VA is perceptive and she moved me to the BiPAP ASV. It is apparently a much more expensive machine, so they don't suggest it often, but it has been a dream ever since. I can ramp down from 5.0 to 4.0 and the ASV automatically lowers the pressure when you go to exhale. Between that and the new mask they gave me (F&P Vitera full face) the experience is much more tolerable.
1 hour ago, Fat said:Good luck BellRungBoxer and the BVA will get you victory.
So after getting my denial letter yesterday, I read through the evidence list (thanks hadit members!) and noticed that my Sleep Doc DBQ with her treatment notes with a positive nexus were not included, so I'll go with another supplemental and cross my fingers hard!
Let us know how your situation continues as well!
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27 minutes ago, Fat said:
There is literature which supports the connection of CSA to TBI.
This is what my TBI neuro doc sent me: https://www.dovepress.com/traumatic-brain-injury-induced-sleep-disorders-peer-reviewed-fulltext-article-NDT
I added it to my previous supplemental, but it appears that they made a decision prior to receiving my DBQ and positive nexus, so I should be good to go on this next supplemental.
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My past few supplemental claims have had the following:
October 2019 to Jan 2020
December 2019 to March 2020
Jan 2020 to possibly the end of this month, it appears that there is movement via vets.gov
With the Coronavirus stuff, I don't think it would affect Supplementals or HLRs, but I could see it clogging up BVA for a bit.
I will say that my recent supplemental had a similar issue as yours...it went SO quick that some of my evidence from the end of February wasn't included in my rating. Because this is crucial evidence (DBQ and "more than likely"), it's time for Supplemental #2.
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1 hour ago, deedub75 said:
They are processing supplementals and HLRs in record time now.
You got your supplemental completed in record time and it wouldn't be a surprise that they did not do any research on it. If you have the evidence to show the effective date you have and they are moving at record pace on supplementals, what is the cost of going that route first?
I will admit though, I'm a novice at this and have only done supplementals because I have wanted to add to my claims to weigh in my favor prior to going the other routes.
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2 hours ago, rootbeer22 said:
I've been at 90% for a while and have been thinking about trying to "push up the mountain" for the other 10%? I was pretty close but did not want to endure going through the process again with all of the waiting and pain. But now that there's a new system maybe I'll try it? I have to do some research on the VA Claims Modernization Act to see if it's actually helping or hurting veterans that have been submitting claims since I left the board? Before, I left I had a about 4 claims that got denied even with good evidence but just did not want to go through the pain again.
I have been fortunate to have only been climbing that last 10% for three years. I have pushed VA doctors to correct patient treatment notes in myhealthevet, been sure to explain my symptoms to them in rater's terms, and I've been relentless at using every test or procedure available through the VA to document the ailments and I still have three more claims to continue to fight on. I would encourage you to make a move up the mountain, especially if you are having conditions worsen as time goes on.
The claims and appeals process has sped up, but just because the shade of lipstick became more appealing doesn't change the fact that it's an ugly pig wearing it. Getting denials sooner than before doesn't make you happy, but if we attack them with their own playbook, you increase your odds of catching them with their pants down. The claim that put me to 100% was a 30% migraines claim that I put in for an increase to 50%. Instead, they dropped me to 0%.
But by doing some reading on here, scouring through my health records, and putting my VA doc on the spot with a DBQ in hand, I gave a reversal a shot in January and it just now paid off.
@rootbeer22, I hope you give it another go and let us come along for the ride
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2 hours ago, broncovet said:
If you have new evidence, then its supplemental Claim lane or BVA.
If you dont have new evidence, then its Higher level review or BVA.
BVA take longer but you are more likely to win benefitis.
Now, you can still go on to the BVA AFTER a denial of either HLR or SCL, but that just takes more time. Some recommend going direct to BVA. I concur.
That is very helpful! Thank you
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After checking the mail religiously for weeks...I finally got the letter bumping me up from 90% to 100% P&T! I still have more claims to fight for, but this is such a relief to finally have this milestone met. I am sticking around here in this community to help others get what they deserve and I can't wait to hear more success stories!!
Now I just have to figure out the additional bennies outside of the increase...
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@broncovet which appeal do you suggest for showing a medical record is less than one year prior to the increase request? I have a medical note from November 2018 hospital visit showing I claimed I was experiencing more than 1 migraine per month plus my migraine log that dated back to July 2019 for proof that this increase is earlier than the effective date of October 2019 that they gave. It isn't much proof, so I am hoping that doing this won't open me up to losing my 100% P&T.
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@pete992 I got the denial letter today. Even though the decision was dated March 18th, they somehow did not get my DBQ and physician's notes that were sent on March 5th. So, a supplemental claim will be on it's way and we shall try again!
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This is awesome! Congrats!
I may need a similar letter if I have to resort to a CUE, so thank you for the question and thank you @Berta for the template!
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Does anybody know if there is a certain place I should post the files, or a moderator I need to send them to?
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Can these be downloaded and posted to the site?
Edit: I saved all of them in case it is needed on here. What is strange is that some of these forms "expired" back in September 2019.
- Vync and JustGettingStarted
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3 hours ago, Fat said:
The CSA mainly occurs on the second night of tritation while using the CPAP.
I have heard/read the use of a CPAP can cause a unusual reading regarding CSA.
Yeah, this sounds like textbook "Treatment Emergent CSA". It's supposed to eventually go away in OSA cases after continued use with the CPAP, so if it dropped your amount of obstructives to be lower than the amount of centrals, that is proof positive that it is necessary.
On my original sleep study with no PAP titration, I had 6 obstructive apneas, 19 central apneas, 2 mixed apneas and 31 hypopneas. Because of the inability to distinguish a "central hypopnea", they label them as obstructive and boom, I was labeled OSA. In my case though, the sleep doc noted that the amount of central apneas was abnormal and my obstructive apneas disappeared with my BiPAP ASV, while centrals lowered but were still persistent (AHI of 3.5 avg). Therefore, she deemed it "more likely than not TBI related CSA".
3 hours ago, Fat said:I SEE WHERE THE PHYSICIAN MUST NOTE: A CPAP machine is recommended/needed/necessary/essential for the treatment of the veterans OSA.
I believe this is the KEY for 50%. A word of caution on the word "recommended" though because I feel like it isn't strong enough. "Required" or the other words mentioned would be more definitive and not leave much wiggle room.
However....PAP treatment may still end up being listed as an option because there are "mouth guards" that could be used for OSA. I have an extremely sensitive gag reflex and couldn't even stand a mouth guard in sports, so that was a no go for me. Not sure if a mouth guard would be effective for your situation, but if it isn't make sure the doctor notes it or try to find literature that suggests why it was not chosen for treatment.
3 hours ago, Fat said:is a CPAP the only treatment option acceptable by the VA
I do not believe the mouth guard counts for the 50%, but I could very well be wrong. As far as the CPAP, I read that the VA classifies other positive airway pressure devices (AutoPAP, BiPAP, etc.) as equivalent to a CPAP.
Despite my VSOs hesitation due to my recent 100% P&T, I'll likely be heading to the BVA on my denial because if this apnea were to make me kick the bucket, I want the service connection.
I sincerely hope you don't have to do the same for your claim!
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Thank you so much @pete992
I really do appreciate the battle buddies on this site, so my intention here is to maintain or improve the high quality that exists here!
As for the CSA, I will do whatever I can to get it SC bc if the apnea were to kill me in my sleep, my wife would revive me just to say "I told you so"
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2 hours ago, pete992 said:
I understand that you are seeking guidance and insight.
I'm not looking for guidance on this issue from these users or others, I'm hoping to establish that previous precedents exist because my searching has nearly run dry. I have found multiple precedents that deny OSA as a secondary connection to TBI and hint that a CSA would be in favor, however, I cannot find any citations that reverse an opinion that CSA is not likely a secondary connection to TBI. This brought me to a search here, and the closest evidence I would possibly come by are in graveyard threads with inactive users. I'm sorry if this action is inappropriate in this community and I will cease and desist if that is the case.
3 hours ago, pete992 said:it is about time you start looking for an attorney
Unfortunately, this denial would not have brought any new rating or backpay, so it would be a waste of money at the time. My fear is that my Central Sleep Apnea will have impacts on other areas in my body later in life and I would like to have some assurance.
If I am misusing this community site, please let me know. I'm not trying to be a nuisance, I have just been excited to see the knowledge and wisdom here and I hope I can be able to contribute to other vet's claims from my own experiences.
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@Fat I see that you mentioned that you had both CSA and OSA. I was given a diagnosis of OSA at the get go despite having more central apneas than obstructive because they "lumped' my hypopneas in with the OSA. Once I began treatment via BiPAP, the obstructive apneas went away and I still had persistent CSAs, which my VA sleep doctor stated was "more likely than not" connected to a service-connected TBI. Unfortunately, it seems that this was still denied despite the "magic words".
I say all this because I honestly don't understand how the VA goes about awarding Sleep Apnea claims. I thought I had bullet-proof evidence, but I'll see what's missing once I receive the denial letters.I'm also curious how you went from OSA to CSA to OSA again. Did the doctor have any opinions on that? CSA is a very rare issue when seen on its own because it usually is brought on by significant issues. However, if this was a CSA diagnosis while on CPAP, apparently it can be a negative reaction caused by CPAP use. I only mention this because they will try to fight on every angle and reading up on all the different forms of apnea has really helped me discuss things with my doctor that would have otherwise been overlooked. Obviously, it still hasn't paid off for me yet, but I hope you find success on landing the 50% rating!
Tbi And Central Sleep Apnea
in TBI Traumatic Brain Injury
Posted
As unbelievable as it seems, I filed a supplemental appeal and resubmitted the same evidence with a Claim Information form (im blanking of the form #) on April 16th , and they granted 50% on April 30th!