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pog
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Posts posted by pog
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Word. I'm not stressing over what the VA will do, I'm not concerned they will "screw" me. I've been treated fairly and with respect every time I've had to deal with them. I can prove my case it just might take more time. I'm cool with that.
What frustrates me is to have my question derailed - I get it. The statements might be verified. But given that they are credible what are the implications of the C and P examiners opinion? - I have yet to get an answer on that.
I think the CandP opinion helps me but I don't know why it did not include a reference to my doctors nexus letter (it was in the list of evidence considered).
Thanks for the words of encouragement Pete and Blackbird.
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The buddy statement is very strong. It has all of that. It has everything but the notary seal. I'm not at all concerned about the buddy statement not checking out. My question is about the raters decision. Can the rater ignore the C and P examiners opinion and a sleep medicine physicians opinion that it is linked to service? (Given that the statement is truthful and verifiable)
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No... She also had my sleep medicine physicians opinion who reviewed my medical records that "more likely than not" my sleep apnea was related to service as it was present but undiagnosed b/c of other medical issues. She listed my doctors note in the evidence she reviewed but was not in her "impression" where she said "at least as likely as not". I don't know why.
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So.... Carlie.... What is your JHMO on the rating in light of this CandP opinion?
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They will all check out. Only one was a buddy I served with. One was a homeowner who I was guest of, the other was my girlfriend at the time. When they check out the statements... I should be rated right since the CandP examiner said "at least as likely as not"?
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I received a copy of my C and P examiners impression today. She wrote...
"It is at least as likely as not that the veterans current condition of obstructive sleep apnea existed during military service as evidenced by multiple buddy statements to support the presence of snoring, apnea and sleep disturbances during active duty, symptoms which are consistent with sleep apnea."
Does this mean Ill be rated for sleep apnea?
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I received a copy of my C and P examiners impression today. She wrote...
"It is at least as likely as not that the veterans current condition of obstructive sleep apnea existed during military service as evidenced by multiple buddy statements to support the presence of snoring, apnea and sleep disturbances during active duty, symptoms which are consistent with sleep apnea."
So what do you guys think?
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Hey Guy's,
I had my CandP exam this morning. The examiner (I'm not sure she was an MD or not...) commented on my evidence by saying it was "good" what ever that meant. I think was just trying pacify me.
But when I gave her my nexus letter from my doctor she asked "Who wrote this?" then She asked if my doctor was a VA doctor. Then she commented that the language in the letter was exactly how medical opinions are given by the VA. Then she read the sentence..."Based on my review of his service medical records, I believe his sleep apnea today is more likely than not related to military service, as it was likely present and undiagnosed at that time." I took that as a good sign.
Other than that... We'll see soon.
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The VA just called to schedule my C&P Exam for this coming Tuesday at 0900. As you can see below this is for my reconsideration of sleep disorder as Sleep Apnea. I'm not sure what to expect since I got the sleep study already done and they are not making me take another sleep study. Any tips for a sleep apnea c&p exam would be very welcomed.
Thank you all so much for your feedback.
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pog,
No matter what - a claimant needs those 3 things.
BOD is a whole different issue.
Read those 3 cases again that I posted.
carlie
Thanks Black bird! I think I'll lay down the cash for Dr Bash :o And get an air tight IMO. I just got a packet from the VA. They said they will schedule VA claim soon, and outlined what they need and will do to resolve my claim.
Carlie, I went back and looked over the cases you linked to. As near as I can tell the BOD is for application when "...there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter.
That's what I ineffectually tried to communicate when I said. "And at least 50 percent likely hood of a nexus to military service".
Do you think a nexus letter written by Dr Bash to satisfy the VA needs is a good idea at this point?
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Carlie,
Let me see if I understand... For the benefit of doubt to be applied in a case you still need three things.
A current diagnosis of a disability as defined by the VA.
A history of cause, origin, or aggravation of said disability originating in active service.
And at least 50 percent likely hood of a nexus to military service.
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So what do I need to do to not even make it a question of a balance of doubt? I had sleep apnea that started in active duty. How do I make this clear for my C&P exam?
I'll shell out the cash for a IMO if it would make the difference.
I have a Negative counseling statement for falling asleep on the side of the road in my car on the way back to work. How can I enter that in as evidence to be considered?
You guys are such a great help. Thanks for all the help you've given so far!
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Carlie, Got it. What do I need to bring to my C and P exam, and what do I need to be ready to tell the examiner?
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Thanks man! Anyone with some experience with the VA got any impute here? I want to put my mind at ease here cause I'm driving myself up a wall.
After reviewing the patients service medical records and current medical notes is is my professional opinion that the sleep apnea symptoms that are documented on active duty are at least as likely as not related to his sleep apnea condition today.Thiss is close to what my doct did for mee (for diferent condition) and won my appeall. I just repplaced my conditions with yours. Of course this would be just an examply.
good luck
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What can I do to further strengthen my nexus letter/claim?
I have a developmental counseling for going home to sleep when I should have been at work and being late to work because I pulled my car off the side of the road to sleep. How do I enter the counseling statement into my VA claim as evidence?
I'm going to get a buddy statement from someone who heard me snore loudly many times.
But as far as this nexus letter I don't know what else to do. If I must have yet another one written I'm going to have have to hire and IMO. (Sigh)
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I went back to my Dr today and this is the letter I was able to get him to write. Is this good enough?
Dear Sir/Ms.
I am writing this letter on behalf of my patient, Mr. Pog, who is under my care for obstructive and possibly complex sleep apnea syndrome. I am a board certified sleep medicine physician.
I have reviewed Mr Pog's service medical records from May 2007 to November 2007. I have also reviewed a developmental counseling from 01, October 2007. Based on my review of his service medical records, I believe his sleep apnea today is more likely than not related to military service, as it was likely present and undiagnosed at that time.
Mr. Pog provides a history that suggests symptoms consistent with sleep apnea during his time of military service in 2007. At that time, he was under medical care for both depression and post traumatic stress disorder, both of which could have contributed to these symptoms, as could have the patients medications at the time.
However, I believe that it is more likely than not that Mr. (first name) did suffer from obstructive and possibly complex sleep apnea at the time of his military service, and that his symptoms, consistent with this disorder, were not recognized, due to his other medical problems.
Please feel to contact me for additional information if necessary.
Sincerely,
Dr SoandSo
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Its probably not strong enough. The Doc really needs to say its their opinion and not what you reported to them'
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I would ask the Doc to shore it up if they can see fit to doing it.
Then in the assessment portion of my chart he wrote.
"I beleive it is as likely as not the pt had sleep apnea while he was in the Army."
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Hi folks,
I asked my Dr for a nexus letter. He complied. So I thought. He made a note in my chart, that I have forwarded to my VSO.
In the section of my notes under "History of Present Illness" the Dr noted...
"Patient reports that OSA symptoms began while he was in active military service, while serving in the Army. He believes that his symptoms were present, but were at the time attributed to PTSD and depression. I HAVE REVIEWED SEVERAL SERVICE MEDICAL RECORDS THAT ALLUDE TO SLEEPINESS AND UNREFRESHING SLEEP AT THAT TIME."
Then in the assessment portion of my chart he wrote.
"I beleive it is as likely as not the pt had sleep apnea while he was in the Army."
My question is... Is this strong enough to link my Sleep Apnea to service for disability rating?
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I was awarded 50% for PTSD starting the day after my discharge from the Army by the VA. As I was researching my appeal I started to realize I should have been Boarded instead of Chaptered. I had a clear diagnosis of PTSD, from an independent PSYCHIATRIST but the Army mental health said I should be Chaptered. At the time I just wanted out because I was working in a clearly hostile work environment.
Is it possible to appeal my chapter to receive the benefits I would have received if I had been med boarded?
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...VBA will not consider that,
" "I have a diagnosis from a MD who ordered a sleep study and prescribed a CPAP and I am certain that it is service connected."
The VBA will have to have a doc's opinion in writing that your SAP is secondary to your PTSD or a direct SC'd disability as shown
in SMR/STR's.
As I mentioned before I am visiting the MD that diagnosed my SAP to get a nexus letter on the 15th. I am going to ask him if he can give his written medical opinion that my central sleep apnea is at least "as likely as not" either caused to aggravated by my prescription of Lorazapam for acute anxiety (PTSD). This seems to be the strongest link I can make as a lay person. Any suggestions you all may have are welcome!
As for my NOD... I think the regional VA office interpreted my "Request for Reconsideration" as an NOD. I think this because they sent me a letter informing me they received my letter disagreeing with their rating decision and out-lining my options for appeal. So its appears to be a moot point now, as the VA has responded to me as if I had filed an NOD.
Thank you very much Carlie for your thoughtful response. You seem to have it together as to how to approach the VA.
V/R,
POG
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I've not received little more than a knee jerk reaction to file a NOD here. I've talked to two VSO's and both suggest the best thing for me to do is file a request for reconsideration. I'm going to stick with that plan. I'll update this thread either way it goes.
On the 15th I meet the MD that prescribed my CPAP. I'm going to bring him any evidence from what Army medical records I have on had that I think could be evidence of sleep apnea in service or conditions I was treaded for in service that could aggravate sleep apnea and ask him to write a nexus letter.
Thank you for all your feedback, and I'm still open to it.
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pog,
At this late of a date, the VSO putting in a request for reconsideration
is absolutely crazy.
You need to file a NOD and you need to have a date stamped copy in your hand
I would say no later than 2/15/2010.
Your NOD can address the fact that at different times, different doctors and examiners will refer to the same condition under different verbage of diagnosis.
Sleep disorder/ Sleep apnea are along the same lines.
Get that NOD in or kiss your effective date good bye.
I would NOD every issue on the 2/18/2009 Rating Decision that was either a lowballed grant or out n out denied, if I had the medical evidence
to support a higher percentage or grant for SC I would file that NOD.
jmho,
carlie
That's kinda what I thought but my VSO was adamant that this was the last best option I had. I don't want to ruin our relationship if she is going to represent me. And I don't know how I should go about asking for another opinion from another DAV VSO in the office. Should I hire an attorney or go the VFW or something else?
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The NOD may negate the reconsideration but you are going to run out of time. You have one year to file a NOD. If that runs out and you lose the reconsideration you are going to lose your effective date. You may be better off opening a new claim for sleep apnea. How are you linking sleep apnea to PTSD? Is there medical literature that links PTSD with sleep apnea. What is your nexus from PTSD to sleep apnea? If you are obese the VA is going to say that is the cause of your sleep apnea. I understand a sleep disorder due to PTSD. I don't understand sleep apnea due to PTSD. Probably my ignorance. As far as I know the VA has to complete the reconsideration before the one year for the NOD. With four weeks left in February that is uncertain at best.
I'm not linking it to PTSD unless my MD can do this. I was going to ask him to make the connection that the allergic rhinitis I was treated for while on active duty is as likely as not to have aggravated my sleep apnea.
I was also going to ask him about the likely hood of my PTSD med's contributing to my mild obesity, that caused or aggravated my SAP.
The ultimate truth of the matter is I did not have Sleep Apnea before I was on active duty. But during active duty I would wake up chocking and gasping for air. I thought this was a result of the nightmares I was having. It was not until I discovered what sleep apnea was that I realized what I had. But I had already filed the claim for sleep disorder.
I got my own sleep study done privately and just received the diagnosis.
My VSO wrote the request for reconsideration to the VA as follows:
"Request for reconsideration for decision dated 2/18/2009, regarding the denial of entitlement to service connection for sleep disorder. Mr POG did file a claim for sleep disorder, but he was suffering from sleep apnea. Please re-develope the claim for sleep disorder as sleep apnea.
It is respectfully requested all appropriate action be taken to assist in the development of the facts pertinent to this claim pursuant to the regulatory provision of 38 CFR etc. Should thorough and contemporaneous examinations be deemed necessary to ascertain eligibility for the benefit(S) sought, then we ask they be scheduled in accordance with regulatory provision of 38 CFR etc.
Once complete records have been obtained and reviewed by the rating board, we ask a determination be rendered which is considerate to the regulatory provision of 38 CFR etc. We further ask that any additional pertinent regulatory provision, statutory guideline, or holding by the US court of appeals for veterans claims applicable to this claim be utilized in the determination."
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If the VA said denied due to no diagnosis-
I dont see why the way you worded the claim(as secondary due to PTSD) would matter.
You could appeal that there is in fact a diagnosis.
Can you scan and attach here (cover personal info) the decision as to exactkly how the VA worded the decision?
"I have a diagnosis from a MD who ordered a sleep study and prescribed a CPAP and I am certain that it is service connected. But what are the chances they will make the effective date of the decision the same as my PTSD claim?"
Did the VA receive that MD's diagnosis and list it as evidence prior to making their decision?
Did the MD (or could the MD ) make a statement that it is more than l;ikely the sleep apenea is due to your PTSD?
I dont feel a Reconsideration request will be process in time - as your NOD date is running out.
You can attach any evidence whatsoever that helps this claim to the NOD but it would help us to know exactly how the VA worded that denial.
If the rep files the reconsideration request make sure it is also considered as a NOD if the request is not acted on expeditiously (and make sure a NOD is filed separately too-in time- one year after the decision date you are nodding.
The recon request will need some evidence they haven't seen yet or have but never considered in the decision.
No I just received the diagnosis a few weeks ago. I attached the medical records from the sleep study that I got on my own. On the 15 FEB I'm visiting my doctor to request a Nexus letter. When I booked the appointment his receptionist said he has written nexus letters before. I'm very clear on what I need to get from my private MD as far as a nexus letter.
What I am less clear on is if I should file an NOD. My VSO was very sure that because I had claimed "sleep disorder" and not "Sleep Apnea" the VA had not evaluated me for sleep apnea and their decision would stand. She said my only chance was to file a request for reconsideration because I had claimed the wrong condition. And to submit the recent diagnosis and nexus letter. Should I listen to her? If I file a NOD won't it negate the request for reconsideration?
Thank you for your answering...
Nexus Letter
in IMO Independent Medical Opinion
Posted
Claim was granted according to the letter DAV sent me today. I'll get the official decision from the VA soon.
Thank you all for your suggestions.