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Regulatory And Procedural Review

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Ok I have not posted in quite a while. My current claim just moved to complete. This claim took exactly one year. My claim was for insomnia with sleep apnea, major deppressive disorder, and ptsd. The only c&p exam i got was for a pscharist they didnt get me a sleep study. In october my house burnt down and i am now in the homeless program living in a transitional housing unit. I have been trying to get a sleep study for over two years. Last month my homeless counser made a request to get me a sleep study. I had a appointment in less then a week and recieved my cpap last wednesday and on friday my claim became complete. and there is a regulatory and prodedural review posted on ebenefits. and my folder moved from muskogee to souix falls. What does the review mean. I am still waiting on my packet and I know I will have to appeal it because of the cpap.

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1.  Sleep apnea:   A "diagnosis" of sleep apnea alone wont get you much, even if SC.  You need to be actually using a CPAP, prescribed by a doctor, and the doctor has to say its "medically necessary" for compensation at 50 percent, "but only if" you meet the Caluza elements for SC. 

    Given that you have been diagnosed with PTSD, some Vets have obtained SC for sleep apnea "secondary" to PTSD.   To get sleep apnea secondary to PTSD, a doctor would have to give an opinion that your sleep apnea "at least as likely as not" was due to your (service connected) PTSD.  

2.  A "regulatory and procedural review" likely means VA made one or more mistakes with your claim, and they are trying to fix them prior to the decision.  Some examples are failure of duty to assist, or possibly some sort of confict with the records, such as missing cfile, could have generated the review.  Its probably good news.  

3.  A year is quite long for an initial VARO decision, or an increase.    THIS could have even generated the procedural review.  If you dont have a home, its tough to get mail and the VA may have requested some information from you, and you didnt get the letter because you dont have an address.

4.  Most importantly, VA needs to be informed you are homeless.  They are supposed to give you priority, and that seems to have not happened.  Many times the left hand does not know what the right hand is doing..you may have told your doctor you were homeless, but that information may not have been passed to VBA (Vets benefits and Vets health are seperate)

5.  If you are trying to find out in advance of VA mailing the packet there are 2 methods to do so.

      A.  Check ebenefits letters to see if the letter generator shows an increase over 30 percent.  The effective date will likely be wrong in ebenetits/va.gov.  

      B.  Check with your representative, such as your VSO, who has VBMS access.  Not all VSO's have VBMS access, but this has your cfile in "real time", much more updated than simply ordering your cfile.  

    My advice:

1.  Wait a week or so, then begin running down what happened.  

     A.  File an IRIS email request on status of your claim.

     B.  Call Peggy and ask the status.

     C.  ASk your representative to give you the status.  

     D.  Call the white house hotline, and ask why you are homeless and it still takes a year for a decision, when the average is supposed to be 125 days.  

2.  In the interim, if you dont have a bank account, try and get one for direct deposit..its faster than a paper check.  There are alternatives to bank accounts but a bank account is best.  

3.  If you find out some favorable results, based on the above, you can begin making plans, to include obtaining a place to live.  Ask for help.  Some states have special funds to help homeless Vets, but if you dont know about those, you wont get any help.  

4.  If you are unable to work, consider applying for tdiu.  And, file for social security disability if applicable.  You can get both VA and social security.  



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broncovit has some great advice and info.

As for as requesting the IU  , If I was you I'd wait to see what they rated me  because you may get a 100% rating on what all you have filed.

  especially sleep apnea secondary to your PTSD if you can get a qualified  Dr to  state  his opinion that your sleep apnea " is at least as likely as not" was due to your (service connected) PTSD.   or the medications you take for PTSD including sleep meds.   another thing for sleep apnea dr would need to say your c-pap machine is medically needed for you to use. the use of a c-pap machine is automatic 50% 

However if your 30% currently  your going to need some big percentage increases to reach the 100%  so If I was you I would file on everything you can   because with your ptsd rated at 30%    another  combined increases  to  even 90% would only put you up to the combined 90%  so file on each and every condition you can get service connected.

30%plus 90% in va math is 94% rounded back down to the 90%

also some of these meds will cause ED  that is not a direct service condition but it can be filed secondary to your PTSD also  they will service connect it at 0% and it pays another 138.00 month in addition to what your being paid  even if you get the 100%

 and you may not need the TDIU  ..I am only mentioning this because with TDIU you can't work, if your 100% you can work   Remember both of these pay the same  100%  so if your rated 100% then you can work and make extra income  as with the TDIU you can't

As for as an increase on your PTSD you will need a C&P Forensic exam, even if your records show you have been rated for PTSD. at 30%


Edited by Buck52

I am not an Attorney or VSO, any advice I provide is not to be construed as legal advice, therefore not to be held out for liable BUCK!!!

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VA does not have to give you a C&P. they can just look at your records. here you filed for SA while you did not have a Dx of it, then you got one some time later. Now they see it in your records. They do not need to have a C&P to see that your records show that you now have SA.

Good luck in the nexus.

James A. Bunker

Executive Director

National Gulf War Resource Center

Phone: 785-925-9887

Email: Do not post your email address.

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