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Need Help W/imo 2Nd To Ptsd For Osa And Dc Possibly Type 2 Diabetes.


Hi all,

currently have osa on appeal as my initial claim I didn't have an IMO. I'm 70% ptsd, major depression/panic w/agoraphobia, 20% bilateral shoulder dislocations (major and minor), 10% HTC, 10% Tinnitus...90% combined.

I have increase tdiu for ptsd and appeal on my b 70% from July. Guy said I should be 100 but Cuz I worked 2 yrs ago, he had it at 70. My osa I use full face sleep mask pressure is 13.0.. Finally got sleep study in 2010 were was diagnosed. Complained for 5 yrs prior.

I believe my osa is due to my massive 150 lb weight gain due to. My ptsd...I'm in Boston area, who can someone recommend. Don't have insurance. Ch 61 retiree from usmc for shoulders and ptsd.

I also recently was diagnosed with type 2 diabetes last February. Any Suggestions?

I'm currently in 3rd week of CUP program for ptsd at VA.

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clarification of my previous post.

current VA rated disabilities SC'd: PTSD/MDD/Panic w/Agoraphobia) 70%, Bilateral Shoulder dislocations (20/20 plus bilateral factor), 10% Hypertension, 10% Tinnitus

I'm a chapter 61 PDRL Retiree 2007 for PTSD & Bilateral Shoulders.

Not yet SC'd: Sleep Apnea (VA diagnosed & issued CPAP), DMII (type 2 diabetes, take Metformin pill)

Other Non compensatable disabilities:Hyperlipidemia (High Cholesterol), Obesity

  • Filed Claim for Increase, is in the gathering of evidence stage for TDIU, for PTSD filed Dec 2013

  • Filed Appeal 70% PTSD rating which was continued from previous 70% rating. The C&P examiner said he believed I should be 100% but due to some work in the past, lowered his to 70%. This C&P was in June 2013. I have not worked since Dec 2012.

  • Another appeal still at RO from initial denial for SC'd for OSA 2011 time frame. I'm looking to obtain an IMO for My Sleep Apnea to be service connected secondary to my SC'd PTSD. I don't think my original claim was secondary to ptsd. I think it was purely a stand alone claim for sleep apnea. So, I'm wondering if I must file a new claim for OSA as secondary to ptsd. I currently use my VA issued full face cpap machine with pressure at 13.0

  • Diagnosed with Type 2 diabetes (DMII) Last Feb 2013. I'm wondering if I could get an IMO as Secondary to my PTSD. I'm relating my massive weight gain (150lbs gained) due to my PTSD/MDD

I'm wondering what steps I should take next?

I've never had an IMO, how does one go about it? who can anyone recommend in the greater Boston, MA area?

thanks to all that take the time to read this and/or reply. I truly appreciate any help.

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Maybe an IMO for Dr. Bash might be the only way to get OSA SC'ed if you have no record of it in service. OSA is probably due to weight gain.

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well I did some research on my own timeline....my sleep apnea 2nd to my ptsd claim was from 11/2009....denied in 8/2010, then in 2011 that was appealed. it had mulitple original claims for increase but i only appealed the OSA, which is still sitting at RO. Having sleep apnea is no picnic and dont wish this on anyone...having to be Maverick everynight (CPAP) going to bed is annoying, but Im used it by now. Still awkward to travel or sleep over someones house.

I tried to email Dr. Bash, is he the best to make the 2ndary connection for OSA to PTSD. I'm wondering what he will charge for the IMO as well.

I also became diagnosed with type 2 diabetes last yr. I have not filed any claim. I'm wondering is it becuase of my obesity, that has caused this and the obesity came from my ptsd....

when i take a step back, its depressing how horrendous of health i truly am in. Has anyone asked for an IMO for type 2 diabetes (DMII) secondary to ptsd??

thanks gents for your help...

also what is the best method to contact Dr Bash or soemone else? I hear positive things about Dr Bash just curious as how the process works in a down and dirty break down....


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This is Dr. Bash's email. Also we did SVR shows with him and John Dorley,who works with him.

All available in the SVR archives, if you click on the SVR link in that forum above.In the MArch 7 2010 show I discussed IMOs with him

and I based the IMO criteria here in our IMO forum on 2 IMOS he did for me.

As a former VA doctor and a veteran, he is very well aware of the regulations and the medical nuances that help to SC many disabilities.

John's contact info is here at hadit as well.I think he is Minnysoda,when he is on line with us.

I assume ( but dont know) that you are not an incountry Vietnam Vet or a Thailand/Korea vet who fits into the Agent Orange regulations?

If so, the DMII is presumptive to your AO exposure.

"I hear positive things about Dr Bash just curious as how the process works in a down and dirty break down...."

I had a very unusual situation. I wanted to prove that my husband died from undiagnosed and untreated diabetes mellitus due to his exposure in Vietnam.

I had already won a 1151 and FTCA claim on wrongful death so I had to shape this claim without raising the malpractice issue.

I prepared a cover letter for Dr. Bash,in which I laid out my lay medical opinion with a full medical rationale, referencing my husband's medical records and autopsy.I supported this with medical abstracts that supported my contentions.

No DMII diagnosis at all yet I proved he manifested symptoms, documented by VA, as far back as 1988,6 years before he died.

In your case I assume you have your SMRS but they show no inservice sleep problems.

I believe Dr. Bash would carefully review the SC meds you take to see if they have any impact on the OSA, asd a possible cause or an aggravating factor.

I think he would also seek a cause for the obesity ,which could in fact be an eating disorder (VA does SC eating disorders) due to the anxiety of PTSD.And would see if the meds caused the obesity.

I agree with John that the OSA is surely the result of the obesity, but is the obesity a result of the DMII?

And if so, would that help or hinder the claim,if the DMII cannot be SCed.

That is something Dr, Bash would consider.

My first contact with Dr. Bash was a brief email at the above site, in which I told him what I was claiming, and mentioned a few of the documented medical facts ,that supported my claim.

He responded, 'if you have what you said you have, this is a good case'.

Within days either I called him or he called me, we discussed the fee, and I sent him the whole medical evidence packet, a cover letter explaining the tabbed records that supported my claim, and additional copies of probative evidence,along with the fee check.

He happened to be cross country on vacation when he got it and immediately prepared a strong IMO.

In my case he did not need the SMRs. In your case I am sure he would want to see them.

"Filed Appeal 70% PTSD rating which was continued from previous 70% rating. The C&P examiner said he believed I should be 100% but due to some work in the past, lowered his to 70%. This C&P was in June 2013. I have not worked since Dec 2012."

The 'work in the past' remark is mere speculation.

The EED my husband got posthumously for 100% SC PTSD was dated the day after the last day he worked.

To me, that is a very unusual statement the C & P doc made and could be aggressively rebutted.

A good IMO could cover a rebuttal to that as well as the OSA.

"Other Non compensatable disabilities:Hyperlipidemia (High Cholesterol), Obesity"

That too is something Dr Bash or any IMO doctor will look over.

My husband's VA med recs (he had never been diagnosed or treated for DMII) was one of many records that revealed his untreated DMII.

(To even include his VA employment physical. his driver's license, and even his dental VA records.

DMII can affect almost every organ in the body.

His blood chem reports for example revealed hyperlipedimia, and high triglycerides, along with the cholesterol breakdown...a definite affect (and proof of) the undiagnosed diabetes,when assessed with the other evidence.

My point here is, did the obesity come from DMII and is the DMII service connectable as an AO presumptive?

On the other hand


(OSA secondary to PTSD at a SC non compensable rating) remanded for potential higher rating)




Service connection for OSA is granted to the extent that it is aggravated by the lack of ability to use a CPAP machine as a result of PTSD-induced sleep disturbances.”

There are certainly awards of OSA as secondary to PTSD at the BVA web site.

These specific awards however wont help support your claim, but they might provide the name of the IMO doctor in them (Such as Dr. Smales in the first link).

BVA decision , whether awards,remands, or denials contain a wealth of info on the VA thinking patterns and what evidence they need.

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PS, when you attain the TDIU or 100% (and I sure think you will with an IMO)

make sure the VA considers you, in that decision, for SMC "S" as I believe the agoraphobia should warrant SMC S.(Housebound award)

This also is something that an IMO doctor could make a supporting statement on, in the IMO.

Dr. Bash is not a MH professional, but instead a NeuroRadiologist....Still, I believe he might surely be able to provide a strong medical rationale that secondarily connects the OSA to the PTSD.

If you get SSDI solely for your SC conditions, make sure VA knows that, gets the SSA records, and thoroughly considers them for your TDIU claim.

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