Service Connecting Dvt/pe & Osa - Secondary To Sc Lumbar Disability

[Byte187]

Filed claim. Asked for advice. Moving on.

Edited September 9, 2014 by Byte187

[Byte187]

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Edited September 9, 2014 by Byte187

[carlie]

Did the sleep study provide any information on what they feel is

the cause of your OSA ?

[Byte187]

Did the sleep study provide any information on what they feel is

the cause of your OSA ?

I never talked to them about a cause. In fact, I've never met the doctor who evaluated my test, only the tech who did the test. My primary care feels pretty confident of the cause though. Who knows how the VA raters will feel about that.

[broncovet]

If your doc did a good job with the nexus, and provided a rationale as to WHY he thinks your OSA is "most likely" related to (your service connected condition) then you should get the SC for OSA. It all turns on the nexus. However, most of the time you still have to appeal even if you have a solid nexus, because the VA has financial incentives to deny you:

1. Many Vets never appeal, so you denial will become final after a year. VA wins...Vet loses.

2. Even if you do appeal, expect a very long delay. You may die or give up on your claim in this very long delay. VA wins..Vet loses.

3. If you finally win your appeal, you get paid, but the VA gets an interest free loan, as you get exaclty "o" interest. VA still wins..Vet still loses.

This is the reason VA loves denials.

[Byte187]

If your doc did a good job with the nexus, and provided a rationale as to WHY he thinks your OSA is "most likely" related to (your service connected condition) then you should get the SC for OSA. It all turns on the nexus. However, most of the time you still have to appeal even if you have a solid nexus, because the VA has financial incentives to deny you:

1. Many Vets never appeal, so you denial will become final after a year. VA wins...Vet loses.

2. Even if you do appeal, expect a very long delay. You may die or give up on your claim in this very long delay. VA wins..Vet loses.

3. If you finally win your appeal, you get paid, but the VA gets an interest free loan, as you get exaclty "o" interest. VA still wins..Vet still loses.

This is the reason VA loves denials.

To be honest, I don't think my PCP wrote a very well though out nexus. He simply wrote that it is his professional opinion, but did not go into the reasons why it's his opinion. I still expect it to have some weight with the raters though, since he's been my only doctor for the past four years (except for the specialists now working on my pulmonary embolism), so he's more familiar with me and my condition than anyone else.

[carlie]

Any opinion to provide a nexus of condition A to condition B must be supported

with full medical rationale.

If medical treaties / studies are factored in, the medical professional will also in most cases

need to associate those directly to the claimant rather than just the populace in general.

Here's some info from a BVA case that goes into more detail regarding medical opinions,

rationale and probative value.

"OSA was first diagnosed in the first half of 2008 after considering the results of a sleep study.

In July 2008, a VA physician opined that the Veteran had been diagnosed with severe OSA and that it was as likely as not due to Agent Orange exposure during his service or the result of the service-connected PTSD.

That favorable opinion, however, does not provide any explanatory rationale, so resultantly does not have probative weight towards establishing the required causation or aggravation. Generally, the degree of probative value that may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the Veteran's claims file, although mere review of the claims file is not determinative or dispositive of an opinions probative value since the pertinent medical history may be obtained in other equally reliable ways. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000).

Rather, also significant and perhaps most important is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually had examined the Veteran, did not provide the extent of any examination, and did not provide any supporting clinical data).

The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998).

A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner's opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the Veteran).

So as the Court made clear in Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008), the probative value of a medical opinion comes from when there is factually accurate, fully articulated, and sound reasoning for the conclusion, not just from mere review of the claims file). See also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[a] medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions")."

Edited September 7, 2014 by carlie
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