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Nexus Letter Help

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I was wondering if i could get some opinions from the experts on this letter from my primary doc.

I was denied SC for Apnea . Retired mar 2002, diagnosed at civilian doc with sleep anea Aug 2002, who didn't refer for sleep study, then sleep study May 2013

I submitted lay statements from wife and sister, attesting to snoring and stopping breathing and i also submitted the following.

I have recently been seeing and taking care of Mr x for the past several months, and he has been seen by other medical providers while being a patient in our clinic. While being a patient he was diagnosed with Obstructive sleep Apnea. Upon review of his medical records during his time in the Navy, he had signs and symptoms consistent with OSA. these signs and symptoms included an elevated BMI (31.46 on 28 Jan 99) neck size of 17.5" chronic fatigue with poor exercise tolerance, repeatedly elevated blood pressure despite treatment, history of laryngeal swelling and irregular nasal septum which required surgery, history of smoking and EKG changes with evidence of possible LVH. these signs and symptoms are all consistent with a diagnosis of OSA. Based upon review of his STR from the Navy and the fact he was diagnosed shortly after his retirement, it is my opinion that he had some form of OSA while serving on active duty that was not diagnosed .Furthermore this was likely contributing to some of his medical conditions especially in regards to fatigue, hypertension and heart disease. I suspect his medical condtion developed at some point in his Navy career and not after retirement.

Also the same rater denied my Heart attack (CAD) as not service connected, but I am 0% for Hypertension.

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I would imagine that Gastone will reply with better help however, right off the bat you need to submit the DX from Aug 2002. Then you need a definitive statement from your doctor as to whether your SA is related to a specific incident during military service, the opinion should be expressed as follows:

  1. “is due to” (100% sure)
  2. “more likely than not” (greater than 50%)
  3. “at least as likely as not” (equal to or greater than 50%)
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This being the Christmas Holidays it maybe a while before anyone can help you they maybe with Family's? ect..ect.. just hang in there buddy!

NOD or Appeal the decision!''

Remember a diagnoses does not mean they will approve a decision they usually need a Dr stating '' its likely to as not'' cause from his military service and render him totally disable.

The only thing about the sleep apnea IS he went a long time 11 years before the sleep study was done that maybe why they denied? and never looked at the other evidence?

Maybe a CUE is due?

others will chimm in Ms Berta ? Asknod, georgiapapa? N Kelly? Gastone?. Phillip Rogers, Ms Carlie, broncovet, Chuck75?? John999 anyone?

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You were diagnosed with OSA in 2002 (5 months after discharge) by a civilian doctor.


Is the doctor who diagnosed you in 2002 the same doctor who conducted your sleep study in 2013 and provided you with the IMO you referenced in your post?

If not, have you attempted to obtain an IMO from the doctor who made your OSA original diagnosis in 2002?

Do you have copies of the records of your 2002 diagnosis and did you submit these records?

Did you submit buddy statements from your military buddies (bunk mates) stating they actually heard you exhibiting symptoms of OSA (snoring, stopped breathing, gasping for air, snorting, fatigue during day, concentration problems, etc.) during your military service?

Have you obtained and submitted all medical records (military, VA and civilian records) showing any OSA symptoms and/or OSA diagnosis?

Some suggestions, if you have not already done so:

Try to get IMOs from any doctors involved in your OSA treatment and diagnosis (2002-2014) using the IMO format available on the Hadit website.

If you have not done so, obtain as many military buddy statements as possible to support your OSA claim. Statements from your wife and sister help but buddy statements are more credible. The statements should list the OSA symptoms witnessed and when they were witnessed. You need statements showing OSA symptoms during your military service.

If you had any vehicle accidents as a result of falling asleep, especially during your military service, you need these records.

Based on your statement that a civilian doctor diagnosed you with OSA five months after your discharge and the comments from your current doctor stating your SMRs included signs and symptoms of OSA, I think you have a good chance of winning your OSA claim, especially if you submit properly formatted IMOs, strong buddy statements, all relevant medical records (especially 2002 diagnosis records), relevant vehicle accident records, if any, etc.

Good luck to you and your family and Happy Holidays.

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Unfortunatly the doc who diagnosed me in 02 has since moved on. He was great and would have given me an excellent IMO. I did go through my STR and civilian health record, found anything remotely related to OSA, highlighted it and submitted it, with this letter. My sister is a physical therapist which kind of puts her in the medical field, and her statement went back to the early 90's. I have an appt with my VSO, so hopefully we can formulate a strategy. Like I said they denied my heart attack, which should have been automatic since I'm rated for hypertension.They decided this Dec 19 so I'm thinking they were in a rush to close it because it was 16 mos old. Especially after the director of the Philly RO testified to Congress in Oct 2014 claims were averaging 4 months

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FHL Dad,

Service connected OSA with CPAP is an automatic 50% rating just by itself. Please don't take this the wrong way but if you want the ratings you deserve, you must be willing to do the leg work. Most VSOs will not do the leg work. They usually handle the paper work. It would not take a lot of effort to track down your doctor from 2002. You need a strong IMO from him/her along with copies of his/her records from 2002 showing your OSA diagnosis and his/her medical rationale for his/her diagnosis. Even if your 2002 doctor has retired, his/her records are stored somewhere and he/she could still give you an IMO. An IMO from your 2013 doctor, eleven years after your discharge, will not carry the same weight as your 2002 doctor. Your OSA claim without the 2002 doctor's IMO is weak in my opinion. Even though your sister is a PT, the VA would not consider her to be a medical expert on OSA. Her statement as a witness to your OSA symptoms should be considered. Even IMOs from your PCPs would not be as strong as IMOs from doctors who specialize in sleep medicine such as ENTs and pulmonologists but PCP IMOs are better than no IMOs. Your OSA claim would also be strengthened by doing the leg work to obtain as many buddy statements as possible as I suggested above.

In regards to your heart attack, you didn't say if you had hypertension in the military. If you had hypertension in the military, you should try to get an IMO from your cardiologist stating it is "as likely as not" your hypertension caused your heart attack. The cardiologist would have to support their opinion in the IMO with reasonable medicare rationale. If you did not have hypertension in the military, you will have a difficult time being service connected for your heart attack. JMO

Good luck.

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Was the "0" HBP a SC rating or a NSC rating?

Did the VA have that OSA letter as evidence ,but ignored it?

Nothing is automatic with the VA unless it is a presumptive disability.

You need an IMO from a cardiologist to show that you had HBP in the service and that the heart attack you had is directly related to the HBP, to appeal the heart denial.

IMos must be worded carefully as to

"as likey as not" etc criteria here in our IMO forum, with a full medical rational.

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