ptsd Requesting Some Guidance

[armyvet00]

Hello,

A few weeks back my claim was completed and went from 0- 90 % rating. I am still relatively unsure to the whole process of appealing and if I should .. I am grateful to be awarded the 90%. I have quite a few conditions also rated at 10% and not sure if I should appeal a few of them.

A few questions:

1.) I was denied sleep apnea, I did sleep study Sep last year but was not fitted for CPAP and I have moderate OSA. I could not get fitted as I was in the process of moving at the time. I am getting CPAP next week at VA. Also I had a nasal fracture in 1995, and I have 70 % PTSD. would I have some grounds to appeal?

2.) There are a few claims I needed to add that I did not add initially like migraines and knee pain, if I did add those now would it affect my appeal for SA? Another wards could I appeal my SA decision and still file a new claim or would something get bumped?

3.) Is the appeal process very lengthy?

4.) Is going to the VA better for treatment and records wise than a private provider?

5.) Some of the decisions say a reevaluated in 5 years? can anyone elaborate on this..

[MRRRR5]

Hello,

A few weeks back my claim was completed and went from 0- 90 % rating. I am still relatively unsure to the whole process of appealing and if I should .. I am grateful to be awarded the 90%. I have quite a few conditions also rated at 10% and not sure if I should appeal a few of them.

A few questions:

1.) I was denied sleep apnea, I did sleep study Sep last year but was not fitted for CPAP and I have moderate OSA. I could not get fitted as I was in the process of moving at the time. I am getting CPAP next week at VA. Also I had a nasal fracture in 1995, and I have 70 % PTSD. would I have some grounds to appeal?

2.) There are a few claims I needed to add that I did not add initially like migraines and knee pain, if I did add those now would it affect my appeal for SA? Another wards could I appeal my SA decision and still file a new claim or would something get bumped?

3.) Is the appeal process very lengthy?

4.) Is going to the VA better for treatment and records wise than a private provider?

5.) Some of the decisions say a reevaluated in 5 years? can anyone elaborate on this..

Congrats on your award and thank you for your service to the nation; my assessment to your questions:

1. Yes, you should appeal the denied OSA decision now that you have been provided your CPAP.

2. No, the added claims would not affect the sleep apnea appeal as they would most likely be considered "new, initial claims"; however, the SA appeal decision make take longer; you could ask for a "reconsideration" on the SA denial as well which may get you a quicker decision back, however, just keep in mind the reconsideration does not toll your appeal clock.

3. Yes, it can take anywhere from 24 to 60 months or longer in some cases to get a decision.

4. The VA have many great providers treating Veterans and this would probably get varying opinions from Veterans so this would be an individual decision on what's best for you.

5. My understanding of the reevaluation in 5 years is those specific SC conditions will be checked again by a VA provider to see what the current level of severity is; i.e., has there been any improvement, have the conditions gotten worse, etc.

The above responses are my opinion only on the questions you ask; other more experienced Vets may also chime in to give you more advice.

P.S. I would recommend you get a Service Organization Representative to assist you if you don't already have one; if you do have one, get their recommendations on your next step as well.

[Fat]

I would appeal any decision if you feel you deserve a higher rating.

I would enroll in the VA system and continue treatment for service connected disabilities.

The appeal process is lengthy, but medical evidence eventually prevails.

Last, file your new claims in.

[broncovet]

ArmyVet

1. With sleep apnea, there are 3 issues.

The first is "Is it service connected"?

Then, there is the issue of percentage. If you are service connected for OSA AND your are on a CPAP, its 50 percent.

Finally, there is the issue of effective date. Right now, you are looking for the 2 above, then you can work on the effective date if you dont like the effective date the of the decision.

2. It sounds like you are appealing sleep apnea, and adding new claims. You can move forward on both at the same time.

3. Yes, the appeal is lengthy. If you elect a DRO review, this could happen in as soon as 1 year to 18 months. Mostly tho, my 2008 BVA Appeal was decided in August 2012 (4 years later), and I am still trying to get VA to implement the 2012 Board decision. Expect your appeal to take 5-10 years and you probably wont be disappointed. Yea, I know that is crazy, but it is what it is.

4. There are advantages to VA and advantages of private care. Personally, I would take private care, if available. However, I dont have a choice unless I pay out of pocket..I have to go to VA. Its somewhat rare where private care is better than VA care, but stranger things have happened.

5. You dont need to worry about reevaluations at this time. Let the VA worry about that. Generally, after you have been rated 5 years or more, your condition is considered "stabalized".
After the 5 year period, you can consider requesting "permanent and total"..which means your kids will be eligible for DEA Chapter 35 benefits, and there are many more benefits for a 100 percent permanent and total Vet.

I would have to disagree about the Veterans Service Officer, and here is why (tho I do think they can be a help if you are a "new" claimant unfamiliar with VA):

In your service officer (DAV, VFW, etc) charter, they agree to "cooperate with VA", And are paid by VA.

Whenever you use your opponents lawyer, and your opponent is paying him, who do you think he is "representing", VA or you? If you guessed VA, you probably understand you owe loyalty to the guy who signs your checks.

As long as you remember your service officer represents VA and not you, then feel free to have one. Dont be suprised, tho, if you find out they are representing VA's interests, and not yours.

Edited May 31, 2015 by broncovet

[MRRRR5]

ArmyVet

1. With sleep apnea, there are 3 issues.

The first is "Is it service connected"?

Then, there is the issue of percentage. If you are service connected for OSA AND your are on a CPAP, its 50 percent.

Finally, there is the issue of effective date. Right now, you are looking for the 2 above, then you can work on the effective date if you dont like the effective date the of the decision.

2. It sounds like you are appealing sleep apnea, and adding new claims. You can move forward on both at the same time.

3. Yes, the appeal is lengthy. If you elect a DRO review, this could happen in as soon as 1 year to 18 months. Mostly tho, my 2008 BVA Appeal was decided in August 2012 (4 years later), and I am still trying to get VA to implement the 2012 Board decision. Expect your appeal to take 5-10 years and you probably wont be disappointed. Yea, I know that is crazy, but it is what it is.

4. There are advantages to VA and advantages of private care. Personally, I would take private care, if available. However, I dont have a choice unless I pay out of pocket..I have to go to VA. Its somewhat rare where private care is better than VA care, but stranger things have happened.

5. You dont need to worry about reevaluations at this time. Let the VA worry about that. Generally, after you have been rated 5 years or more, your condition is considered "stabalized".

After the 5 year period, you can consider requesting "permanent and total"..which means your kids will be eligible for DEA Chapter 35 benefits, and there are many more benefits for a 100 percent permanent and total Vet.

I would have to disagree about the Veterans Service Officer, and here is why (tho I do think they can be a help if you are a "new" claimant unfamiliar with VA):

In your service officer (DAV, VFW, etc) charter, they agree to "cooperate with VA", And are paid by VA.

Whenever you use your opponents lawyer, and your opponent is paying him, who do you think he is "representing", VA or you? If you guessed VA, you probably understand you owe loyalty to the guy who signs your checks.

As long as you remember your service officer represents VA and not you, then feel free to have one. Dont be suprised, tho, if you find out they are representing VA's interests, and not yours.

Broncovet,

great points on the VSO rationale you provided as well as the other detailed explanations.