ptsd Just saw that my C&P Doc rejected my claim for "Sleep Apnea secondary to ptsd" but VA Approved it..

[oats]

So, i submitted a claim for "PTSD secondary to sleep apnea".   I had no evidence of sleep apnea in the service, except for a few buddy statements.  I submitted a package from Dr. David Anaise for the nexus....Had my C&P Exam... the dr (who i would love to share the name of cause shes seriously did not know what the hell she was talking about)  kept telling me that "Sleep apnea cannot be secondary to ptsd because it does not cause it", i told her "it aggravates it"... i asked "Why would it be an option for me to choose "sleep apnea secondary to ptsd if it doesnt exist? why would the va even give that option to us".. she said "I dont know".    I had all the studies printed out to give to her (as well as submitted in the claim by dr. anaise and myself).. she didnt even read it.. Just kept telling me that ptsd does not cause sleep apnea.   I was going back and forth telling her "You dont think that my ptsd aggravates my sleep apnea?"  "She says i dont know if it does or not"...... She then said she will grant me "Sleep Apnea" but not secondary to ptsd.. i was like i am not putting in for just "sleep apnea"  i am putting it into connection with ptsd.   She had no idea wtf she was talking about and had no general understand.  I uploaded a statement after the C&P Exam stating all my points.   I even showed her a BVA decsion showing that veterans have been service connected for it in the past even (i know) that all claims are individual... she wouldnt have any of it.  Just kept denying me and saying not worry as i will get service connected anyway.... Well few monthes go by and i got service connected for it. Amazing... that was like 6 monthes ago.... Fast foward to today and i go through my blue button on myhealthyvet and i saw that that doctor DENIED me and said


"b. The condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service connected condition. c. Rationale: Obstructive sleep apnea is caused by narrowing of the upper airway leading to obstruction while sleeping. This needs to occur on average a minimum of 5 times per hour to have a diangosis of ostructive sleep apnea. There is currently not enough medical evidence to show that PTSD causes obstructive sleep apnea."

also she stated:


"I reviewed his medical chart, VBMS records, letters from an outside physician and studies he presented. total time spent 1 hour. After extensive discussion, Veteran did not agree with my medical opinion"


Has anyone ever heard of being granted service connection for something that the C&P doc denied you for? i did not appeal or do anything, i was simply granted....

I would really like this doctor to see that she got rejected as bask in all my glory.  She was something else... Good luck to all and if you have questions please feel free to ask me....

 

attached is a letter i submitted after my claim disagree with the c and p doc... stating shes an idiot in kinder words

Edited October 1, 2015 by oats

[toddt]

Yes, you can be granted service connection for a condition that the C&P doctor rejected, if your evidence of your condition is in "equipoise" with the C&P doctors.  Of course this isn't always the case.

 

To help your case here is an article that you might want to read and submit copies of the three articles it references:

 

http://www.ngwrc.org/updates.htm

[Berta]

Since you submitted an IMO from Dr. David Anaise and also rebutted the C & P examiner's findings (GOOD FOR YOU)

the VA had no choice but to weigh the medical evidence under Benefit of Doubt and award the claim.

I rebutted a C & P the BVA had ordered years ago for my DMII AO claim.

I had 2 IMos from Dr. Bash and a brief freebee from a former VA Neuro and VA had 2 Endo opinions against the claim and remanded for a cardio opinion.

I got a PA opinion,and immediately rebutted it and told the BVA it was too speculative and why. BVA agreed and awarded the claim.

C & P doctors have no power at all to "grant" a claim and they step over their boundaries when they try to make any claimant think that. Obviously she said whatever it took to get the C & P exam over with.

That happened to a local vet I helped years ago. But I knew he had probably bullied the NP doing the exam and he also had started to bully me too ,so she, the NP, C & P doc  told him she would make a favorable C & P statement to award the claim  (but she didnt)

I know this was not the same situation with you but sometimes it just does not pay to say too much to these C & Ps about the actual claim because it can put  them into a defensive position.

Some however are definitely quite willing to read an IMO and even abstracts of other medical info that supports the claim. I suggested based on all of the SMR legwork and medical research I had done for the above vet ,that he needed an IMO .

This is funny now but at the time I was livid about it. The vet wanted me to sign a statement that I would refund  his personal cost of an IMO, if it was not favorable enough to garner him an award..     BS to that!!!

His evidence (which he didnt even understand)  was spectacular but his request was highly inappropriate.

And his private doc, with far more expertise than the NP examiner, after reading the work I had done on the claim, gave him a FREE IMO and then VA gave him an award and a good chunk of retro.

 

 

 

 

 

 

 

 

 

[broncovet]

Interesting.   Could you post your "reasons and bases"...I would like to see what VA said in your decision.  Thanks.  

[USMC_VET]

1) Please post your full decision letter, i am going to pull the pin on my sleep apnea claim later this year, also secondary to PTSD. 

2)  I cant ding the examiner for this because she is not a rater.  However the rater did do the right thing here and abided by their own regs! wow!

In the M21-1MR, Part IV, Subpart ii, Chapter 2, Section B,6

Very Clealry states in there that aggravation is one of the big ones with secondary.  And in part d it specifically mentions what must be in the examiners report and specifically says "aggravation.".  Im glad it worked out for you.

a.  Provisions for Service Connection Under 38 CFR 3.310(a) and (b)

Grant service connection for the following under the provisions of 38 CFR 3.310(a) and (b):   ·   disabilities that are proximately due to, or the result of, a SC condition, or ·   the increase in severity of a nonservice-connected (NSC) disability that is attributable to aggravation by an SC disability, and not to the natural progress of the NSC disability.   Reference:  For more information on service connection for aggravation of NSC disabilities by SC disabilities, see ·   38 CFR 3.310(b), and ·   Allen v. Brown, 7 Vet.App. 439 (1995).

 

b.  Medical Evidence Required to Show an NSC Disability Was Aggravated by an SC Disability

Do not concede an NSC disability was aggravated by an SC disability unless the baseline level of severity of the NSC disease or injury was established by   ·   medical evidence created before the onset of aggravation, or ·   the earliest medical evidence created between the -  onset of aggravation, and -  receipt of medical evidence establishing the current level of severity of the NSC disability.

 Continued on next page

 

6.  Determining Secondary Service Connection, Including by Aggravation, Continued

 

c.  Developing Claims Based on Aggravation of an NSC Disability by an SC Disability

When developing a claim for secondary service connection based on aggravation of an NSC disability, ask the Veteran to furnish medical evidence showing the   ·   current level of severity of the NSC disability, and ·   its level of severity -  before aggravation by the SC disability, or -  as soon as possible after aggravation.   Note:  Enclose VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, in the request letter.   Upon receipt of this evidence, request a medical examination and opinion, to include a review of the claims folder by the examiner, to establish whether increased manifestations of the NSC disability are proximately due to an SC disability.   Notes: ·   Do not request an examination if the Veteran has failed to furnish medical evidence establishing a baseline level of the severity of the NSC disability. ·   The examiner must have all available evidence for review when providing an opinion on the issue of aggravation. ·   Identify the evidence of particular relevance in the claims folder for the examiner.

 

d.  Information That Must Be Included in the Examiner’s Report

The examiner’s report must separately address all of the following medical issues in order to be considered adequate for rating a claim for secondary service connection based on aggravation:   ·   the current level of severity of the NSC disease or injury ·   an opinion as to whether an SC disability proximately caused the NSC disability to increase in severity, and ·   the medical considerations supporting this opinion.

Continued on next page

 

6.  Determining Secondary Service Connection, Including by Aggravation, Continued

 

e.  Determining the Extent to Which an NSC Disability Was Aggravated by an SC Disability

To determine the extent to which, if any, an NSC disability was aggravated by an SC disability   ·   determine the baseline and current levels of severity of the NSC disability under 38 CFR Part 4, Schedule for Rating Disabilities, and ·   deduct the baseline level of severity of the NSC disability, as well as any increase of the disability due to natural progression, from the current level.   Note:  This policy applies even when the current level of severity of the NSC disability is 100 percent.

 

 

[Navy04]

I have had multiple conditions granted by RO, where Examiner did not agree, and even had a few conditions granted SC that I did not even ask for. Congrats on the great news, and for now don't worry about it. Good luck and God Bless

[MarkInTexas]

Oats, you mentioned you used a nexus IMO from Dr. David Anaise?  How much probative value did the VA give when they awarded your claim?  Did they mention it in the narrative as a basis for the award?  Congratulations!

 

Mark