Criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed

[Tbird]

The Veterans Law Blog just got word today that the criteria the VA uses to assign a 50% rating to VA Sleep Apnea Claims has just changed, effective April 18, 2016. http://www.veteranslawblog.org/va-sleep-apnea-ratings-rules-changing/

[brokensoldier244th]

Quote

• Use absent a medical determination that the device is necessary does not qualify.  The regulation requires that the device be necessary and this is a medical question. 
• If the competent medical evidence of record shows that use of a qualifying breathing assistance device is medically required, the fact that the claimant is not actually using it as prescribed is not relevant. 

All it says that that you have to have evidence that a CPAP or breathing assistive device is required. Nothing about a specific  "letter from a doctor stating medical necessity...." as VLBlog says. If you have a prescribed CPAP then you already have this, anyway. If you have a CPAP with no medical backing or prescription, but just because you 'think' you need one, then no, you should not be getting a rating for it. The other part says they can't go and change your rating for not using one if you have one prescribed. 

 

This change is common sense, IMO. 

Edited April 19, 2016 by brokensoldier244th

[Vync]

3 hours ago, Buck52 said:

I really never understood the VA giving a veteran a 0%rating for a SC Disability...Don't make a lick of sense to me...b/c they admit the veteran has a disability.

Not to take away from the content in this topic, my father was SC @ 0% for a heart issue over 30 years ago. It did not rise to the 10% criteria, but DIC is on the table though.

[Buck52]

Getting S.A. Service Connected is a problem for thousands of veterans  including myself   even when some of us veterans have been diagnose with S.A. by the VA,

I never claim S.A. While in service  but I do have a SC 70% PTSD Rating via VA Also .

I don't use my CPAP because'' I think I need one''I use it to get some darn much needed sleep/rest, and It has worsen since I been on PTSD Medications,  so there should be a secondary rating for S.A. based on this issue.

my problem is getting a VA MH Doc to nexus the two.

Actually the VA MH Docs is the ones who diagnosed my PTSD and ordered a sleep study, low and behold I was diagnose with S.A & giving a CPAP  Immediately 

During the time they were treating me for PTSD..I did file  my PTSD Claim and was giving a 70% rating my PTSD Is consider chronic as my other SC DISABILITY is P&T With no future exams  and this decision was made when I was 50 years old  so my age was not a deciding factor   if your over age 55  or at age of 62 63 64 65, at age 65 if veteran has a 100% SC Disability  then he his automatic consider P&T  According to the M21 Manual.

However the rater or the C&P Examiner ''NEVER'' consider my S.A. in my PTSD Claim.

I am still being treated at VA  For all my SC Disability's 

Before I recieved my C-PAP I had hell sleeping and most of the time I'd say 4 out 7 nights my spouse was there to wake me when I stopped breathing.

Edited April 19, 2016 by Buck52

[brokensoldier244th]

I get that, but the point is whether or not the CPAP was prescribed. If it was, then you already have the necessary information to satisfy VA's change to M21 "medical necessity":. If you got it off Ebay or something then you wouldn't. If you got it through a private provider even they usually want a prescription before they will sell one, or supplies, masks, hoses, etc for it. Either way you should be covered. The only people affected by part 1 of the change are those that are using a CPAP  and don't really need one according to a doctor, or do need one but bought it and never actually had it prescribed. 

 

 

Edited April 19, 2016 by brokensoldier244th

[Buck52]

I need to add this to the statement above.

At Age 62 -63-64-65 a veteran that has a SC rating of 100% or TDIU & is on SSDI or SSR is automatic considered  P&T 

I read that in the M-21 Manual

 

.........Buck

[Buck52]

Even though if a veteran has a VA  S.A. Diagnose & prescribed a CPAP Machine....does not particularly mean the VA will S.C his S.A.   If this is TRUE why for all the denials?