Sleep Apnea Claim

[EODCMC]

Hi, I am a 30 year retired vet. I retired 13 years ago. I as recently diagnosed with "very severe" obstructive sleep apnea. The machine they gave me is preset on the highest output flow. My episode exceed 35 times an hour with some lasting more than 30 seconds. 

I was diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record. In fact, they wanted to operate on my uvula. There lies the rub. The operation could have ended my career so I didn't persue. Additionally, while on active duty I developed severe chronic sinusitis and allergic rhinitis and this also is documented in my service health record. I have been living with this and chalking it down to getting old.

Fast forward...I recently got a machine that they say I have to wear for the remainder of my life. I just learned that Tricare Prime does not pay for it all. So, I researched online and submitted a claim the E-benefits and it has been received and was under review until today when they changed this to "gathering of evidence" Development Letter Sent.

Does anyone know what this means? What do I have to look forward to concerning the process. I watch the news. It doesn't look good, right?

thanks in advance.

[silverdollar22]

EODCMC,

  Same here, just went to gathering evidence or as we like to call it gathering dust stage!!! First of all, was it a standard claim or a FDC so called fast claim? If it was a FDC (fast claim) then the expected wait time should be posted in the claim application. Probably around 6 months. Either way, this is usually the longest stage of the game, so sit back and relax and find a good hobby that will take your mind off this process. Many a vet including myself have driven themselves crazy by looking at ebenefits every hour expecting it to change. By what you are saying you should have no problem getting your claim approved but, you never know with the VA.  Anyway, Welcome to the HADIT Family!!!!  Spend some time researching stuff here and remember knowledge is power when it comes to the claim game!!!

                                                                                   Silver

[TALON II FE]

12 hours ago, EODCMC said:

diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record

I believe that this would establish the SC, and the 'prescription' of the CPAP by the VA meets the 50% criteria, without having actually seen any of the evidence.  That shows an in-service diagnosis and a current diagnosis. I think where many Vets run into problems is that they never get the diagnosis to begin with, while in service, so they are forced to rely on 'Buddy Statements' or have to try and tie it in as a Secondary.

  DEFINITELY order a full copy of your service medical records (if you haven't already) and start gathering any other private medical records, etc.

I think you are now in the 'waiting game' stage of the process, and there are too many variables to pin down exactly how long this stage will take you. It varies by location, claim, etc, etc.  Next, you should get a C&P exam.  Do not get to 'wrapped up' in what Ebenefits says.  It is a useful tool, but it does not accurately portray the internal process of the VA, so it can cause a lot of frustration.  Good luck!

 

[Buck52]

 Original poster  the VA Should give you a C-PAP to use and all the equipment  hoses.Mask..you need to use distilled water.

Anyone that has Sleep Apnea /OSA  needs to be using a C-Pap/Bi-Pap machine.

For some  reasons the VA is turtle slow on getting VietNam Veterans their C-File....but some do get their C-File within 3 /4 months.

I guess the C-file for us Vietnam Vets got lost in the mail room.

 Next Month (June) will be a year for me and I requested it twice during this last year...and not a word from them..I do have the greencard receipts

I need my C-file bad  I wonder if it has been didtized and on CD? 

Could I make an Unexpected Visit to RO?

And  ask for it that way?

jmo

....Buck

[hilltravis]

On ‎5‎/‎28‎/‎2016 at 0:31 PM, EODCMC said:

If there is anyone with apnea experience, I have one question that I can't find in my research. Is 50% and 100% the only rating you can get or can someone be rated somewhere in between?

There is nothing between 50 and 100%.  You can get:

Persistent day-time hypersomnolence ................................... 30

 

Travis

 

Edited May 31, 2016 by hilltravis
Formatting

[Andyman73]

Yeah, SA is pretty much a half or nothing, or all or nothing kinda deal.  Which is one of the main reasons the VA probably resists it so much. I think SA or OSA with out Cpap should be 30%, with = 50% and O2 added in should be 70-100%, or  something like that.

 

Semper Fi

[Andyman73]

I'd contact the sleep lab and let them know what you are going through.  It's possible that a simple increase of pressure will solve your problem.  Worth a shot, anyway.

Semper Fi