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.

[cooter]

Thanks! I do have a question about what you just mentioned. The last time I submitted a new claim the DBQ's were just being introduced in the system. How does that work now? Are they using a DBQ instead of C&P's and is it required to one filled out by your Dr when you file? Totally confused on this. 

 

   <Coot>

[EODCMC]

Coot, no worries. If my post generates dialogue that helps anyone, I'm good. I might learn a thing or two. This process that the VA has created is really a culture that they seem to cultivate. Perhaps the government feels they can save money by stringing this system out. My problem with it is that they are doing this over the backs of veterans that have real problems. The afflicted die on the vine alongside the malingerers.

[cooter]

LOLO...You really don't want me to emphasize on that cause I'll talk your head off on that subject!!! 

But you are so right!!!!!!!!!!!

 

   <Coot>

[EODCMC]

Ha...you're right. This gripe is better suited for a different segment of the forum. However, Gastone is correct, in my view. The system is meant for veterans like us. After seeing a glimpse of your problems, I would gladly give up my place in line for you and anyone else with DXs that are more serious than mine. I'm not against triage, but I sense that is not the reason for the delays. Good health Coot.

[Andyman73]

On 7/9/2016 at 3:16 PM, EODCMC said:

Ha...you're right. This gripe is better suited for a different segment of the forum. However, Gastone is correct, in my view. The system is meant for veterans like us. After seeing a glimpse of your problems, I would gladly give up my place in line for you and anyone else with DXs that are more serious than mine. I'm not against triage, but I sense that is not the reason for the delays. Good health Coot.

I got to say,  be cautious with letting others go ahead, cuz you feel they are more deserving or worthy.  Trust me, I know, I did that for 17 years, and it got to the point of me calling the hotline late last spring.  I had reached the point where the next step I took would have been the one going beyond the point of no return.

And now that I've done that, made the call, that is, I still feel like the point of no return is only a step or two further back from the line, now, instead of right at my toes. I really dislike talking about it, because the voices in my head then start up their chaotic cat calls and jeers, pushing me back towards that last step.

It's great and all that my VA MH dr wants to talk about my feelings, but what about the very real pain I live with every day?  Why do I sleep and wake like I haven't truly slept? Why do I continue to feel like I'm still invisible, and my voice has no volume? More so, why do I feel that because I stood aside, so that others more deserving and worthy may go ahead of me, that now I have to stand in that "other" line, the one that leads to the window with the sign that says, sorry, today is not your day, and tomorrow doesn't look good either. Then I look to see how long the line is behind me....and find that I'm the only one in that line.

Hey, that's just like the time I was at the gas chamber for training and the truck that delivered our box lunches ran out when I got to the tailgate, last in line...and they told me...get this...they actually told me I should have gotten in line sooner.  Which meant that then someone else wouldn't have gotten a lunch. 

Who am I kidding....

[Gastone]

Coot, other than PTSD DBQ's, your VA Clinician is required by VA Reg to complete a DBQ when you request it. PTSD DBQ requests, are supposed to be referred to another VA MH Clinician, that isn't directly involved with the Vet's treatment. The whole Patient/Dr Trust thing, comes into play.

The VA Dr is required to give the Vet a copy of the completed DBQ during the office visit, insert the DBQ in to the Clinician Notes for that day and to fax a copy of the DBQ to the RO Rating Dept.

As to the DBQ taking the place of a C & P. After the VA Rating Dept looks over your New Claim, decisions regarding the need for specific C & P's are made. If the VMC Med Record and/or the Vet's C-File contain a DBQ completed by a VA or Private Specialist, the need for an actual C & P exam by a VA GP would be unnecessary.

Get the DBQ, be sure it's in your VMC Med Records (within 3 days, posts on your MHV), File an FDC attaching a copy of the DBQ. Sit back and relax, you'll get a C & P or an Award/Denial Letter in 2 - 6 months. FDC's are the only way to Fly.

Semper Fi