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.

[EODCMC]

Gastone, I googled the Dr. And came up with he is  a Geriatric Dr. Affiliated with the VA Hospital San Diego.

[Buck52]

Oh yeah I realize the C-PAP Works , I use one but not S.C.

 Although I been Diagnosed by VA for Sleep Apnea  they gave me a C-Pap to use...I use mine every night too  and it helps tremendously , I was thinking filing a secondary to PTSD that aggravated my S.A.  But this would take nexus  from a qualified SLEEP Dr.

I ask my VA-MH Phyistrist  to write me a nexus  but she denied me.  I can't really afford a PRIVATE Dr.  no insurance   VA Medical is all I got for my health care.

so without the nexus from a qualified Sleep specialist  or Phyistrist   I'd be flat denied.

besides I won't get any more compensation  I'm on SMC-S 1 H.B.  as. it is  and to get more Compensation I'd need to go blind or lose my legs  or arms  or be a vegetable.

The only reason I want to Service Connect  Sleep Apnea  is for my spouse in case that is what gets me &  I die in my sleep from S.A.  She can file the 1151 DIC .

[Gastone]

Buck, I could be wrong, doubt it though, as long as you have a SC SA DX requiring a Cpap or Bipap, regardless of if you use it, the 50% SC is a lock.

If a 50% SA Vet had surgery to correct the SA and subsequently was DX'd  as SA SC but no longer requiring the CPap or Bipap, then a Reduction Rating Proposal would be on the Vet's horizon.

With non VA Medical Ins or Medicare, failure to use your Cpap will cause the Ins Co to no longer cover it's total or partial cost.

I've been 100% use compliant since 2010, VA Checked the SD Card for 6 or 12 months, haven't required it since 11 or 12. I still get a Download print out each yr before I see my private SA Neurologist.

I know a couple other Vets that claim they can't or won't use their Cpap, WTF, untreated SA is a KILLER, literally.

Other than certain Surgeries to correct breathing problems, SA is for the most part, is the Train you ride till you die. I certainly haven't seen any "Cured SA," stories over the past 8 years.

Semper Fi

[EODCMC]

Update- Gastone, you were right. When I responded to the 3 requests; dependent info, EFT info, and information release for civilian DX files, I received a big yellow envelope. It informed that my claim was moved from an FDC to a traditional claim. This after a favorable C&P. Additionally, my E-benefits estimated completion date was pushed back 3 months to Nov 17- Jan 3. Oh well.

[Gastone]

Going from FDC to Reg Axx Claim Status, Sucks for a Big Dawg.

You would think your SMR indicating a SA DX and whatever current Medical SA DX evidence that you included with your SA FDC, along with your recent SA C & P, should have been enough to Seal the Deal.

Not much you can do now, sit back & try to relax. The Old, "Is what It Is," is now in play. Hopefully your in the Homestretch now, just don't rely to heavily on the estimated Claim completion Date.

If you haven't already done so, start educating yourself regarding possible SC Secondary Issues that could exist or develop as a complication of your SA SC. Hypertension, Cardiac and certain Pulmonary conditions, DX'd post SA Dx can quite often be successfully  Nexus-ed to the SA SC condition.

Semper Fi

[EODCMC]

Status: After languishing in the "Collecting Lint" phase, I sent a message through IRIS. The next day (today) it jumped to Prep For Decision" and the timeline moved up from early next year to Nov 4 - Dec 7. Good sign? Probably another tease.