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]

Status: Although I was awarded 50% for OSA and 10% for Rhinitus on 21 Oct, I am still stuck in the VA bureaucracy...no payment nor retro. Apparently, because I am a retired vet, they have to verify CRDP and military pay records before I can receive both. They say it can take up to 60 more days. Go figure.

Additionally, although my effective date was May 4, they say they will only pay from Jun 1. Is this true that they do not prorate? That is 27 days of non payment.

[mrthing2000]

On 5/25/2016 at 7:44 AM, TALON II FE said:

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.

 

If the servicemember did not have a diagnosis in-service, does that change anything?

I was diagnosed by the VA in 2009 with severe sleep apnea, given a CPAP, etc.  But I left the service in 2008.  
Anyone who had the (mis)fortune of knowing me, knows I gasped and snored like a chainsaw.  Reasonably I had it then also.  But minus a buddy statement, I'd have nothing to that effect.

[pepperD]

Quote

Congrats on your award.  Retro should come soon.

 

[Buck52]

mrthing2000

Unfortunately, if a veteran had no medical documentation of any type of sleep dis-orders/OSA while in military or from any private medical facility  , and years later file a claim for OSA (Sleep Apnea) he will need a good IMO/IME from a specialist linking it to a Secondary S.C. Disability,Such as medications, opiates has been proven to cause sleep dis-orders,'' Chronic PTSD'' and other medical issues the Veteran may have, but the one thing you need is that valuable/very Important Nexus Letter, from a qualified specialist, and a good lay statement from your spouse or someone that knows you very well and has been around you while you sleep.

Buddy Statements are good but need to be accurate and names and phone #s and places (units) where the OSA Took place?  The VA Can and will call them up and ask them for their testimony about your sleeping disorder.

you will need to swear to the fact all this is true to the best of your knowledge.

If a Veteran has had a sleep study from the VA or Private  and was diagnose with Sleep Apnea and prescribe a C-Pap Machine...that's not enough for service connection and more than likely without a Specialist Opinion will be denied.

The VA is cracking down on the S.A. Claims  making it much harder for a veteran to succeed.

jmo

........................Buck

Edited November 6, 2016 by Buck52

[Andyman73]

The VA doesn't prorate comp pay, regular or retro. Your claim date of May 4th will get you June for 1st month of pay, which comes at the end of the month. So the  VA comp check you get on July 1st is for the month of June.

[EODCMC]

So, if I'm understanding this correctly. A person doesn't get paid for any days of the month that they apply?