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]

Nadas 

[Andyman73]

Dang!

[Gastone]

Your 60% SC, do you get any treatment from your local VMC?

VA has supplied all my Bipap & 02 concentrater, on a no charge basis, even before I got the SA SC'd.

Are you precluded from using the VMC because of Tri-Care?

I may have asked you before, you filed a SA Claim, was it an FDC or Reg A$$ Claim? Did you attach "All the available supporting Medical Evidence?" A need for "Gathering Evidence" certainly sounds as though there wasn't enough evidence presented with the claim, for the Rater to make a Decision. Have you had a SA C & P Exam yet or scheduled?

Semper Fi

[Slick]

"Are you precluded from using the VMC because of Tri-Care?"

In answer to that if qualified you can use either VMC (for SC), Tricare for life or Medicare or a combination of all three.

I have a VA primary doc and a civilian doc who takes medicare and Tricare. I use both and get my meds from both.

CPAP supplies and hearing aids I get from VA. Prescription drugs I split between the two- don't double dip, just get some from one and the rest from the other.

As far as med records go I have not auth them to share, but each knows what total meds I'm on are.

apologize for the long answer

[EODCMC]

Gastone: I am going to he the local VA health facility between the holidays to get answers. On the phone I was told that I am entitled to both since I am more than 50%. I have to bring my award letter since they don't show me in the system. Thanks Slick, that info is encouraging.

Gastone, I'm unclear of your questions in the 2nd para. I granted 50% for OSA and 10% for Aletgic Rhinitis. It was disappointing they gave me nothing for Sinusitis. The Dr. At my C&P Exam opined that all my diagnosis in my SMRs and current one from my Tricare Dr. we're misdiagnosed. They said it was all consistent with Allergic Rhinitis. I'm considering a NOD. I could use some advice. It was an FDC that turned into a regular claim because I offered a med request form from my prior Tricare PCM that I didn't think they had. This was after my initial FDC.

One never knows what information the VA is working from, so you continue to offer help when things go so slow.

Thanks everyone for your interest and help.

[EODCMC]

Gastone, the "nadas" was meant as a status for the retro situation. I received my approval for 60% on Oct 20 and was informed I'd get a direct deposit for $1156.09 on Nov 1.

The problem is I'm retired military and receive a retired check every month. I am entitled to CRDP because I'm more than 50%. But, since the award was after the 17th, I missed the cutoff for the Nov 1 payment and received my 1st payment on Dec 1. But no retro.

Apparently, because I'm a military retiree, my pay records had to be audited to receive retro for some reason. I received the 1st payment so it wasn't because they had to verify CRDP. I havnt heard a thing since. I have made 2 request through IRIS and 2 phone calls. Both resulted in a canned answer and suggested patience.

Edited December 22, 2016 by EODCMC
Misspelled word.