Sleep Apnea - Appeal or New Claim

[John Royal]

Greetings everyone! 

Seeking advice on how best to proceed with my Sleep Apnea Claim. I retired in 2011 after 21 1/2 years of Naval service and I am currently SC at 40%. I need advice on whether to appeal my Sleep Apnea Denial (VA letter dated 3/9/12) or to file a new claim, since the 1 year to appeal has come and gone. In July of 2012, I received Progress Notes (VISTA Electronic Medical Documentation) that stated a diagnosis of Sleep Apnea diagnosed while on Active Duty with a plan for Sleep Services Consult. I assume the Progress Notes that I have came from my SMR, which I located where it said I had Mild Obstructive Sleep Apnea and it is confirmed from the Sleep Study performed (referred by VA to Civilian Provider) on 1/7/2011. I just had another Sleep Study (referred by VA to Civilian Provider) in April of 2016 and the results are that I have Moderate Obstructive Sleep Apnea and need a CPAP (which the VA will issue - soon I hope, as I have been dealing the effects of OSA for years now). I used eBenefits to get myself to the 40% level and wanted advice on whether I should submit an Appeal or New Claim using eBenefits or via a DAV/American Legion etc. 

 

Very Respectfully,

John Royal "JR" (USN Chief Petty Officer, Retired)

[Gastone]

John, how far do you live from your VARO?

If it's not an unreasonable distance, trip down there one morning or afternoon. You could accomplish a couple things while there, 1st file your FOIA Request for your C-File in person, 2nd request a Personal Viewing of your C-File per VA Walk-in no Appointment necessary, which you might have to push hard on. Lastly, recon the different VSO Offices, usually located on the same floor as the RO.

Your looking for a Well Staffed VSO, stop in and talk to 1 of the MFIC's about your situation and their repping you. Better to do this, prior to filing any type of Appeal. Might be a good time to get VSO Assistance.

Do you really believe you have New & Material Evidence, supporting your previously Denied and Final Claim? What makes you think it was in your C-File, did you supply it originally?

Read up on the VA Policy regarding Receipt of New & Material Evidence received post Denial Decision, triggering an Automatic Review of your Denial by a Sr Rater or Actual DRO, giving deference to the original raters Decision.

[John Royal]

1 hour ago, Gastone said:

John, how far do you live from your VARO?

If it's not an unreasonable distance, trip down there one morning or afternoon. You could accomplish a couple things while there, 1st file your FOIA Request for your C-File in person, 2nd request a Personal Viewing of your C-File per VA Walk-in no Appointment necessary, which you might have to push hard on. Lastly, recon the different VSO Offices, usually located on the same floor as the RO.

Your looking for a Well Staffed VSO, stop in and talk to 1 of the MFIC's about your situation and their repping you. Better to do this, prior to filing any type of Appeal. Might be a good time to get VSO Assistance.

Do you really believe you have New & Material Evidence, supporting your previously Denied and Final Claim? What makes you think it was in your C-File, did you supply it originally?

Read up on the VA Policy regarding Receipt of New & Material Evidence received post Denial Decision, triggering an Automatic Review of your Denial by a Sr Rater or Actual DRO, giving deference to the original raters Decision.

I was told by my VARO in Roanoke Virginia (5 hours from here)  that my files are now located in Janesville Wisconsin, so I will not be able to request in person. Maybe can speak to one of the VSO Offices and speak to a MFIC (what is a MFIC), but I can call and hopefully discuss my situation over the phone.

I am assuming that I have New and Material Evidence, as my SMR specifically states that I had mild OSA while on Active Duty and now I have moderate OSA that requires a CPAP (get machine this month), which to me says they either missed seeing that in my SMR or they disregarded it all together.

I will research the VA Policy for New and Material Evidence received after Post Decision. Is there information on Hadit in regards to this or is it specifically on the VA website?

Thanks for the guidance Gastone!

JR

[Andyman73]

MFIC is the M...F...in charge, and their boss would be the Head MFIC.  This is not to be confused with JAFO...just another F...observer.  Though when the whole thing is AFU, sometimes the MFIC acts like a JAFO, and when that happens it's FUBAR.  Which gets you thinking...BOHICA.  Then you begin to realize it's SNAFU!

[Gastone]

MF In Charge.

Do you have a copy of your SMR with the DX of mild SA? If not, requesting your Complete SMR on your E-Ben site will be about 9 months faster than the usual wait of 13+ for your C-File.

As to your "Viewing" your C-File, 5 hr ride to RO is not worth the trip, if your not absolutely certain of the outcome. Whys your C-File in Ohio?

This will take some work on your part. Find out which VSO is the best staffed at your RO. You need a VSO that you can reach by Phone, Fax or E-Mail on a regular basis. How far are you from your VMC? There should be at least 4+-, VSO-Reps there. They won't have the same computer access that their RO HQ Offices have but they can help. There might even be a State VSO Office near you, Google it.

I just spoke with my VSO HQ regarding viewing my C-File at the RO. He's a Retired DRO and very well seasoned. He concurred regarding the VA Walk-in, 1st come 1st served C-File viewing policy. He stated that all Det RO Files have been digitized, everything is now on computer. All the better, for our viewing pleasure.

I have no info to support this but I have to believe that your C-File is also digitized. If that's the case, you should be able to view it on an RO Comp Dept Computer. You need to check that out with a VSO MFIC.

Or, you can wait a week or so, I have an upcoming appointment at my RO. While I'm there, I was planning on trying the C-File Viewing policy out.

Semper Fi

[John Royal]

24 minutes ago, Andyman73 said:

MFIC is the M...F...in charge, and their boss would be the Head MFIC.  This is not to be confused with JAFO...just another F...observer.  Though when the whole thing is AFU, sometimes the MFIC acts like a JAFO, and when that happens it's FUBAR.  Which gets you thinking...BOHICA.  Then you begin to realize it's SNAFU!

I was thinking about the acronyms on that level, but after your reply I am ROTFLMBO....

[John Royal]

4 minutes ago, Gastone said:

MF In Charge.

Do you have a copy of your SMR with the DX of mild SA? If not, requesting your Complete SMR on your E-Ben site will be about 9 months faster than the usual wait of 13+ for your C-File.

As to your "Viewing" your C-File, 5 hr ride to RO is not worth the trip, if your not absolutely certain of the outcome. Whys your C-File in Ohio?

This will take some work on your part. Find out which VSO is the best staffed at your RO. You need a VSO that you can reach by Phone, Fax or E-Mail on a regular basis. How far are you from your VMC? There should be at least 4+-, VSO-Reps there. They won't have the same computer access that their RO HQ Offices have but they can help. There might even be a State VSO Office near you, Google it.

I just spoke with my VSO HQ regarding viewing my C-File at the RO. He's a Retired DRO and very well seasoned. He concurred regarding the VA Walk-in, 1st come 1st served C-File viewing policy. He stated that all Det RO Files have been digitized, everything is now on computer. All the better, for our viewing pleasure.

I have no info to support this but I have to believe that your C-File is also digitized. If that's the case, you should be able to view it on an RO Comp Dept Computer. You need to check that out with a VSO MFIC.

Or, you can wait a week or so, I have an upcoming appointment at my RO. While I'm there, I was planning on trying the C-File Viewing policy out.

Semper Fi

I do have a copy of my SMR with a DX of mild OSA.

The C-File is actually in Wisconsin and I am not sure why. I plan on calling the VARO office in Roanoke to see if I can find a MFIC that will be able to put me in touch with a VSO rep to talk to.

Thank brother,

JR