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Please review my C&P Sleep Apnea DBQ


Leon2015

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Hello guys, please let  me know what you think about my Sleep Apnea DBQ, hopefully this is enough to get my service connected? 30% or 50%?

Sleep Apnea
Disability Benefits Questionnaire

Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination

Request?
[X] Yes [ ] No

ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this

document:
[X] In-person examination

Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA) [X] CPRS

1. Diagnosis
------------
Does the Veteran have or has he/she ever had sleep apnea? [X] Yes [ ] No

[X] Obstructive
ICD code: G47.33 Date of diagnosis: 03/24/2014

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's sleep disorder condition (brief summary): The veteran is claiming a service connection for obstructive sleep apnea (OSA). The veteran was first diagnosed with mild OSA in March, 2014 after completing a home sleep study while he was residing in CA. He reports using CPAP since being diagnosed and was seen 02/02/2017 by a physician from the Pulmonary & Sleep Specialists 

Please note, the veteran brought a copy of this Office Consultation Note to this C&P appointment/examination; I requested that he submit this to the RO. As per the 02/02/2017 Office Consultation Note, and by the veteran's own self report he continues to experience the following symptoms: morning headaches, excessive daytime sleepiness, weight gain that he attributes to the medications he is prescribed and taking for PTSD and depression. Other symptoms that the veteran endorses and that are not listed on the 02/02/2017 Office Consultation Note include: "choking and gasping during sleep, waking up with a dry mouth or sore throat, hoarseness in voice/throat, restless/fitful sleep, insomnia and waking up during the night, going to the bathroom frequently during the night, waking up feeling out of breath". As per this 02/02/2017 physician's note, "His weight gain appears to be worsening his sleep
apnea. He has gained over 20 pounds...IMPRESSION: 1. Obstructive sleep apnea by history, worsening with increasing weight gain, may be related to some of his medications that he is taking for his chest pain. 2. PTSD. 3. Depression. 4. Increased weight."

Of note, the veteran's weight recorded in CPRS 03/17/2014 was 198.6 lbs.

On 03/13/2017, the veteran's weight is recorded as 201.0 lbs.

b. Is continuous medication required for control of a sleep disorder condition?
[X] Yes [ ] No

If yes, list only those medications required for the Veteran's sleep

disorder condition:
Mirtazipine 30 mg qhs for sleep.

c. Does the Veteran require the use of a breathing assistance device? [ ] Yes [X] No

d. Does the Veteran require the use of a continuous positive airway pressure (CPAP) machine?
[X] Yes [ ] No

3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms attributable to sleep apnea?
[X] Yes [ ] No

If yes, check all that apply:
[X] Persistent daytime hypersomnolence

[X] Other, describe: SEE MEDICAL HISTORY

4. Other pertinent physical findings, complications, conditions, signs, symptoms and scars

-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above?
[ ] Yes [X] No

b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above?
[ ] Yes [X] No

c. Comments, if any:
No response provided.

5. Diagnostic testing
---------------------
a. Has a sleep study been performed?

[X] Yes [ ] No

If yes, does the Veteran have documented sleep disorder breathing? [X] Yes [ ] No

Date of sleep study: 03/18/2014

Facility where sleep study performed, if known: San Diego

Results:
Home sleep recording performed using the Carefusion T3 System.

IMPRESSION: Mild obstructive sleep apnea.

b. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No

6. Functional impact
--------------------
Does the Veteran's sleep apnea impact his or her ability to work? [ ] Yes [X] No

 

 

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Not really, no discussion of in service symptoms, only "Lightly" mentions "Possibly" associated with PTSD.

What's the Date and SC% of your PTSD, when exactly was it DX'd, before 03/18/2014?

The Dr indicated that your SA doesn't interfere with "your" employment. How can that be?

An SC for SA requiring CPAP or BiPap is 50%.

What are your P02 % from your Sleep Study, do they drop below 90%, if so how often? Talk to your Dr about the possible need for supplemental 02 while on Cpap. The Dr would have picked it up but you never know.

Semper Fi

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Gastone, please keep in mind that is this claim is for secondary/and or aggravation to GERD and MDD.  My SA claim is been ongoing since 2007, it went all the way to CAVC and now back to AMC for this current C&P. Since this appeal started I have been approved 60% for GERD and 70% for MDD with diagnosis a for PTSD  all through out my VA records.

The examiner wasn't a doctor it was Nurse Practitioner who was there just for paperwork. He just ask me a few questions at the C&P. I know in order to win I will need a IMO. I have that in the works too and will be submitting this week.

I'm not sure if this DBQ from the NP helps me at all?

Edited by Leon2015
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Leon, I just got on this bus, missed all your back story. If you have time, how about posting an Awards, Denials, and appeals timeline?

This recent SA C & P was the result of a Remand from the CAVC? How about a Docket Number?

CAVC Remands are supposed to be conducted by Sr Medical Personal with extensive Specialist training in the condition in question. An NP doesn't seem to meet the criteria of being an Expert in Sleep Medicine.

What is your current Combined SC Rating?

Semper Fi

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Wow I didn't know I was suppose to have a experienced person working on my remand. Ok. Current combined rating of 90% SC.

Here is the Docket# 

Case Number:15-885

I'll update some more the timeline tomorrow but most of the info is in the docket case file.

Edited by Leon2015
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You mention "PTSD has been documented throughout your Med File," have you ever filed a claim for it?

I see no mention of an actual PTSD SC and date Awarded. Do you have a VA or Private Psychiatrist definitive DX of PTSD?  how about a copy of your PTSD DBQ?

If you review the DSM V, of interest, is the discussion regarding SA and Depression. Strictly my Lay interpretation but the Psychiatrist's seem to acknowledge that Moderate/Severe SA is a Nexus to, not from depression.

Semper Fi

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I have letter from my VA Psychiatrist diagnosing PTSD and it mention all throughout my VA records since 2014. No claim for it because I'm 70%MDD.

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I originally put in a Sleep Apnea claim all the way back in 2007 secondary to GERD. This claim was denied all the way to CAVC and Aug 2016 it was remanded back to AMC. Since the initial claim I went from 10% GERD to 60% GERD and gained 70%MDDepression. Since I was allowed to add in additional information my VSO also added in secondary 70% mental health in addition to GERD=Sleep Apnea secondary to GERD/and or MDD basically.

**Update** New info:

At this stage I decided to get an IMO done stating my case for Sleep Apnea secondary to GERD/MDD/Tinnitus. The IMO was submitted as additional evidence last week. 

I had my Comp and Pen on March 21, 2007 and I just received SSOC April 16, 2017 stating that I'm denied and they will be sending my file to the BVA for a final determination. I have 30 days to submit for evidence.

I'm not sure what to do at this point to try and win my case. Should I just wait on the BVA to make a decision on the RO remand denial? In the SSOC they did not list all the evidence that I submitted over the years. I will make this known to my VSO this week. Can you please give me some advice.

Thank you!

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"I had my Comp and Pen on March 21, 2007 and I just received SSOC April 16, 2017 stating that I'm denied and they will be sending my file to the BVA for a final determination. I have 30 days to submit for evidence."

You mean they never gave you any C & Ps since 2007????

"At this stage I decided to get an IMO done stating my case for Sleep Apnea secondary to GERD/MDD/Tinnitus. The IMO was submitted as additional evidence last week. "

If the IMO or IME was favorable and followed the IMO/IME criteria here at hadit, make sure they get it ASAP and send it to the RO  AND to the BVA, using your docket number in a brief cover letter, referencing the IMO.

 "In the SSOC they did not list all the evidence that I submitted over the years."

I have been victimized by that crap in almost every claim I have had....but it didnt work----

make sure you point out any probative evidence that you feel is missing , if it impacts on your case.

And if the RO ignores your recent IMO, you can request they call CUE on the decision under violation of 38 CFR 4.6 . If your VSO does not understand that tactic, I have plenty of info here he needs to read.

That tactic has worked Very well for me and 2 other claimants here and I asked the new Secretary to turn the tactic into a fast letter. We have the same ability to use the CUE regs ( 38 USC 5109) against them, within the appellate period ,as they use it against us.

By IMO/IME criteria I mean did the *IMO doc have all of your SMRs and  medical records?

Did they give a full medical rationale for the opinion citing those records?

Did they have a copy of the C & P exam results that denied the claim?

You are at the point I was at with my AO DMII death claim.I had 3 IM0s the VARO refused to consider ( I should have used the CUE yourself Tactic but didnt...besides I knew the BVA can read and knew the BVA would award.The VARO had 2 bogus C & Ps (posthumous) from an endocrinologist.

I asked for remand because my VCAA rights were violated. BVA remanded instead for another C & P exam.

I got a copy and immediately rebutted with my lay medical opinion ,stating the exam was too speculative.

BVA agreed that my VCAA rights had been violated but said  that was a moot point because they awarded -agreeing with my lay medical rebuttal. Also the C & P was done by a PA, but my opinions were done by real doctors.

BVA had asked for a Cardio opinion for the DMII claim.The fact that I got a PA opinion helped me prove how speculative the PA C & P was. I knew more about cardio than the PA did (BVA knew that from my FTCA settlement /1151 award, in the C file. No IMOs, No lawyer- I proved death by VA.)

Is anyone representing you at the BVA?

You have had a long trek so far and have had some great success!

A remand from the CAVC can be Golden as it opens the claim up for more evidence.

I hope all here read your post because this is very inspiring and it shows that we must NEVER give Up!

 

 

 

 

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Ps, do you have USPS proof of mailing them the IMO?

I have used Priority Mail with tracking slips for everything I have ever sent to them.In testimony I gave to the H VAC years ago ,I sent three pages of the green and white tracking slips, all 53 of them,to help prove that Shreddergate was no urban legend, it was real.

I dont think they shredded much of my stuff however, they just chose to ignore it.-which is just as bad as shredding it anyhow.

 

Edited by Berta
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Gee, I read this too fast-the first time ---- You did have a more recent C & P exam.......sorry about that.....

It doesn't change my opinion.That IMO could turn this all around.

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Do you have any Medical Clinician Treatment Notes indicating a preponderance of medical evidence supports your 2014 SA DX as being  Secondary to your Long Standing MH DX's?

A friend just got his CAVC Denial Letter from a C & P Remand last year. It was signed by a CAVC Judge, BVA wasn't involved. Shortly after his Remand C & P, he got a "Continued Denial Letter" from his RO. The Remand C & P Report and the RO's Continued Denial Decision were both referenced in the recent CAVC Denial Letter.

As of last week, he's still awaiting a response (60 Day Filing Clock is running) regarding Appealing the CAVC Denial, from his VA Appeals Lawyer (Vet Pro Bono Consortium). They were awarded about $18K in legal fees from his Remand.

Will be very interesting to see if they agree to rep him at the Appeals Court. Not sure, but if they don't win, I don't think legal Fees are on the table.

Semper Fi

 

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Berta, thanks for your information it is very helpful. Hopefully they will look at all my evidence at the BVA. 

I just call this morning and the BVA received my file from RO on April 6. How much time do you think I have before they make an determination on my case? 

 

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I got my BVA award in a mere 3 or maybe 4 months after their receipt of the remanded claim but that was in 2009 and the backlog has increased significantly since then.

I had gotten two vets BVA decisions by mistake in 2008-2009 and called the BVA and the POAs about them, and when the big brown envelope came again I just threw it on the table, for a few days unopened,thinking it was another BVA  mailing error.It seemed way too soon to be a decision on my BVA case.

I also had jumped the gun, after paying 4 thousand for my IMos andI  had paid for a Cardio forensic IMO-just in case, as soon as I got the PA Bogus C & P crap, and I had to call the IMO firm up right away because the BVA envelope contained my award.Their IMO was not done yet and they refunded me about 900 bucks of the 1400? or so I had paid.

It is very hard to determine how long anything will take these days.

Someone at the BVA told me last year  they don't have any ombudsman anymore-however I think they still do.

I asked the ombudsman how high the stack was and where was my case in it once....but they really couldn't tell me. A remand will usually go faster than a regular BVA claim,in my opinion, beause so many facts have already been established at that point.

BVAOMBUDSMAN@VA.GOV is their email I think.

 

 

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Leon, it appears that you have never actually filed a claim for PTSD, nor have you ever had an actual Rating Department requested PTSD Forensic Exam. If that is the case, from the VA Rating Dept perspective, you don't actually have a PTSD Ratable Claim or Diagnosis.

You'll know soon enough, CAVC seems to be much more punctual (within 6 mos) in rendering their Decisions after receipt of the Remand Results. Have you received a New RO Decision Letter based on the Remand? 

Semper Fi

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