Denial of Sleep Apnea without C&P Exam

[Galen Rogers]

Howdy All,

I originally file a claim for Sleep Apnea (OSA) in 2008 after I was diagnosed in late 2007. That was after I retired from the Navy so the diagnosis was never in my military health record. I filed it on my own because my AMvets rep said it would not get approved and he would not mess with it. The VA sent me a request to allow them to contact my doctor directly that I signed and sent back. I knew nothing about a NEXUS letter or lay letters or even the connection with Reflux, Rhinitis, and Sinusitis. A short while later after they contacted my doctor I received the denial letter stating "Not service connected".  Because of my ignorance I accepted that until a few fellow retirees with OSA said they did the same thing but then provided lay letters from shipmates and their wives and their claims were approved. Since then I have read all I could find and have reached out to others for assistance. So my real question is " Would the fact that I was not provided a C&P exam be a basis for a CUE?" The denial came from the Regional VA office.

[Galen Rogers]

My CUE recommendation came from Dr Craig Bash. I trust his opinion and I am following his recommendations. Also Since the original claim was submitted and denied in 2008 I am past any chance of submitting a NOD or an appeal. I have only two choices. I can submit a CUE if I feel there is justification or request the claim be reopened if I have new evidence. If I request to reopen my claim that will establish a new effective date as I understand the rules. Please let me know if I am wrong in that understanding. If I submit the CUE and VA concurs then my effective date will be back to the 01 Jan 2008 claim date. If they do not concur then I can still re-open the claim or file a new claim based on new evidence not available during the original claim. 

[Buck52]

 I have a lot of respect for Dr Craig Bash  HE HAS HELPED A LOT OF VETERANS AND DOES HADIT RADIO PODCAST SHOWS FROM TIME TO TIME .   HE MEANS WELL

A lot of this rides on what kind of exam Dr Bash did HOW MUCH IN DETAIL HE WENT  and how he worded his opinion,  words like related to or aggravated  ect,,ect,,  The BVA goes in deep depth on reviews of claims like this and everything is going to need to be perfected and not anything left out..again a lot of his opein depends on how he worded his medical reports and examination of you.

Here is just one by BVA Decision that Dr Bash help with in a secondary to depression claim for OSA

A lot of double talk in this  and I realize this is not a claim that is like yours  its just an example as what can happen at the BVA.

https://www.va.gov/vetapp10/files2/1016260.txt

[Galen Rogers]

I may be wrong in my assumptions on what requesting to re-open my OSA claim due to new evidence being available. If i did only that and not for reason of a CUE, would my effective date if approved be retro to 2008 or the date of the claim re-opening?

[Richard1954]

Ok.... is it possible to get a sleep apnea approved even if nothing is in your active records... YES I am living proof it is possible. You  had more in your  active records than I had in mine, I had nothing. I got out of service in 1986, I got sleep apnea rating last April.

1. You have to have a present diagnosis

2.You need too speak with a doctor and ask for an independent medical opinion but only after he/she reviews all your medical records

3. Do research to see if your service connected conditions can cause sleep apnea  you will be surprised what causes sleep apnea.

4. When you get a C/P tell the doctors why you think you had apnea in service, some will listen  my c/p doctor did. ( I told them what my buddies and later wife said about my sleeping) 

5. The va must consider all medical evidence you submit even those you find on the internet,  but if you don't have a current diagnosis and  IMO, your get stuck with a c/p doctors opinion. 

6. You have to look at the va claim like an insurance claim, the C/P doctors  work for the insurance company,  don't be caught without and IMO from your own doctor it makes it to easy to get a denial.  This applies to almost any claim after the initial claim.

7. The trick is to have all the information available so that they cannot deny your claim.  

Just because your overweight doesn't mean it caused apnea, ( I'm 150 overweight, my weight was never mentioned in the c/p exam but that's another story)

Check out this web page this guy wrote my IMO for my case... its expensive ( 1500) but in the end worth it.

http://www.danaise.com/

he also wrote a book about apnea  its on amazon.com

Edited May 1, 2018 by Richard1954

[Richard1954]

On 4/26/2018 at 11:33 AM, Galen Rogers said:

I may be wrong in my assumptions on what requesting to re-open my OSA claim due to new evidence being available. If i did only that and not for reason of a CUE, would my effective date if approved be retro to 2008 or the date of the claim re-opening?

Unless you  get a CUE approved, you would not get retro back to 2008.  You only have a year to appeal so  appealing wound not work either. 

If you reopen the claim, it will automatically be a new claim even if you did not have new evidence and you would only get paid from the date of the new claim

[Galen Rogers]

Here is some info on DR Craig Bash. He did my IMO/NEXUS letter.

Dr Bash VA Experience 2017.pdf