2nd attempt- FDC Rhinitis Increase, Secondary OSA, Sinusitis, and Hypertension

[etfink]

Hi all,

looking for feedback regarding my progress and chances, along with any other suggestions.

I served in the Navy from 1999-2005, Honorable discharge as a nuclear mechanical on subs.  Sadly, like many I rarely reported medical issues while I was in, didn't want to hurt the command with absences.  If only I knew then right?

In 2015 I filed put my first claim in, Rhinitis (this was well documented inservice) sleep apnea, i had symptoms inservice that were documented but never diagnosed and hypertension secondary to OSA.  I thought I had a good package, I had buddy statements and an IMO from Dr Ellis.  Well the VA disagreed.  They granted SC Rhinitis at 10% and declined SC for OSA and HTN.  I applied for a denovo review and they upheld the first rating.  I then let my 1 year expire and things ended there.  

 

A few years later my sinuses were getting worse.  I saw an ENT who diagnosed severe sinusitis a deviated septum and polyps.  We tried steroids and antibiotics and then went with a pretty complex sinus surgery.  Post op several rounds of steroids and still have polyps.  I currently use daily steroid irrigation.  That sucks.  

 

My OSA of course was diagnosed with a sleep study, it was rated as severe and I use a CPAP daily.  I strongly feel that the fact that I can barley breath through my nose makes it a lot worse.

The diagnosis on all of these are unarguable.  Its the SC that will be the battle. 

 

HTN: I have pretty severe HTN, it is controlled with 3 meds daily. The literature is pretty clear that OSA worsens HTN.

And for what its worth, I don't use the VA for health care.  

So my packet:

I had hoped to try the DRC process as, I am very lucky to have the resources to build my own claim.

I used Bethany who is a PA at Valor 4 Vets to do my DBQs for Rhinitis /Sinusitis, OSA and HTN.  She also wrote IMOs for each with literature cited.  The least as likely then not phrase  is there for every condition.  I'm happy to post if it will help anyone. 

I also wanted an IMO from a doc with a little stronger CV so I went with Dr Aniase, I know he's been talked about here and like others have said the service was great.  Also he is a former lung transplant surgeon, who has focused a lot on OSA so I thought that was a good fit.  He put together a solid 65 page letter with a lot of literature and medical rationale that OSA is make worse by Rhinitis and that HTN is made worse by OSA.  He went on to say that sinusitis is only caused by rhinitis and pointed out the rationale for increased rhinitis.  

I of course had all of my private medical records. 

 

I took these to my local VFW service officer on 4/17.  I had no problem doing the claim myself by a DRC claim has to be submitted by a VSO.  She tried to discourage the DRC process as it shifts the responsibility to the Vet and the VSO.    I get that but I already have everything and hopefully wont need additional exams as I have my DBQs.  She relented and took all of my compiled paperwork to submit.  Well shockingly while her cover letter asked it to be processed as a DRC, it wasn't uploaded to the DRC portal and is now showing as a regular pending claim.  The OSA and HTN are re-opens.

So I think i have a pretty bulletproof packet.  What thoughts do you all have?  Is there anything else I should do?

[broncovet]

Sleep Apnea and TDIU, in my humble opinion, are the hardest to win, except maybe for SMC R/2, which pretty much means you are terminally ill in bed.  

I say this over and over:  Focus on the basics of the Caluza Triangle, which I already posted, above.  

Only then worry about symptoms.  

In the case of secondary sc, you need only 2 parts of the Caluza triangle:

1.  Current diagnosis.

2.  Nexus, or statement from the doc that your (secondary condition) is as least as likely as not the result of 

(your primary already sc condition).  

    You dont need an in service event with secondaries, as that is already established with your primary SC.  

    My point is to READ your medical records, dont assume this is in there..it may or may not be for 2 reasons:  One the doc never put it in there, and Two, he put it in your records and the VARO conviently lost it.  Its highly convienient for the VARO to lose documents which are critical to your claim.  Or, they dont lose them, they just dont bother to read them.  

     Attention to my immediatly preceding paragraph would probably win about half the cases at the BVA.  Conversely, neglecting the above paragraph, virtually assures a denial.  Of course, we dont have control over whether or not a rating specialist reads your file, but we do control what/when we send records to the VARO, and assuming the records are there and they are correct is a big mistake.  

Edited April 29, 2018 by broncovet

[broncovet]

I know this from the college of hard knocks, as I assumed they were in my records, while the VARO conviently lost records critical to my case.  

[broncovet]

If you want it bullet proof, document the following:

1.  current diagnosis...no diagnosis no benefits. 

2.  In service event, or aggravation.  You stated this is documented in service.  Did you read your records, and make sure?

3.  Nexus.  A doctor needs to state your Rhinitis is "at least as likely as not" due to x event or aggravation in service.  

If you have all three of these documented, you are good to go.  If you are lacking any one or more of these, you are setting yourself up for a denial.  

    Based on your post, you have 1 and 2.  Now, make sure a doctor stated pretty much just what I posted.  VSO's love to send Vets to appeals without a nexus.  That's like going to a trap shoot with no shotgun.  

[etfink]

7 hours ago, broncovet said:

If you want it bullet proof, document the following:

1.  current diagnosis...no diagnosis no benefits. 

2.  In service event, or aggravation.  You stated this is documented in service.  Did you read your records, and make sure?

3.  Nexus.  A doctor needs to state your Rhinitis is "at least as likely as not" due to x event or aggravation in service.  

If you have all three of these documented, you are good to go.  If you are lacking any one or more of these, you are setting yourself up for a denial.  

    Based on your post, you have 1 and 2.  Now, make sure a doctor stated pretty much just what I posted.  VSO's love to send Vets to appeals without a nexus.  That's like going to a trap shoot with no shotgun.  

broncovet thanks for your reply!

 

The Rhinitis is already SC at 10, They have found polyps which is the criteria for 30% so I'm going for an increase.

I tried for OSA and HTN in service but it was declined.  No diagnosis although documented symptoms.  So instead I'm going for this.

OSA secondary to Rhinitis.  I have the DX, and 2 doctors saying that the Rhinitis (already SC) aggravates it (as likely as not).

Sinusitis secondary to Rhinitis. I have the DX, and 2 doctors saying that the Rhinitis (already SC) causes it (as likely as not).

HTN Secondary to OSA. I have the DX, and 2 doctors saying that the OSA (applying for SC) aggravates it (as likely as not).

 

Sorry if I was rambling a little and not clear.

 

I went with my own DBQs and 2 strong Nexus letters.  I heard the VA is tightening up on OSA claims so I really wanted my ducks in a row.

[etfink]

16 hours ago, broncovet said:

Sleep Apnea and TDIU, in my humble opinion, are the hardest to win, except maybe for SMC R/2, which pretty much means you are terminally ill in bed.  

I say this over and over:  Focus on the basics of the Caluza Triangle, which I already posted, above.  

Only then worry about symptoms.  

In the case of secondary sc, you need only 2 parts of the Caluza triangle:

1.  Current diagnosis.

2.  Nexus, or statement from the doc that your (secondary condition) is as least as likely as not the result of 

(your primary already sc condition).  

    You dont need an in service event with secondaries, as that is already established with your primary SC.  

    My point is to READ your medical records, dont assume this is in there..it may or may not be for 2 reasons:  One the doc never put it in there, and Two, he put it in your records and the VARO conviently lost it.  Its highly convienient for the VARO to lose documents which are critical to your claim.  Or, they dont lose them, they just dont bother to read them.  

     Attention to my immediatly preceding paragraph would probably win about half the cases at the BVA.  Conversely, neglecting the above paragraph, virtually assures a denial.  Of course, we dont have control over whether or not a rating specialist reads your file, but we do control what/when we send records to the VARO, and assuming the records are there and they are correct is a big mistake.  

Thank you so much for the solid advice. I’ve heard the same thing about OSA being hard to prove. 

 

My IMOs not only referenced the diagnosis over and over they inserted the relevant records into my letter and then backed up the nexus with studies and excerpts from medical texts. 

 

So on paper I feel good. 

 

Of of course I submitted the raw records as well.  

 

I’ll upload a redacted copy tommorow it might be good for other members to see. I’ve certanly learned by following other members cases here. My IMO/nexus is over 60 pages so it’s a lot of redacting. 

[Fat]

Is Rhinitis and OSA considered respiratory issues.

Can you be service connected for two respiratory issues at the same time?

Rhinitis and OSA ??????