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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Question

Okay so my C-file arrived, and did so amazingly  fast. Less than two months, not bad time.

Going through all the files and sorting them but one of the first things I need to get together is the claim on OSA.

I know the rules have changed about OSA ratings and now the med file must have a doctors saying specifically OSA is a medical condition

From the MR21-1MR

“When determining whether the 50-percent criteria are met, the key consideration is whether use of a qualifying breathing assistance device is required by the severity of the sleep apnea.”

“Use absent a medical determination that the device is necessary does not qualify.  The regulation requires that the device be necessary and this is a medical question.” 

So here is my situation.

On 07/07/2013 I had my initial PTSD C&P which noted serious sleep problems, chronic fatigue, hypersomulance but it did NOT mention the SLEEP STUDY diagnosis given on 4/13/13

At that time the simple issuance of a CPAP was considered sufficient to getting a 50% rating for OSA, but as the change listed above notes that is not the case now.

I have already filed a claim for OSA secondary to my PTSD. I did this before my Review C&P for PTSD exam, which resulted in getting bumped to 100% PTSD P&T.

With the change in MR21, I suspect they may disapprove the OSA claim.

If they do, would my path be to file a CUE because the record showed the apnea existed and a cpap was issued when they rated me for PTSD.  The retro pay would be awesome!

That would seem to be an error on their part and under the old standard I would have gotten a 50% rating for OSA as well as my 70% for PTSD and 10% for Tinnitus. The 70+50+10 calculation is 87 which rounds up to 90 for pay purposes and getting that retro 20% difference for 60+ months would be a nice holiday or new years present to me 🙂

In the alternative, would I submit a NOD with the same information?

or would I have to get a DOC to say that the CPA was medically necessary and would that mean I needed another Sleep Study?

Thanks in advance. I am just trying to get things ready for whenever they make a determination on the existing claim.

Edited by GeekySquid
did not click to get responses

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17 hours ago, GeekySquid said:

At that time the simple issuance of a CPAP was considered sufficient to getting a 50% rating for OSA, but as the change listed above notes that is not the case now.

I should have also noted that on the Epworth sleepiness scale i am rated at 20/24, which is not a good thing. The sleep study result shows I get very limited amount of rest and very little REM sleep.

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