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CUE for OSA?
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GeekySquid
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 GeekySquiddid not click to get responses
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