Sleep apnea- does the DBQ cover the "medically necessary/required" language?

[chibears3531]

Hey everybody! Long time lurker, first time poster.

My question is regarding the sleep apnea language that specifies that a prescription of a breathing assistance device is "medically necessary" for a 50% rating:

Assuming that a vet is already prescribed a CPAP/APAP by the VA, does the sleep apnea DBQ portion under 2B "IS CONTINUOUS MEDICATION REQUIRED FOR CONTROL OF A SLEEP DISORDER CONDITION?" fulfill that language requirement?

Edited December 6, 2018 by chibears3531

[Berta]

"I read a very informative post of yours at the top of IMO criteria forum and I had a question about doctor credentials- does the title of the medical professional come into play often during VA claims?"

Absolutely-meaning the VA will take the word of a VA doctor over a FNP whenever  they can- even when the VA doctor is not a specialist in the field of the disability and/or a downright quack-

but that depends on the issues and what evidence supports the claim.

Can you scan and attach the IMO  here? (Cover C file #,name, prior to scanning it)

I say that because I experienced this issue-

I had 2 VA Endocrinologist C & P exams (posthumous) reports against my AO DMII death claim. I also had 2 IMos from Dr. Bash- a Neuro-radiologist-and also an additional brief Freebee from a former VA Neuro.

It might seem odd to ask a Neuro radiologist to opine on a DMII claim but by then I had known Dr. Bash for years via our radio shows and he was able to state in one IMO that the VA Endo doc  was medially inaccurate , with a full medical rationale, (I had rebutted something she said as well)and also stated that he had exerience from reviewing  X rays and MRIs from "thousands" of diabetics.

His expertise fully outweighed anything I could find on the VA Endocrinologist.

I asked BVA to remand the claim because my VCAA rights had been violaed by Buffalo VARO.

They remanded instead for a Cardio VA opinion.

I obtained and knocked down the opinion myself, and sent my rebuttal to the BVA, as it was from a PA and I had more cardio expertise then he did and the BVA had ordered a Cardio opinion- the PA's opinion was therefore too speculative.

BVA agreed they had violated my VCAA rights but considered that as moot and trashed the PA C & P and awarded the claim. DMII Direct SC death- diabetes was never diagnosed or treated by the VA in my husband's lifetime-

I already had won wrongful death FTCA and 1151 DIC.Therefore I had to file for  direct SC.

This was the most important claim I ever have had- my VARO refused to re=open it many times saying I had sent them only  " a few internet printouts". Those printouts were not even needed for the claim.They ignored all of my IMOs but the BVA sure didnt.

I dont mean to say the DBQ in your case wont fly- I just am not sure it will..

I was willing to pay $4,000 for the two IMos and also spent $1,400 more on a cardio IMO but the BVA award came without it even being prepared yet- I knew my medical evidence was a s solid as it could be.The forensic cardio firm refunded about half of my IMO fee.

 

 

 

 

Edited December 10, 2018 by Berta

[chibears3531]

3 hours ago, Berta said:

"I read a very informative post of yours at the top of IMO criteria forum and I had a question about doctor credentials- does the title of the medical professional come into play often during VA claims?"

Absolutely-meaning the VA will take the word of a VA doctor over a FNP whenever  they can- even when the VA doctor is not a specialist in the field of the disability and/or a downright quack-

but that depends on the issues and what evidence supports the claim.

Can you scan and attach the IMO  here? (Cover C file #,name, prior to scanning it)

I say that because I experienced this issue-

I had 2 VA Endocrinologist C & P exams (posthumous) reports against my AO DMII death claim. I also had 2 IMos from Dr. Bash- a Neuro-radiologist-and also an additional brief Freebee from a former VA Neuro.

It might seem odd to ask a Neuro radiologist to opine on a DMII claim but by then I had known Dr. Bash for years via our radio shows and he was able to state in one IMO that the VA Endo doc  was medially inaccurate , with a full medical rationale, (I had rebutted something she said as well)and also stated that he had exerience from reviewing  X rays and MRIs from "thousands" of diabetics.

His expertise fully outweighed anything I could find on the VA Endocrinologist.

I asked BVA to remand the claim because my VCAA rights had been violaed by Buffalo VARO.

They remanded instead for a Cardio VA opinion.

I obtained and knocked down the opinion myself, and sent my rebuttal to the BVA, as it was from a PA and I had more cardio expertise then he did and the BVA had ordered a Cardio opinion- the PA's opinion was therefore too speculative.

BVA agreed they had violated my VCAA rights but considered that as moot and trashed the PA C & P and awarded the claim. DMII Direct SC death- diabetes was never diagnosed or treated by the VA in my husband's lifetime-

I already had won wrongful death FTCA and 1151 DIC.Therefore I had to file for  direct SC.

This was the most important claim I ever have had- my VARO refused to re=open it many times saying I had sent them only  " a few internet printouts". Those printouts were not even needed for the claim.They ignored all of my IMOs but the BVA sure didnt.

I dont mean to say the DBQ in your case wont fly- I just am not sure it will..

I was willing to pay $4,000 for the two IMos and also spent $1,400 more on a cardio IMO but the BVA award came without it even being prepared yet- I knew my medical evidence was a s solid as it could be.The forensic cardio firm refunded about half of my IMO fee.

 

 

 

 

That's very impressive how your hard work (and Dr. Bash's) eventually lead to you winning in the end. I'm happy you and your family finally got what was due.

The attached file is NOT the IMO in question but it is from the same company called "Valor4vet" and presumably the same FNP working on the medical opinion regarding my OSA. It's for another claim linking my migraines to my service connected TBI.

Nexus_Letter_revised.pdf

Edited December 11, 2018 by chibears3531

[doc25]

12 minutes ago, chibears3531 said:

That's very impressive how your hard work (and Dr. Bash's) eventually lead to you winning in the end. I'm happy you and your family finally got what was due.

The attached file is NOT the IMO in question but it is from the same company called "Valor4vet" and presumably the same FNP working on the medical opinion regarding my OSA. It's for another claim linking my migraines to my service connected TBI.

Nexus_Letter_revised.pdf

If the C&P examiner does not concur with the other nexus and provides an unfavorable nexus? The favorable nexus provided, balances the evidence;in such cases, but the VBA seems to do what they want anyway.

d.  Handling Evidence in Equipoise

As indicated at M21-1, Part III, Subpart iv, 5.1.k, resolve reasonable doubt in favor of the claimant if all procurable evidence, after being weighed, is found in approximate balance or equipoise.  38 CFR 3.102 dictates that the Veteran prevails when the evidence neither satisfactorily proves nor disproves an issue.   Reference:  For more information on applying reasonable doubt, see Alemany v. Brown, 9 Vet. App. 518 (1996).

[Galen Rogers]

My IMO for OSA provided references to medical articles that link OSA to different medical issues like sinus problems and GERD (Reflux). I also got a letter from my Sleep Doctor stating the the BIPAP machine was medically required. I also got lay statements from friends and family stating how long they have noticed my symptoms. I was lucky and the VA secondarily connected it to my GERD. If your Doctor writes a very well laid out IMO with strong medical logic backed up by medical articles why your TBI is more likely than not to have caused your OSA, you have a good shot.