Jump to content
  • veteranscrisisline-badge-chat-1.gif

  • Advertisemnt

  • Trouble Remembering? This helped me.

    I have memory problems and as some of you may know I highly recommend Evernote and have for years. Though I've found that writing helps me remember more. I ran across Tom's videos on youtube, I'm a bit geeky and I also use an IPad so if you take notes on your IPad or you are thinking of going paperless check it out. I'm really happy with it, I use it with a program called Noteshelf 2.

    Click here to purchase your digital journal. HadIt.com receives a commission on each purchase.

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
     
  • Ads

  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

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

    employment 2.jpeg

    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


  • 0
Sign in to follow this  
NoZZZ's

IMO for Sleep Apnea/cervical - where to get one?

Question

Hello All,

I am planning on filing a claim for sleep apnea, which was not diagnosed while I was on active duty, as well as cervical pain and Allergic Rhinitis, which were noted in STR's but not officially diagnosed until a few years later, despite continuous treatment for them by the VA. While there is some reference to sleep issues while I was deployed, and treatment records in service for the other two, I want to make my claim as strong as possible from the start.

Having read through many of the posts here and elsewhere regarding the nexus to service connection, I believe I will need an IMO to connect the in service event (injury on deployment) and my current diagnosis for sleep apnea, since it was diagnosed about 9 years after I left active service. My spouse is willing to write a statement regarding the symptoms she has witnessed since I left service until my diagnosis, and I have had two sleep studies confirming a diagnosis of sleep apnea (both done at the VA, 6 years apart).  I plan on trying for direct service connection (unlikely but worth a shot) as well as secondary service connection (I have other SC conditions, but only rated at 20%, to connect it to). The pulmonologist at VA said my chronic pain likely contributes to my sleep apnea, but I am guessing this is not affirmative enough language for the  VA rater, which is why I plan on seeking an IMO, for all three issues I am claiming.

My primary care Dr is at the VA, and tends to write in generalities, so I don't think she will be a good choice for writing the IMO/DBQ (she tells me I have to wear my CPAP or I will stop breathing or die in a car accident, but only writes in my chart that "CPAP is recommended"). I have been looking (unsuccessfully) online for doctors who specialize in providing IMO's, and have read about the ones reviewed here, but was wondering about another I keep seeing pop up in the google searches - VA Claims Insider. Seems like a one stop shop, but I have not found much information about them other than what is offered on their website and Youtube channel.  Also, the idea of paying after a claim increase seems like a good option, since multiple IMO's can be expensive, but I would think this could present a conflict in the eyes of the VA, since the fee increases with the size of the award.  Also, I'm not going to lie, I think it would be great to have someone go over my records and possibly identify issues that I can rightfully claim that I am just not aware of. That seems to be the service they also provide, along with IMO's.

So, any guidance or reviews would be appreciated.  I am pretty confident that I will need the IMO's. I just don't know where to get them without a potentially awkward first visit to a new Dr, "Hi, I know that we just met, but can you write this very detailed letter for me so I can get disability compensation. No pressure."

Thanks, and thank you all for the great info on this site.

P.S. - I do not intend for this to become a thread to bash one service over another, or to endorse any particular service. I would just like some honest opinions about any of the people you folks have used. The nexus letter seems to me to be the deciding factor in many of the BVA appeals I have read. Despite its importance, I have had difficulty finding solid info and advice about getting one.  Also, I assume VA Claims Insider probably reads this forum, and I don't want to disparage anyone who is trying to help vets.

Share this post


Link to post
Share on other sites

Recommended Posts

  • 1

OSA or (Sleep Apnea) are the most common claims to be denied especaill if you have no rational/nexus to coonect it to your prior military service. its a 90% denial rate.

The best way to claim sleep apnea in my opinion is  through a secondary condition that can cause or be related to S.A.

Start off with a referral from your VA PCP to a sleep study. to prove you have OSA and the severity of it.

then you will be Prescribe/ issued a C-pap or bi-pap machine  to use  and hopefully the Dr will state in his/her report in your medical records  that the C-PAP is a health necessity to use every night.

You need a  qualified Dr to state that your OSA is likely related to  your  s.c. condition that you have at present, What ever s.c. condition that will be?

example  if you have been diagnose and S.C. with chronic PTSD and  PRESCRIBE MEDICATIONS  these medications are the magic words that a Qualified Dr can use  as a secondary condition to your Diagnose Sleep Apnea.

That usually will get you S.C. for OSA and the VA  Prescribe C-PAP MACHINE IS A 50% Rating by its self ,  it depends on the severity of the Sleep Apnea  what they rate you on above the 50%

without all this and what others here have mention  its more than likely you will be denied for OSA.

 

Share this post


Link to post
Share on other sites
  • 0

Welcome to Hadit!

I'm glad you know about nexus letters and their purpose. That often is the key factor that causes trouble.

Here are some good links to help you out:

https://www.hadit.com/nexus-letter

-and-

My nexus letters stated:
- Doctor described his curriculum vitae (qualifications)
- Doctor explained how long he has treated me
- The doctor reviewed my service and post-service medical treatment records from (start date) to (end date)
- Details of the examination (i.e. labs, imaging, physical examination, range of motion including where pain begins), basically what you can find in the DBQ's provided by the VA
- Nexus based on strong medical rationale explaining why your disability is related to service
- Just make sure they don't use vague terms like "probably" or "possibly". "As likely as not", "more/most likely", or "due to/caused by" are the best

Most VA doctors will not write a nexus, but I was surprised when I had one do it. They simply wrote one paragraph in my VA progress notes and used the correct jargon. This is rare from what I hear.

You can ask your doctor to fill out a DBQ, but not all will do it. It is pretty much a C&P without the nexus or record review, but they can add a nexus if they want. Some folks have asked their doc if they would do this and then brought back the form on their next visit.

There are a number of non-VA doctors who do IMO's. The first one that comes to mind is Dr. Craig Bash. A lot of veterans used him, but he is not cheap. Also, keep in mind that just because you pay a doctor for an exam, that doesn't mean they will opine in your favor. Definitely ask around first.

If you can get everything tied up, you can submit a fully developed claim. The VA will review and bring you in for a C&P if they need additional exams or imaging.

If you cannot get everything tied up, consider filing a claim to preserve your effective date. This is when you tell the VA you want to file for X, Y, and Z, but am still putting things together. You have a year to get it submitted otherwise the VA will just deny the issues. You could always reapply at any time.

 

It took me quite a while to go through all of my service treatment, VA, and non-VA medical records. I made a list of every diagnosis and dates. I also obtained a copy of my VA claims file (took months) because it contained some additional information that was not present in the preceding records. This process took quite a while. I researched the VA rating criteria for each potential disability. Get very familiar with this, especially when your decision letter arrives.

 

For cervical, the most common ratings are based on limited range of motion. Keep in mind that maximum range of motion and when pain begins are two completely different things. The VA is supposed to rate on the latter, but doesn't always do it. They are also supposed to use a special protractor (goinometer) to measure the range of motion, but some just eyeball it (could be grounds for a new exam if they deny).

Allergic rhinitis ratings are based on blockage and potential presence of polyps. 

Sleep apnea has criteria based on hypersomolnence (daytime sleepiness) or the use of a CPAP machine. Just make sure you are compliant in using the machine. 

The crazy thing is that the VA considers sleep apnea a respiratory condition in most cases. If you happen to get SC for SA and the rhinitis, the VA might consider it pyramiding and grant the higher of the two ratings for percentage calculation purposes.

I hope this helps. You are doing the right thing by asking questions.

 

Share this post


Link to post
Share on other sites
  • 0

Thanks for the reply Vync. I have already submitted an intent to file in order to preserve the date. Since then I have been gathering my records and reviewing them to make sure it is even appropriate for me to file a claim. Since doing so, I started wondering why the VSO I had used the first time had not submitted for these already. I didn't file a claim when I got off of active orders, because I was still in the reserves and didn't think I could (which I now know is wrong). I also didn't want to get kicked out of the reserves for medical reasons, so I waited until my enlistment was up to file.

I do remember him saying that it would be easier to file for what I did, since I had LOD's in my file already, but I have continuity of symptoms for other conditions that arose in service and still bother me now that I think should have been filed for but were not. Now, 15 years later, I fear it will be harder to service connect, despite 15 years of VA medical records dealing with the same issues. 

I plan on connecting the dots in my claim as much as I can. I have a spreadsheet of all of the issues I am submitting, with date, provider location, and a summary of the visit/lab/test report. I also have a summary for each condition, including the symptoms I experience, and a timeline of Dr visits from the first onset until present. My wife will write a buddy letter as well. I do not keep in touch with anyone I was in the service with, and feel awkward trying to call out of the blue and ask for a letter about something they may not remember (I don't remember that they snored, why would they remember that I did). Which leaves the nexus letter firming up the connection between my medical history, my current diagnosis, and my military service.  I can't think of anything else I can do to make this as strong as possible, but that nexus letter seems to be the vital link.

I have read about Dr Bash on this forum. I have also started finding other "services" like vets4valor and va claims insider, but its hard to find reviews of those services. I would hire an attorney, but I know that is not allowed unless I have been denied already, which is what I am trying to avoid. This is becoming a part time job!

 

 

Share this post


Link to post
Share on other sites
  • 0

Remember that VSO's are human too. There are good ones who are very thorough and some which are not as good to varying degrees. When I got out of the service in 1995, my VSO submitted a single sentence for the disability claim and said I could trust the VA to be thorough. Found out that was completely incorrect and I spent years on appeal.

Keep in mind that you can file secondary disability claims for side effects of medications used to treat your existing SC disabilities. If you have no SC disabilities, you can file against the initial claimed disabilities (pending SC).

It does take a considerable amount of effort, but it sounds like you are on the right track.

Share this post


Link to post
Share on other sites
  • 0
19 hours ago, NoZZZ's said:

Thanks for the reply Vync. I have already submitted an intent to file in order to preserve the date. Since then I have been gathering my records and reviewing them to make sure it is even appropriate for me to file a claim. Since doing so, I started wondering why the VSO I had used the first time had not submitted for these already. I didn't file a claim when I got off of active orders, because I was still in the reserves and didn't think I could (which I now know is wrong). I also didn't want to get kicked out of the reserves for medical reasons, so I waited until my enlistment was up to file.

I do remember him saying that it would be easier to file for what I did, since I had LOD's in my file already, but I have continuity of symptoms for other conditions that arose in service and still bother me now that I think should have been filed for but were not. Now, 15 years later, I fear it will be harder to service connect, despite 15 years of VA medical records dealing with the same issues. 

I plan on connecting the dots in my claim as much as I can. I have a spreadsheet of all of the issues I am submitting, with date, provider location, and a summary of the visit/lab/test report. I also have a summary for each condition, including the symptoms I experience, and a timeline of Dr visits from the first onset until present. My wife will write a buddy letter as well. I do not keep in touch with anyone I was in the service with, and feel awkward trying to call out of the blue and ask for a letter about something they may not remember (I don't remember that they snored, why would they remember that I did). Which leaves the nexus letter firming up the connection between my medical history, my current diagnosis, and my military service.  I can't think of anything else I can do to make this as strong as possible, but that nexus letter seems to be the vital link.

I have read about Dr Bash on this forum. I have also started finding other "services" like vets4valor and va claims insider, but its hard to find reviews of those services. I would hire an attorney, but I know that is not allowed unless I have been denied already, which is what I am trying to avoid. This is becoming a part time job!

 

 

Unless, you were diagnosed in-service with sleep apnea. It will be difficult to "direct-service" connect. But, if you know that you went to medical and it's documented you complained of sleep problems such as; waking up gasping for air, choking, severe daytime sleepiness,sleep study confirming sleep apnea in-service, cpap issued in-service etc.You may have a case for direct-service connection.

Since you've been out of the service for awhile, the best route to take is "secondary connection". If you have a service-connected mental health, heart, respiratory,diabetes, neurological condition(TBI or other brain condition) Sleep Apnea is linked to those type of conditions.

Here is what is required to secondary service connect:

1.Must have a service connected disability.

2. Current diagnosis of disability claimed

3. Dr.Nexus of opinion stating "at least as likely as not" #1 and #2 are linked plus a rationale.

I  claimed OSA as secondary to ptsd. I was granted OSA ten yrs after service.

  • Like 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

  • Similar Content

    • By Clarence
      Hello Vets!
      I read on one website concerning Sleep Apnea that in accordance with VA Adjudication Manual M21-1, Part III, subpart iv, chapter 4, Section D updated April 18, 2016; There is no longer the requirement to have been diagnosed with SA prior to leaving the military to receive a rating.
      First, I looked at the cited manual and Section D, does not pertain to Respiratory issues, Section F does. So I'm just looking for clarification.
       
      Clarence
    • By broncovet
      Many Veterans ask, "Where can I go to get an IMO?"  This is a great question!  Answer below.  An IMO is often needed when  Veterans seek benefits especially when their VA doc's nexus statement is non existant, or deficient.  This may also work if seeking an increase to document symptoms worsening.  Thanks to Alex, who mentioned this company in his blog.  While I have not tried Mednick, I may be soon shortly, and Alex Graham apparently recommends them.  
      Now, A mednick or other IMO will NOT fix a lack of "in service event".  This needs to be documented in your service records, an IMO can not fix that.  
      But, a Mednick IMO "may" work to supply a nexus, including one that is secondary to a service conneceted condtion.  
      On the website, it appears the cost is 1500.  
      Mednick webisite:  https://www.mednickassociates.com/2016/05/06/third-leading-cause-of-death-in-us/
      In one of their blogs, they pointed out the third highest cause of death is "medical mistakes."  This is not suprising.  
       
       
      https://www.mednickassociates.com/2016/05/06/third-leading-cause-of-death-in-us/
      Source:  https://asknod.org/
    • By weep4souls
      Does anyone know an IME in the San Antonio area?  San Antonio is known as Military City USA. It would be sad not to have some here.
    • By L2dee2
      I was diagnosed with Diabetes type 2 on 2 Mar 10,  my last day on active duty was 28 Feb 09. I was denied service connection when I filed since I was officially diagnosed 3 days outside the 1 year window.  I never appealed this claim.  I was rated 60% in 2010 and never looked back.
      I recently happened across this site and realized, I might be able to reopen the case and submit a nexus letter stating that the diabetes manifested within the one year of me leaving active duty if not before.  Lab test taken on 25 Feb 09 show a Glucose reading of 324.  For some reason HB A1C test wasn't take until 2 Mar 10.  My HB A1C was 12.5.  The 2 Mar 10 date puts me inside the 1 year window.  There is no way my diabetes appeared in 3 days after the 1 year window.
      I am also service connected with Hypothyrodism (Hashimotos) which caused weight gain and slows the metabolism.  I was diagnosed in 1998.  Some medical evidence also shows slow thyroid can cause Diabetes.  Due to weight gain from my underactive thyroid, I was clinically obese on active duty.    If I can't get Diabetes added by showing it is service connected, maybe I can add it as a secondary to my Hypothyrodisim.  What are your thoughts?
       
    • By dajoker12
      Moderator, you might want to Pin this somewhere, as this seems to be a recurring trend. 
      I have given out this information to others, but I will post it here so that others can find it rather than searching through the forum.
      First and foremost, claiming and getting sleep apnea secondary to PTSD or Mental disorder is not easy. I have personally seen more lost than won, however, it can be obtained and I myself have personally received it. 
      If you had sleep apnea diagnosed while in active duty, it is usually a slam dunk........for the rest of those trying to get it, it could require a lot of work.  I suggest trying to get it both direct and secondary service connected.
      It is easier to get sleep apnea as a direct service connection obviously, however, most Veterans do not get it diagnosed while in service. Best way to get that resolved is through buddy statements. I suggest getting 3-4 (I personally had 7-8) or more. Do not have them only say that they saw you snoring.......that is great and all, but that is not a symptom of sleep apnea.......it is incidental. They would need to say that they saw you gasping for air, choking, etc. Preferably roommates. If you were deployed, it would be easy to have many people saying that they saw/heard this as you would have more than likely been in an open bay setting at some point in time. You can also have your spouse write up a statement. This all needs to be during active duty periods of times and dates need to be included.  M21-1 reference III.iii.2.E.2.b "Types of Evidence VA May Use To Supplement or as a Substitute for STRs" allows for buddy statements to act as STRs for medical evidence.........if they are certified "buddy" statements or affidavits.............having them written on VA Form 21-4138 solves this issue as it has the appropriate verbiage written near the bottom. Under M21-1 reference III.iii.1.B.7.a and 38 CFR 3.200, it meets the certification criteria..........problem solved. From my experience, getting all of the buddy statements needed can take longer than you originally anticipate....plan ahead.
      Now, for secondary criteria.
      Have you ever been diagnosed with alcohol abuse (it is frequently written as "ETOH")? If so, has it been attributed to your mental disorder or did it exist prior to that and is it considered willful? If you have been diagnosed with alcohol abuse, and it is attributable to your mental disorder,  guess what, alcohol consumption is attributable to sleep apnea. 
      would suggest that you start doing your own academic research. You might be able to locate peer-reviewed academic journal articles (those are the types of articles that you want to submit) through https://www.researchgate.net/. If not, another alternative is using a college database to search academic journals through. Ah, but you need to be a college student to use the database to search academic journals through. One might make an argument that you could register for classes at a local community college (you can even register online nowadays without even stepping foot on campus) and even register for "late start" classes, and have access to the aforementioned database immediately (hint hint, look in the academic journal Chest); one could easily find within a 60 minute search at least 5 appropriate and recent journal articles clearly establishing a link between specific mental disorders and sleep apnea; there is a clear link between PTSD, anxiety disorders, depression, and especially schizophrenia. One might make an argument that you could simply then disenroll from the classes that you enrolled in by the date specified in order to get a full refund, thereby being charged nothing. Save the academic journal articles as pdf files, and create a work cited page (bibliography) for them in APA format (google is your friend.)
      You now have a choice...........
      Submit your claim with the buddy statements, mental health notes from a private provider, and evidence that you have and go with either a VA exam or vendor exam (whichever is given) or you can get an IME and IMO from private providers. If go the latter route, I would schedule one with a sleep specialist, why, because sleep apnea is their specialty. Pulmonologists also fall within this scope as well, though I suspect that you will have better luck finding a sleep specialist believing there to be a link between mental disorders and sleep apnea. You will get a Sleep Apnea DBQ and an IMO. Make sure that you have your C - File first as an examiner is required to have access to it and state that they have seen it on the DBQ for it to acceptable proof to the VA.
      I would also get one from your psychologists/psychiatrist (Make sure that they are a psychiatrist or a psychologist.....if a psychologist, they need to be PsyD or Ph.D., or under the observation of a Ph.D.). 
      Make sure before you solicit those medical opinions, that you acquire "buddy statements" from 3-4 (or even more) people with whom you served. Roommates would be best, or people who slept in close proximity to you.........again, this is only if you believe that sleep apnea developed while you were in Active Duty service. Make sure that they are written on VA Form 21-4138. Make sure they say that they witnessed clear symptoms of sleep apnea i.e. gasping for air, choking sounds, moments where they visibly or auditorily could determine that you ceased breathing etc.
      Remember, you will want the sleep specialist and the psych professional to have your academic journal articles and buddy statements.
      Once you have all of them, solicit your medical opinions from the two aforementioned providers.
      Ideally, you would love for the IMOs to say that they believe that you could be both direct service connected for sleep apnea or secondary due to mental disorder, possibly even say that the mental disorder and sleep apnea aggravate one another (which there is medical evidence to support.)
      If you opt to go the route of getting the private IMO and IME, you will obviously submit those with your claim, and all medical records from private providers pertinent to sleep apnea and your mental health treatment, buddy statements, academic journal articles, and a nicely written statement written by yourself on a VA Form 21-4138 talking about the issue at hand and summarizing everything concisely. Mention everything that you are providing that you wont to be considered for the claim, and when the issue first manifested. 
  • Ads

  • Our picks

    • Need your support - T-shirts Available - Please buy a mug or a membership
      if you have been thinking about subscribing to an ad-free forum or buying a mug now would a very helpful time to do that.

      Thank you for your support
        • Like
      • 18 replies
    • OK everyone thanks for all the advice I need your help I called VSO complained about length of time on Wednesday of this week today I checked my E benefits and my ratings are in for my ankles that they were denying me 10% for each bilateral which makes 21% I was originally 80% now they’re still saying I’m 80% 

      I’m 50% pes planus 30% migraine headaches 20% lumbar 10% tinnitus and now bilateral 21% so 10% left and right ankle Can someone else please do the math because I come up with 86% which makes me 90 what am I missing please help and thank you
    • I was denied SC for IBS and GERD IN 2011. In 2019 I was awarded SC for GERD. This CUE  is for 2011, both GERD and IBS. There are some odd aspects regarding the 2011 decision, the way it was written and the C&P report and the way it was written. I've tried to present this as clearly as I can. Note: the decision contradicts itself. the decision also contradicts the C&P Report. Honestly, I think the rater just got confused because the C&P was so poorly written. *THIS CUE HAS NOT YET BEEN SUBMITTED*Please let me know what you think. Appreciate all comments and suggestions. Thanks.

       

      VA RATING DECISION MARCH 23 2011 GERD IBS.pdf C P REPORT 7312010 GERD IBS.pdf GERD IBS CUE 2011(1).pdf

      C P ADDENDUM REQUEST RE DIAGNOSIS 7232010.pdf
      • 56 replies
    • 14 Questions about VA Disability Compensation Benefits Claims
      When a Veteran starts considering whether or not to file a Veterans Affairs Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about when it comes to filing Veterans Affairs Disability Claims. [Reprinted here with permission from Veterans Law Blog]
      • 0 replies
    • Disabled Veterans Property Tax Exemptions by State
      Alabama 
      A disabled veteran in Alabama may receive a full property tax exemption on his/her primary residence if the veteran is 100 percent disabled as a result of service and has a net annual income of $12,000 or less.
      • 0 replies
  • Ads

  • Popular Contributors

  • Ad

  • Latest News
×
×
  • Create New...

Important Information

{terms] and Guidelines