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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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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.

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11 hours ago, NoZZZ's said:

Thanks for the replies.

I do think that I will have to rely on secondary connection, but I am going to propose direct anyway, since this all started when I was in. I wish I knew more about this process when I had gotten out, but there is nothing I can do about that now.

When I submit my claim, I plan to also submit supporting documentation from medical journals regarding the etiology of the conditions I am experiencing, as a way to reduce a negative C&P argument, particularly related to the time since I have been off of active duty. Do the VA raters even look at stuff like this? Is it considered lay evidence, or does it have more weight since they are scholarly journals?

Recently, there's been a discussion on the forum, about using medical journals, articles, or other medical literature.

In my opinion, at least as likely as not, they do add "some" weight as "competent lay evidence":

A veteran that can CONNECT THE DOTS , in my own opinion, shall be deemed competent to provide medical literature relevant to a condition being claimed.

Now, medical literature; such as, journals, articles, research studies, etc is medical literature that uses fact based medical evidence, using what many, not all people understand as the scientific method.

The research is done by qualified and competent medical professionals. Otherwise, they wouldn't put their name and reputation on the line?

Therefore, a veteran that is competent can provide competent medical literature; as lay evidence.

But there's a catch.

If you're going to use medical literature, be sure to submit the same journal, article, study,etc. that you submitted on ebenefits or a VSO, DAV, or other veterans organization;to your IN MY OPINION Dr. or the C&P examiner. Basically, what you're doing is doing the heavy lifting for them already. And use the one that is the most relevent, compelling and probative to your claim. 

Also, in your lay evidence provide a table of contents that's in chronological order. (Ratings schedulers don't have the time to give your claim due diligence. You have to consider that one Ratings Scheduler can be assigned up to 1,500 claims and still get another 1,000 on top of that.)

Unfortunately, the burden of proof, falls on us as veterans. Even though it shouldn't. I'll follow up with more info later today. In the meantime, here is an appealed claim for Sleep Apnea, Secondary to Allergic Rhinitis that was granted. https://www.va.gov/vetapp07/files3/0721554.txt read through all of  it and give secondary connection some thought.

I hope this info provides you some insight.

Edited by doc25

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On 12/8/2018 at 1:42 AM, NoZZZ's said:

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.

I have used VA Claims insider.  They helped get me to 50%.  They looked over my claim, helped me reword some of my personal statements and pointed out where my VSO has made a couple of mistakes.  They were pretty accurate on what they thought would get approved and why.  They are currently helping me with my “reconsideration” and helped me with additional DBQ's and Nexus letters and even reviewed the Nexus letter my personal doctor wrote for me.  They might not be right for everyone, but they helped me.

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On 12/8/2018 at 1:42 AM, NoZZZ's said:

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.

#1. Request your C-file in it's entirety first. It will take awhile (6months+) to get it which will provide you time to gather all your medical evidence. 

#2. File an intent to file.

This will preserve your effective date for retropay purposes.

#3.Gather pertinent evidence for sleep apnea. Request  the VA pulmonologist provide an addendum to her note to state "CPAP Medically Necessary" or an equivalent statement. You can request this through a Patient Advocate at your local VA.The va will deny your claim if that little piece of evidence is not present. 

Dr.Anaise, Dr. Bash, Ellis clinic do nexus of opinions among others.

I've researched VA Claims Insider and Brian markets himself and his company well. Apparently, he has a team of claims specialists, dr.s, and lawyers. 

But, so does comp&pen LLC out of Florida.

Use your own discretion on who you want to go with.

Some Dr.s nexus of opinions go for hundreds into the thousands of dollars.

But that depends on the complexity of your claim.

#4. Must meet Caluza factors for direct service connection.

1). Current diagnosis

2). In-service injury, event (diagnosis), illness.

3) Medical nexus stating the minimum threshold of "at least as likely as not (equal to 50% or greater probability) the claimed condition is due to or the direct result of military service. Plus, a rationale.

*****This is just a recommendation other experienced forum members have been dealing with the VA for decades and have a wealth of information.*****

 

 

 

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Thanks again, everyone for the input.  I am awaiting nexus letters, and will hopefully file the claim soon, as I filed the intent to file last august.  In the meantime, I am still looking for medical research to support the claim, and will be organizing my claim to make it easy for the rater to go through.

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