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

[NoZZZ's]

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.

[GeekySquid]

37 minutes ago, GeekySquid said:

@GBArmy

However, as usual Ladies and Germs, we will have to Hurry Up and Wait.....same old same old. 

 

@GBArmy

My response to you got me thinking that we could test this a bit today.

I went to VA.GOV and selected File a new claim

I got a bit of a surprise.

I screen capped it and they are attached

NOTE each cap is numbered 1-5 with a description of what i was doing

Cap 1- is just filing a new claim---just click the green link and off you go to the EZ form introduction

Cap 2 is disagreeing with an existing decision and this is where it gets interesting. In this cap I used an Aug 2017 date. Look at the response.

Cap 3 I used a Aug 2018 date. Look at the response

Cap 4 I used an Aug 2019 date. Look at the response

It is CAP 5 That answers the ITF question under the new AMA process that started Feb 19, 2019. this relates to Cap 1 Filing a New Claim

Edited May 11, 2019 by GeekySquid

[GBArmy]

Geekysquid-Good S2 work; sounds good. At least I hope you are correct; ITF is one of the best things a veteran can use and it would be a real shame if they took that tool away. I know veterans that use it as soon as their current claim is approved for a new claim. Then they just go get the new evidence while locked in on the filing date. I bet you know others that do the same yourself.

[GeekySquid]

Just now, GBArmy said:

Then they just go get the new evidence while locked in on the filing date. I bet you know others that do the same yourself.

@GBArmy

I agree. In fact I suspect that each and every Vet who has a current rating and believes (but is not sure) if they have a new claim will (or should) open an ITF immediately.

The process literally says Open new Claim, Since you signed in we will pre-fill a bunch of stuff on the form, then the ITF page in Cap 5 above appears and it saves the ITF.  you don't have to continue or add any other info.

Also note the fine print on that Cap 5. It says they "see" my other ITF, so that indicates they know that ITFs from pre-AMA are still valid and floating out there. Logically if they were "dead" that line would say "your previous ITF has been closed" or similar verbiage. The programmers got this right.

One group I see that could benefit from this is all the vets who have an SMC (k) for ED. I know for sure that I was completely unaware that a rating for Voiding Dysfunction was possibly related to PTSD and or ED. It was just not on my horizon. I assumed you had to have lost a kidney or had 'the boys' physically damaged somehow.

So all the vets with the ED SMC might want to consider filing the ITF and then seeing if they can develop an FDC from the record. In my situation it is SC as a secondary, so that means nexus established and like ED, most men will not go to the doc while in service and say "i am dribbling". It is really not until we get older that this is something that we notice or complain about.

Another aspect of the dribbling issue is I never consciously knew that "pads" for men existed. I did know adult diapers existed and my ego said hell no! to that idea. It was not until my ED C&P that I learned they were things on the market and that the VA provided them.

 

[GeekySquid]

On 12/7/2018 at 11:42 PM, NoZZZ's said:

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

@NoZZZ's

I want to apologize for the hijacking of your thread down stream. We got off on an ITF issue instead of addressing your issue. It was not intentional.

[NoZZZ's]

No worries. 

Perhaps I can steer it back. When filing an FDC, the instructions that I have been reading from the VA and other resources say to include relevant medical records. Does that mean all the records I have, or just the ones relevant to my current claimed issue?

Also, I started uploading files to eBenefits. There doesn't seem to be any order to the uploaded documents. Won't that just be a big haystack of files?

[GeekySquid]

3 hours ago, NoZZZ's said:

Does that mean all the records I have, or just the ones relevant to my current claimed issue?

@NoZZZ's

I really appreciate you not being mad about the hijacking of your thread.

As for your questions:

just the records relevant to the claim you are filing at that moment.

For MDD or secondary issues that can seem complex as you are not a doc or a rater and you may not know or think a document is "relevant" when  it really is.

Based on your OP and profile I don't see you as being rated for anything yet. There is also  no suggestion of financial urgency, which is good for you.

If that is true then I would suggest you:

1) go file your New Claim and do it TODAY! Assuming you already have an account on VA.GOV start the claim and when the screen says "Your Intent to File request has been submitted" , stop right there. At least for now. You have just given yourself a year to file that claim with today's date. ( I see you have started uploading files which is good. This step is what I tell all first time claimants to do first)

2) Order your C-file if you have not done so

3) Collect and organize all your evidence for your claim.

4) write your claim as a roadmap for the rater to follow. Think of a table of contents in a book. Pg 1 is, Pg 2, etc etc. When you write the roadmap you say I have OSA requiring I use a C-Pap or I will die. See Exhibit 1 labeled Independent Medical Opinion. Then you say I have Allergic Rhinitis see Exhibit 2,3, 4 which are my in service medical records and 6 7 8 my civilian medical records. Then you say I have 27 buddy statements showing my in service experience see exhibits 9 to 26,,,,etc etc etc

Keep following that type of format in your writing for each element of the Caluza Triangle.  Follow this format for each claimed harm. if you are claiming 6 things you will have 6 major sections, one for each claim all in the same roadmap format.

5) Your in service Nexus and stressors are, in the best of worlds, well documented in your C-file and you have an in service diagnosis for what you are claiming. If not the exact wording, at least analogous complaints in service. You are not expected to be a doctor nor are you expected to have the exact wording in your Military Med records as is found in 38 USC but you will need to have close indicators of what you are claiming to create the in service nexus.

In your service records look for the words chronic and acute. An acute diagnosis is a "temporary" thing a chronic one is ongoing. multiple acutes can become a record of chronic problems. point this out if it exists.

6) at this point in the process you don't need much legalese or references to laws and rules. You are a Pro Se applicant in a ex-parte non-adversarial process. The VA has the duty to develop your claim if in your application you make it clear that it is "possible" your claim has merit and can be proven in the records which is not a high bar to get over. 

7) buddy statements are good evidence just make sure they contain the right phrases. For example sleep apnea. don't say "snores like a freight train" that won't get you rated. The witness has to have observed that you stop breathing in the middle of sleep. The extent and frequency of your lack of oxygen is a key factor. Does it make them fearful you are dying and they wake you up? that would help strengthen their value to your claim.

8 ) when you see the C&P examiner take in your buddy statements and in service evidence. provide a copy if they will take it. Then when the C&P comes back make sure that evidence is taken into account.

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As far as this being a needle in a haystack in the way Ebennies shows it I will ask you to consider if what you are uploading, properly named and identified and categorized, is messier than telling the VA "everything is in my 5000 page C-file, you can go find it. And oh by the way here are a bunch of civilian records you need to go get them".

I would suggest that your answer should be NO, that my uploading of specific files and providing a well written  road map is much easier for the rater to follow than having to do a deep dive into 5K worth of disconnected records.

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You mentioned VA Claims Insider. I have seen their You Tube infomercials.

I for one would not consider them, or any attorney, at your stage of the process. The VA will give you a sleep study and a C&P for the Apnea. If you can afford an IME & IMO that is great.

I suspect that VA Claims Insider actually does not foot the bills up front as they infer. Every one of their infomercials I have seen says "we have a network of providers..." but I don't recall hearing them say "we pay all upfront costs for testing and medical opinions."

Remember their statement is also they only take an amount 6 times the amount you receive payable over many months. That would be insufficient to pay for IME/IMO's in all cases and still have money left over to pay salaries, fixed costs, and allow for profit. Under their scheme unless you are getting 100K in back pay you are not worth much to their business.

I would also suggest they operate like an Ambulance chasing attorney and that alone makes me wary of them. I don't know them personally, just their ads and those ads scare the crud out of me for what they DON"T say. It is all in the fine print you can't see until you sign the contract.

hope this helps you

let us know what happens and definitely keep asking questions. you are your own best advocate