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.

[NoZZZ's]

Thanks for the reply.

1) already did this last year. It took me a while to get nexus letters, so I am putting the claim together now, but have a few months to spare.

2) I do have 4 SC disabilities already, 2 at 0%, the other 2 combined to 20%. My C-File is pretty slim. My claims were pretty strait forward. I have all of my service treatment records and military records, and most of my care has been at the VA. Even the C&P exams from my previous claim are in my VA records. I imagine if I am denied any of the new claims, this will be more vital. 

3) Done. I have it all in PDF format. There is a lot though. Probably about 800 pages, mostly VA records.

4) This is the part I am confused about. I have written a summary of the claim, including an intro section, in-service events section, diagnosis section, and summary of relevant records section. Do I have to put this on a form, or can I submit it like a memo? I have my name and SS# on each page of the memo.

It's the "exhibit" section I don't know what to do with. Since most of my records are with the VA, do I just say the date of service and "found in VA medical records," or do I print off each single relevant record and upload it? For example..."I was diagnosed with OSA on 1/1/2012. Refer to VA Sleep clinic record dated 1/1/2012 in VA medical records." Or, do I print that specific record off and upload it as a single file.

5) I have summarized the in service events, and have referenced the relevant records. unfortunately, no in-service diagnosis.

7) i have one. probably will not be able to get any others.

10-4

9) I agree it is better than a 5000 page c-file. It is still a lot of records, though.

Thanks for the advice. Organizing this mess of records seems to be the most difficult part. 

 

[GeekySquid]

8 minutes ago, NoZZZ's said:

print that specific record off and upload it as a single file.

@NoZZZ's

What I suggest you do is find all the medical records that relate to a specific statement you are making in the claim, combine them into a single PDF and make that an individual exhibit to upload. I would make a title page for each exhibit that matches the file name and exhibit number and  place a table of contents for that file on the title page.

For example if your medical records have 10 notes that support sleep apnea. Such as test dates, outcomes, or notes saying test added as an addendum. Then combine all those and title it like Exhibit 2-VA Medical Record Notes for Sleep Apnea. (that would be a title in the PDF and the actual File Name).

Then I would do the same for test results for Sleep apnea and label it Exhibt 2- VA Medical Records Sleep Apnea Test Results.

While doing this I would make a table of contents for each PDF and create a "master" Table of contents to ensure all associated records are included in the right Exhibit. This is in case you run across another related record and want to find where it fits in best.

A record can be in multiple exhibits as it may relate in multiple ways.

In fact if you really want to be anally retentive in developing your roadmap you can include that Master Table of Contents as an Exhibit to lead the rater by the nose to make the conclusion you want. If you do this right it will look very much like an index but at the front of the document making  it easier for the rater to follow the path you want them too.

21 minutes ago, NoZZZ's said:

7) i have one. probably will not be able to get any others.

one is better than none.

 

21 minutes ago, NoZZZ's said:

Organizing this mess of records seems to be the most difficult part. 

it really is.

====

one more suggestion if you have not done it already.

invest in some black toner and about a case of cheap printer paper. get some folders with clips and a hole punch.

I would print every page in the C-file ...Twice...One copy would be the "master" and the other the "working" copy. With the working copy I would organize every page into the correct folder. If you need a page for more than one folder, print another copy. Then I would write an index for each folder when you are done.

The C-file can have two or three copies of the same record. I don't know why but they do. I have one record that is in my C-file 46 times. It baffles me. It is just a note from a VA visit. I now have 46 copies of it.

Doing this creates an added benefit as you are doing your organizing in that you are having a tactile engagement with the records. You will have to read each and make a decision about it. That will reinforce its relevance in your mind and help you strengthen any statements you make.

 

[GeekySquid]

10 minutes ago, GeekySquid said:

While doing this I would make a table of contents for each PDF and create a "master" Table of contents to ensure all associated records are included in the right Exhibit

@NoZZZ's

If you make this Master Table of Contents and add a TOC to each file I would name the Master TOC as Exhibits included in support of claim as its title and file name.

[NoZZZ's]

Thank you for the suggestions on organizing, they are very helpful!

[GeekySquid]

7 hours ago, NoZZZ's said:

organizing

@NoZZZ's

You are welcome and I hope they help you.

It is a pain in the neck if you are not an anally retentive type LOL. But the clearer your roadmap is the more likely you can get the rater to get to your preferred result and do it faster. They are required  by 4.6 to "thoroughly review" your record. That cannot create the expectation that they will read an remember every single note, line, statement or disease listed. 

What is even better is if you create that detailed roadmap and attach all the evidence and they still screw up your NOD, Appeal and even CUE are stronger and already tell you in your copy where you need to go to fight back.

Please let us know how things turn out and just for me I would love to hear about your experience doing the organizing. Maybe any tips or ideas you come up with that will help us all do the organizing faster and more efficiently.

[mmsmms123]

I was awarded smc t.2 off his imo/nexus exam by itself from Dr Bash