2nd Sleep Apnea Exam

[Avi8tor66]

I have a claim in for sleep apnea and I had a complete sleep study 9 months ago. My claim was filed complete with the sleep study records and  a completed DBQ. My study was not done with the VA, my PCP set it up with a local sleep clinic at the hospital. I have a diagnosis of moderate OSA (Cpap needed) with occasional central episodes, RBD ( acting out your dreams) and PLMD/RLS. 

The VA contractor (VES) called to set up an appt. and they did not have a copy of my sleep study or medical records mentioned above. The VA has the records so I am confused...is this appt to set up another sleep study? Or possibly to have the NP doing the exam review the DBQ and offer a Nexus?  I am hoping I do not have to do a sleep study again...I have SC PTSD and sleeping is very difficult for me anyway, much less in a hospital setting, strange surroundings, etc. 

My question is  has anyone had to have an additional C&P exam (sleep study) when the one they had before was only a few months before?  Also when there was a completed DBQ submitted along with the study notes and records that documents the diagnosis?

Any help is appreciated!

 

 

 

[doc25]

5 hours ago, Avi8tor66 said:

Yes I did claim Amy OSA as secondary to PTSD. I did do a sleep study (not through VA) and have a completed DBQ. The VA has the copies of everything. 

I just got back from my C&P exam with VES, and the NP was nice, asked me some questions, had not and did not look at any of my records, sleep study, etc. She said the VA has them. Should I be concerned that she hadn’t and didn’t review my records? My wife said perhaps she was gonna look at my records later, prior to sending in her report to the VA.  

Any input, etc is appreciated!  Thanks! 

 

 

 

That's how my C&P went with my sleep apnea secondary claim. I was done within 10-15 minutes. Although, my claim was denied twice prior to that C&P exam because I didn't have a DBQ or nexus of opinion.

You have the DBQ, at the very least.

There's  more good news  than bad news in your case.

The good news is that you meet two out of three requirements for secondary connection.

#1. Must have a service-connected condition. Check.

#2. Must have a current diagnosis of secondary condition claimed. Check

#3. Nexus of opinion stating the minimum threshold of "at least as likely as not" (50% or greater probability)   the condition claimed is proximately due to  or the result of Veteran's service-connected PTSD and it is "medically necessary" for the veteran to use a CPAP or other breathing assistance device. Additionally, a clear and concise rationale must be provided.

You do not have a nexus of opinion...yet. Which depends on whether the examiner concurs with the provided DBQ.

( The DBQ is vital in that it should have everything that the examiner needs to input to substantiate your claim. )

 

Now for some slightly bad news....

An NP or Nurse practitioner, I gather, did the exam which provides room for errors to be made and your C&P would be deemed flawed IF your claim is denied.

IF it gets denied. APPEAL, APPEAL, APPEAL. 

Even with the nurse practitioner doing your exam. I'm about 65% certain you'll receive a favorable decision.

Best wishes on your claim.

 

[Avi8tor66]

29 minutes ago, doc25 said:

That's how my C&P went with my sleep apnea secondary claim. I was done within 10-15 minutes. Although, my claim was denied twice prior to that C&P exam because I didn't have a DBQ or nexus of opinion.

You have the DBQ, at the very least.

There's  more good news  than bad news in your case.

The good news is that you meet two out of three requirements for secondary connection.

#1. Must have a service-connected condition. Check.

#2. Must have a current diagnosis of secondary condition claimed. Check

#3. Nexus of opinion stating the minimum threshold of "at least as likely as not" (50% or greater probability)   the condition claimed is proximately due to  or the result of Veteran's service-connected PTSD and it is "medically necessary" for the veteran to use a CPAP or other breathing assistance device. Additionally, a clear and concise rationale must be provided.

You do not have a nexus of opinion...yet. Which depends on whether the examiner concurs with the provided DBQ.

( The DBQ is vital in that it should have everything that the examiner needs to input to substantiate your claim. )

 

Now for some slightly bad news....

An NP or Nurse practitioner, I gather, did the exam which provides room for errors to be made and your C&P would be deemed flawed IF your claim is denied.

IF it gets denied. APPEAL, APPEAL, APPEAL. 

Even with the nurse practitioner doing your exam. I'm about 65% certain you'll receive a favorable decision.

Best wishes on your claim.

 

Thanks! I’ll post soon as I know something.