Primary Physician for Sleep Apnea C&P

[JaeNobe]

Hello All, 

I recently submitted a claim for Sleep Apnea secondary to depressive disorder on Friday (1/25). Along with submitting the claim I submitted and IMO from a non-VA doctor.  Today Tuesday 1/29 got a call to schedule my C&P. (World Record to me) Was wondering if anyone else thought this was weird and they also said that my C&P exam was going to be conducted with a Primary Physician not a Sleep Specialist.  I also just thought about it. I didn't submit a DBQ with my initial claim. Could this be the reason? Just seemed off I'm not going to a specialist.

Edited January 29, 2019 by JaeNobe

[Stick Slinger]

Good luck.. I just had a joke of a C&P exam myself yesterday. I was denied a while back for OSA secondary to PTSD. I am rated at 70% for PTSD. I submitted the first time and was denied for OSA secondary to PTSD. In the paperwork they referred to a phone interview that never happened.. I appealed and was sent to a DR yesterday. This Dr only does C&P exams for the VA and is an outside Dr. I showed up 45 minutes early for my appt, and they took me right in. This appointment was in a Chiropractor's office. The Dr said he comes to town weekly and rents space here to do the C&P?? He is a regular family doctor from what I understood.  I had driven an hour to get here and when we sat down I thought I had all my ducks in a row. I had the same stuff I had originally submitted, I felt lie a lawyer coming in there.. I had my DBQ from my Dr saying 50% more likely than not, A NEXUS letter from my private Dr saying 50% more likely than not that my OSA was secondary to my PTSD. I had the same letter from my private phycologist stating he same thing and he stated case files and study info. I even had a letter from my Dr saying the CPAP was medically necessary. The C&P Dr did not want to see any of it. He said it was in my file already and he had seen them. I tried to give him the last letter stating the CPAP is medically necessary because it was not in there.. and he said to enter it in to MY VET stuff and he will see it there. REALLY? WOW

He asked me maybe 4-5 questions and after he looked into the computer for a few minutes said we were done. I said Doc, I drove an hour to get here and in 10 minutes we are done. You don't want to see any of my paperwork I brought and we are just done? I asked if he believed if OSA is linked or secondary to PTSD. He said he couldn't answer that question because he was employed by the VA. I told him the VA had scheduled me another sleep study next month in March, should I even go to it or does it even matter. He said to yes, go and he will see the results and then he can make his decision. He said check with the nurse out front to fill out the pw for the travel pay. I asked her and she said she has no paperwork and doesn't know about travel pay. I just left...

I didn't leave there feeling very warm and fuzzy if you know what I mean...

 

 

 

Edited February 20, 2019 by Stick Slinger

[JaeNobe]

49 minutes ago, Stick Slinger said:

Good luck.. I just had a joke of a C&P exam myself yesterday. I was denied a while back for OSA secondary to PTSD. I am rated at 70% for PTSD. I submitted the first time and was denied for OSA secondary to PTSD. In the paperwork they referred to a phone interview that never happened.. I appealed and was sent to a DR yesterday. This Dr only does C&P exams for the VA and is an outside Dr. I showed up 45 minutes early for my appt, and they took me right in. This appointment was in a Chiropractor's office. The Dr said he comes to town weekly and rents space here to do the C&P?? He is a regular family doctor from what I understood.  I had driven an hour to get here and when we sat down I thought I had all my ducks in a row. I had the same stuff I had originally submitted, I felt lie a lawyer coming in there.. I had my DBQ from my Dr saying 50% more likely than not, A NEXUS letter from my private Dr saying 50% more likely than not that my OSA was secondary to my PTSD. I had the same letter from my private phycologist stating he same thing and he stated case files and study info. I even had a letter from my Dr saying the CPAP was medically necessary. The C&P Dr did not want to see any of it. He said it was in my file already and he had seen them. I tried to give him the last letter stating the CPAP is medically necessary because it was not in there.. and he said to enter it in to MY VET stuff and he will see it there. REALLY? WOW

He asked me maybe 4-5 questions and after he looked into the computer for a few minutes said we were done. I said Doc, I drove an hour to get here and in 10 minutes we are done. You don't want to see any of my paperwork I brought and we are just done? I asked if he believed if OSA is linked or secondary to PTSD. He said he couldn't answer that question because he was employed by the VA. I told him the VA had scheduled me another sleep study next month in March, should I even go to it or does it even matter. He said to yes, go and he will see the results and then he can make his decision. He said check with the nurse out front to fill out the pw for the travel pay. I asked her and she said she has no paperwork and doesn't know about travel pay. I just left...

I didn't leave there feeling very warm and fuzzy if you know what I mean...

 

 

 

I know the feeling.... My C&P examiner had two questions for me:

1. Had I tried to claim OSA before

2. Do you have any questions for me.

That was it. The rest of the time she explaining to me what sleep apnea is.

[Stick Slinger]

I go to the next Sleep Study on March 22nd, so after that I should know something. I do wonder why he would tell me to go to the Sleep Study so he could see the results if he was going to deny it.. but then again, it doesn't have to make sense to me I guess...

[doc25]

On 2/20/2019 at 11:49 AM, JaeNobe said:

I know the feeling.... My C&P examiner had two questions for me:

1. Had I tried to claim OSA before

2. Do you have any questions for me.

That was it. The rest of the time she explaining to me what sleep apnea is.

You already know what I have to say about that examiner. F-oh-S.

[dajoker12]

First and foremost, I would go back and redact some of your responses in which it shows peoples names and contact information.  I personally do not think that it is appropriate that you include that, but that is just my opinion. 

Second of all, I noticed that your Dx date is after your RAD date. Did you consider getting any buddy statements clearly identifying your symptoms of sleep apnea (not snoring)? 3-4 Buddy statements written on 21-4138 forms would be very helpful in proving a direct service connection to sleep apnea if in fact it did develop during your time in service and you simply did not have it diagnosed during that time frame.

The primary source that the examiner enclosed is current (originally published Jan 2018),  however, none of the references cited (at least that I saw), looked psychological elements. There is a clear linkage between psychosomatic elements in the body, and sleep apnea is no exception.

Interestingly enough, in the third hyperlink,  it did note in the academic reference that alcohol use contributes to sleep apnea. This begs the question, 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, then you have clear grounds for an appeal. 

So, you already have an IMO from a physician. I would recommend getting two more, and here is why. 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. 

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.

Submit the buddy statements to the VA as you get them.

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.)

I 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.

For the record, the reason, more than likely, that you got in so quickly is not because the VA is trying to screw you over so many people keep claiming, but rather due to the fact that many times sporadically throughout the year there is mandatory OT for certain positions at the VBA. Sometimes there is unlimited OT. Perhaps your claim fell into one of those periods. Generally speaking, when a claim moves fast it is due to the fact that the claimant has filled out all of the paperwork correctly, and there is little to no development needed (i.e. we don't need to track down service treatment records, personnel files, send out for private treatment records, clarify anything with the Veteran), exams are warranted, and it is not a complex case.
 

Best of luck.

[doc25]

6 hours ago, dajoker12 said:

First and foremost, I would go back and redact some of your responses in which it shows peoples names and contact information.  I personally do not think that it is appropriate that you include that, but that is just my opinion. 

Second of all, I noticed that your Dx date is after your RAD date. Did you consider getting any buddy statements clearly identifying your symptoms of sleep apnea (not snoring)? 3-4 Buddy statements written on 21-4138 forms would be very helpful in proving a direct service connection to sleep apnea if in fact it did develop during your time in service and you simply did not have it diagnosed during that time frame.

The primary source that the examiner enclosed is current (originally published Jan 2018),  however, none of the references cited (at least that I saw), looked psychological elements. There is a clear linkage between psychosomatic elements in the body, and sleep apnea is no exception.

Interestingly enough, in the third hyperlink,  it did note in the academic reference that alcohol use contributes to sleep apnea. This begs the question, 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, then you have clear grounds for an appeal. 

So, you already have an IMO from a physician. I would recommend getting two more, and here is why. 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. 

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.

Submit the buddy statements to the VA as you get them.

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.)

I 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.

For the record, the reason, more than likely, that you got in so quickly is not because the VA is trying to screw you over so many people keep claiming, but rather due to the fact that many times sporadically throughout the year there is mandatory OT for certain positions at the VBA. Sometimes there is unlimited OT. Perhaps your claim fell into one of those periods. Generally speaking, when a claim moves fast it is due to the fact that the claimant has filled out all of the paperwork correctly, and there is little to no development needed (i.e. we don't need to track down service treatment records, personnel files, send out for private treatment records, clarify anything with the Veteran), exams are warranted, and it is not a complex case.
 

Best of luck.

Good catch on the personal info. LEAVE IT OUT JAENOBE.

I've provided JaeNobe two articles that are of relevance to his claim. If I'm not mistaken, his sleep study was conducted by one of the named VA contributers to one of the articles. I'll fact-check myself on that. 

I agree 100% with getting buddy statements. Anyone that has witnessed him having Sleeping Apnea symptoms while he slept will place more weight in his favor.

I think if it gets denied again, the RO level is not the ballpark his claim would have a fair chance to win on appeal. Maybe the BVA or CVAC?? His claim has been continuously prosecuted; so if he wins on appeal he won't have to find a CUE to appeal to the effective date.

Edited February 24, 2019 by doc25