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

[david dupe]

Thanks for the research doc 25.

i see in the csa rating that long term csa can cause major pulmonary and heart problems.

i have copd been diagnosed with chd several times, va give me a cpap for my  csa, hypertension and leaking aortic valve in my heart they just replaced. According to my heart surgeon he's surprised the Navy missed it. 

I guess I would qualify for 50% or 100% with these issues.

[doc25]

2 hours ago, david dupe said:

Thanks for the research doc 25.

i see in the csa rating that long term csa can cause major pulmonary and heart problems.

i have copd been diagnosed with chd several times, va give me a cpap for my  csa, hypertension and leaking aortic valve in my heart they just replaced. According to my heart surgeon he's surprised the Navy missed it. 

I guess I would qualify for 50% or 100% with these issues.

I would say 100% would be more accurate.

[MrStryker]

My sleep apnea RAMP appeal was denied due to no medical opinion even though the IMO by Dr. Anaise was submitted via E-Benefits.  The IMO was not even on the list of evidence according to the decision letter.  I would definitely fax in the IMO to the evidence intake center just in case.

Edited February 12, 2019 by MrStryker

[david dupe]

The first time I applied for csa they denied me saying that it wasn't sc. But all of my new evidence is in my va med records.

[JaeNobe]

On 2/10/2019 at 8:08 AM, doc25 said:

Indeed it is Wanderer.

In 2014, I was pretty much at the end of my rope. All I had been getting was 20% that didn't start until 2012. I was married with a baby and unemployed(eventually did find work.) I wasn't aware that I could get an increase to the 10% PTSD with MDD I had and I wasn't aware about secondary Sleep Apnea until 2015(initial claim for increase) and 2017(granted sleep apnea), respectively.

In 2016, I was awarded 70% PTSD with Depression, 10% Tinnitus, 0% Hearing loss, and 10% L Knee Patellofemoral Syndrome. My VSO asked me after my award if I had Sleep Apnea by any chance. I said,"Yes. Why?" She said that I could secondary connect Sleep Apnea to PTSD.

So, I submitted the secondary claim, which was DENIED twice. I had the first two parts for secondary connection of OSA:

#1. Must have a SC condition.

#2. Must have a current diagnosis for secondary condition claimed, plus a CPAP and it said "medically necessery" .

#3. NO NEXUS OF OPINION

I was able to re-open my OSA claim with a filled out DBQ from a pulmonologist. Got sent to a C&P exam at another VA and that's where I received the favorable nexus of opinion for secondary OSA.

So follow up to my C&P today:

Went in and it was all about Sleep Apnea. HOWEVER....

She asked me no questions just if i had any questions for her. I made sure she seen the statement by my doctor saying it was critical that i use my CPAP. She agreed because she said anyone that has OSA should be using a CPAP.

Then she goes on an on about how Sleep Apnea causes depression not the other way around. I asked her well what about aggravating.. .she said yeah same thing.

Says she sees my IMO and will review it but unless there is evidence that she agrees with then she doesn't see how Sleep Apnea can be secondary to Depressive Disorder or Pain from other service connections. 

She believes that my weight being over 33% BMI that it may have something to do with it. I asked if it could be medications that I take for Depression and Pains that cause drowsiness she again reiterated that it could be depression because im not getting adequate sleep.

After leaving the exam with my wife we looked at each other said didn't know what to take from it. Then I began to think... She didn't write anything down. She didn't take notes, measure my neck look at throat anything. So very interested in know what her notes will be. Also, discouraging that she didn't even read my file prior to coming into the office to get a good diagnoses. Furthermore, if you didn't do any test, questions or takes notes why was I even there for a C&P?

 

[doc25]

4 minutes ago, JaeNobe said:

So follow up to my C&P today:

Went in and it was all about Sleep Apnea. HOWEVER....

She asked me no questions just if i had any questions for her. I made sure she seen the statement by my doctor saying it was critical that i use my CPAP. She agreed because she said anyone that has OSA should be using a CPAP.

Then she goes on an on about how Sleep Apnea causes depression not the other way around. I asked her well what about aggravating.. .she said yeah same thing.

Says she sees my IMO and will review it but unless there is evidence that she agrees with then she doesn't see how Sleep Apnea can be secondary to Depressive Disorder or Pain from other service connections. 

She believes that my weight being over 33% BMI that it may have something to do with it. I asked if it could be medications that I take for Depression and Pains that cause drowsiness she again reiterated that it could be depression because im not getting adequate sleep.

After leaving the exam with my wife we looked at each other said didn't know what to take from it. Then I began to think... She didn't write anything down. She didn't take notes, measure my neck look at throat anything. So very interested in know what her notes will be. Also, discouraging that she didn't even read my file prior to coming into the office to get a good diagnoses. Furthermore, if you didn't do any test, questions or takes notes why was I even there for a C&P?

 

The examiner is full of horse manure. Want to know why? Review the research study I attached below that was  conducted by a VA doctor and other doctors from Baylor.

If your IMO is favorable and the examiner provides an unfavorable conflicting nexus....that is a positive and negative balance of evidence. That's a tie and a tie has to go to the veteran.

 

§3.102   Reasonable doubt.

It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships.

 

If it gets denied. APPEAL, APPEAL, APPEAL.

SecondarySleepApneaArticle.pdf