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

[Wanderer]

2 minutes ago, Vync said:

Central SA has a neurological cause. There could be many, but people with certain MH disorders can develop SA.

Obstructive SA is often seen in people with weight issues or other respiratory issues. 

Aha! That explains it fully. I have severe obstructive SA (just lost 11 lbs). Thank you.

[doc25]

3 hours ago, Wanderer said:

Now, sleep apnea secondary to depression is a new one on me. What does secondary mean? I have 30 for asthma and 70 for bipolar and have a sleep apnea C&P exam for next week that I'm pretty sure is secondary to asthma. 

How exactly would sleep apnea be related to a mood disorder? Should I look into that route, too? 

Here are two articles I found for you to research.

SecondarySleepApneaArticle.pdf

Association with Sleep Apnea and Asthma.pdf

[doc25]

On 1/29/2019 at 1:53 PM, JaeNobe said:

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.

The IMO (nexus of opinion) must state the minimum threshold of "at least as likely as not" (equal to or greater than 50% probability) the veteran's Sleep Apnea is due to or the direct result of the veteran's service-connected Depression. It is "medically necessary" for the veteran to use a CPAP or equivalent breathing assistance device.

[Then the physician's rationale such as a referenced medical study, journal, article, linking OSA to Depression.] 

If you need an article. I've taken the liberty of providing one below. Print it out if you need to give it to your private physician. 

As far as, a primary physician doing your C&P exam, I had one do mine too. So, it's not unsual, but if you are provided an unfavorable exam, yet you have a favorable nexus of opinion from your private physician...then it's a tie of medical evidence...and guess what?? A tie has to go to the veteran.

Immeadiately, file your notice of disagreement (NOD) and appeal IF it happens to get denied. Best wishes.

SecondarySleepApneaArticle.pdf

[JaeNobe]

17 hours ago, doc25 said:

The IMO (nexus of opinion) must state the minimum threshold of "at least as likely as not" (equal to or greater than 50% probability) the veteran's Sleep Apnea is due to or the direct result of the veteran's service-connected Depression. It is "medically necessary" for the veteran to use a CPAP or equivalent breathing assistance device.

[Then the physician's rationale such as a referenced medical study, journal, article, linking OSA to Depression.] 

If you need an article. I've taken the liberty of providing one below. Print it out if you need to give it to your private physician. 

As far as, a primary physician doing your C&P exam, I had one do mine too. So, it's not unsual, but if you are provided an unfavorable exam, yet you have a favorable nexus of opinion from your private physician...then it's a tie of medical evidence...and guess what?? A tie has to go to the veteran.

Immeadiately, file your notice of disagreement (NOD) and appeal IF it happens to get denied. Best wishes.

SecondarySleepApneaArticle.pdf

Thank you so much... 

Is there a difference in at least as "likely as not" and "more likely than not" (more than 50 percent)  - This is what my IMO says.

[doc25]

2 hours ago, JaeNobe said:

Thank you so much... 

Is there a difference in at least as "likely as not" and "more likely than not" (more than 50 percent)  - This is what my IMO says.

1. “is due to” (100% sure)
2. “more likely than not” (greater than 50%)
3. “at least as likely as not” (equal to or greater than 50%)
4. “not at least as likely as not” (less than 50%)
5. “is not due to” (0%) "

Wonderful! As long as you have one of the top 3 you have a favorable nexus of opinion. #3. Is the minimum threshold for a favorable nexus.

[JaeNobe]

On 2/8/2019 at 5:35 PM, doc25 said:

1. “is due to” (100% sure)
2. “more likely than not” (greater than 50%)
3. “at least as likely as not” (equal to or greater than 50%)
4. “not at least as likely as not” (less than 50%)
5. “is not due to” (0%) "

Wonderful! As long as you have one of the top 3 you have a favorable nexus of opinion. #3. Is the minimum threshold for a favorable nexus.

Thank you so much... that gives me so much hope. I appreciate it!