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Primary Physician for Sleep Apnea C&P

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JaeNobe

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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 by JaeNobe
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1 hour ago, doc25 said:

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

I thought the same thing that she was concluded the exam with no exam. Like this was a waste of time. 

Glad to see its some kind of VA law that looks at it in our favor. 

 

Thank you like always doc25

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2 minutes ago, JaeNobe said:

I thought the same thing that she was concluded the exam with no exam. Like this was a waste of time. 

Glad to see its some kind of VA law that looks at it in our favor. 

 

Thank you like always doc25

Yea. Unfortunately, we have to educate ourselves on VA law and medical terminology, conditions, and symptoms. 

I have medical experience and even I had to re-educate myself on how VA interprets medical evidence....with a blindfold. LOL. 

The law side is like trying to understand Klingon.

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15 hours ago, doc25 said:

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

I looked at the SecondarySleepApneaArticle you posted. image.thumb.png.1f07ab4191284e9e5d302277bda314f2.pngimage.thumb.png.5bcb3a026a5303a149113718a870ca32.png

 

Same Doctor!! 

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5 hours ago, JaeNobe said:

I looked at the SecondarySleepApneaArticle you posted. image.thumb.png.1f07ab4191284e9e5d302277bda314f2.pngimage.thumb.png.5bcb3a026a5303a149113718a870ca32.png

 

Same Doctor!! 

That same doctor did your C&P exam? Or he did the IMO?

 

Edited by doc25
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4 hours ago, doc25 said:

That same doctor did your C&P exam? Or he did the IMO?

 

no that is the doctor that did my sleep study at the VA and then the same name shows up on the Article you posted. 

My IMO was done by Dr. David Anaise

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On 2/13/2019 at 3:37 PM, doc25 said:

That same doctor did your C&P exam? Or he did the IMO?

 

The C&P doctor finally updated the the DBQ. Please tell me what you think... 

NOTE: I have submitted to ebenefits a favorable IMO along with studies to prove my secondary condition. 

PULMONARY C & P EXAMINATION CONSULT : 
LOCAL TITLE: C&P RESPIRATORY 
STANDARD TITLE: PULMONARY C & P EXAMINATION CONSULT 
DATE OF NOTE: FEB 12, 2019@12:30 ENTRY DATE: FEB 15, 2019@12:51:05 
AUTHOR: xxxxxxxxxxx-AOUI EXP COSIGNER: 
URGENCY: STATUS: COMPLETED 


Sleep Apnea
Disability Benefits Questionnaire

Name of patient/Veteran: 

Is this DBQ being completed in conjunction with a VA 21-2507, 
C&P Examination
Request?
[X] Yes [ ] No


ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete 
this document:

[X] In-person examination


Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS

A . Diagnosis
------------
Does the Veteran have or has he/she ever had sleep apnea?
[X] Yes [ ] No

[X] Obstructive
ICD code: G47.33 Date of diagnosis: 2006

2. Medical history
------------------
a. Describe the history (including onset and course) of the 
Veteran's sleep
disorder condition (brief summary):
3/5/02
STR - YES TO FREQUENT TROUBLE SLEEPING - AND DEPRESSION 
SINCE ONSET OF
?CHAPTER PROCEDURE ENTERING ALCOHOL COUNSELLING FOR 
INCREASED ETOH USE
(???)

2/7/02
HEIGHT: 5'11
WEIGHT: 195 LBS
BMI = 27.2

BMI AT TIME OF OSA DIAGNOSIS = 32

b. Is continuous medication required for control of a sleep 
disorder
condition?
[ ] Yes [X] No

c. Does the Veteran require the use of a breathing assistance 
device?
[ ] Yes [X] No

d. Does the Veteran require the use of a continuous positive 
airway pressure
(CPAP) machine?
[X] Yes [ ] No

3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms 
attributable
to sleep apnea?
[ ] Yes [X] No


4. Other pertinent physical findings, complications, conditions, 
signs,
symptoms and scars
----------------------------------------------------------------
-------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to any 
conditions
listed in the Diagnosis Section above?
[ ] Yes [X] No

b. Does the Veteran have any scars (surgical or otherwise) 
related to any
conditions or to the treatment of any conditions listed in 
the Diagnosis
Section above?
[ ] Yes [X] No

c. Comments, if any:
No response provided.

5. Diagnostic testing
---------------------
a. Has a sleep study been performed?
[X] Yes [ ] No

If yes, does the Veteran have documented sleep disorder 
breathing?
[X] Yes [ ] No

Date of sleep study: 7/25/06

Facility where sleep study performed, if known: HOUSTON 
VA

Results:
AHI = 19
RDI = 25
SAO2 NADIR = 76%

b. Are there any other significant diagnostic test findings 
and/or results?
[ ] Yes [X] No


6. Functional impact
--------------------
Does the Veteran's sleep apnea impact his or her ability to 
work?
[ ] Yes [X] No


7. Remarks, if any:
-------------------
FULL TIME EMPLOYED DOING INVENTORY FOR COMPUTER HARDWARE X 3 
YEARS



****************************************************************************


Medical Opinion
Disability Benefits Questionnaire

Name of patient/Veteran: 

ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete 
this document:

[X] In-person examination


Evidence Review
---------------
Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS


MEDICAL OPINION SUMMARY
-----------------------
RESTATEMENT OF REQUESTED OPINION: 

a. Opinion from general remarks:
**CLAIM TYPE: ORIGINAL
**SPECIAL CONSIDERATIONS: FDC
**INSUFFICIENT EXAM: NO

ELECTRONIC CLAIMS FOLDER AVAILABLE.

The Veteran has filed a fully developed claim. 
Please expedite.

Date of claim: 01/25/2019

Days pending: 4

Veteran has a power of attorney.

Please send a courtesy copy of the exam notice 
letter to 049 - TEXAS 
VETERANS COMMISSION

Attention C&P clinical staff - This exam request was 
scheduled at your 
location based on the claimant's residing zip code 
and ERRA instructions.
These remarks were generated using version 4.45 of 
the Exam Request Builder 
(ERB_v_4.45).

The Veteran will need to report for the following exam(s) 
unless the ACE process is utilized. Clinician: If using 
the ACE process to complete the DBQ, please explain the 
basis for the decision not to examine the Veteran, 
and identify the specific materials reviewed to complete 
he DBQ. Also if the exam is completed using ACE, please 
review the Veteran's claims folder 
and indicate so in the exam report.

DBQ RESP Sleep apnea
_________________________________________________________


The following contentions need to be examined:

Sleep Apnea secondary to Depressive Disorder
Medical Opinion 

Active duty service dates:

Branch: Army

EOD: 08/17/1999
RAD: 06/28/2002



DBQ RESP Sleep apnea:

Please review the Veteran's electronic folder in 
VBMS and state that it was 
reviewed in your report.

A sleep study is already of record in the Veteran's 
claims folder.

MEDICAL OPINION REQUEST

TYPE OF MEDICAL OPINION REQUESTED: 
Secondary Service connection.

OPINION REQUESTED: Secondary Service Connection.

Is the Veteran's Sleep Apnea secondary to 
Depressive Disorder at least as 
likely as not (50 percent or greater probability) 
proximately due to or the 
result of depressive disorder (claimed as depression)?

Rationale must be provided in the appropriate section. 
Your review is not 
limited to the evidence identified on this request form, 
or tabbed in the 
claims folder. If an examination or additional testing 
is required, obtain 
them prior to rendering your opinion.

POTENTIALLY RELEVANT EVIDENCE:

NOTE: Your (examiner) review of the record is 
NOT restricted to the 
evidence listed below. This list is provided 
in an effort to assist the 
examiner in locating potentially relevant evidence.

Tab A (Private treatment record in VBMS): 
Independent medical expert opinion 
dated 01/21/2019

Please direct any questions regarding this request to:


b. Indicate type of exam for which opinion has 
been requested: SLEEP APNEA

*** REFERENCED DOCUMENTATION WERE REVIEWED ***


TYPE OF MEDICAL OPINION PROVIDED: 
[ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ]

b. The condition claimed is less likely than not 
(less than 50% probability) proximately due to or the 
result of the Veteran's service connected condition. 

c. Rationale: 
OBSTRUCTIVE SLEEP APNEA IS A PHYSIOLOGICAL CONDITION 
OF THE UPPER AIRWAYS. ALTHOUGH SLEEP DISTURBANCE IS A 
SYMPTOM OF MOOD DISORDER, IT WOULD NOT CAUSE THE 
SOFT-PALATE PROBLEM ASSOCIATED
WITH SLEEP APNEA. 

"SLEEP APNEA IS A PERIODIC COMPLETE (CAUSING APNEA) OR 
PARTIAL (CAUSING HYPOPNEA) COLLAPSE OF PHARYNGEAL SOFT 
TISSUE DURING SLEEP"
http://www.dynamed.com/topics/dmp~AN~T115600/Obstructive-sleep-
apnea-OSA-in-a
dults#General-Information


IT IS NOTED THAT THE VETERAN'S BMI HAD INCREASED FROM 27 TO 32 
(AT
THE TIME OF DIAGNOSIS; BMI OF 30 AND ABOVE IS CATEGORIZED AS 
OBESE.

OBESITY IS ONE OF THE STRONGEST RISK FACTOR FORSLEEP APNEA. 
IT IS ASSOCIATED WITH ALTERATIONS OF ANATOMY THAT MAY LEAD TO 
UPPER AIRWAY OBSTRUCTION BY INCREASING THE NECK CIRCUMFERENCE 
AND DEPOSITS OF FAT AROUND THE NECK. THIS PLACES A LOAD ON THE 
UPPER AIRWAY THAT MAY LEAD TO AIRFLOW OBSTRUCTION. 
http://www.atsjournals.org/doi/full/10.1513/pats.200708-
137MG#_i1


OTH REFERENCES:
1) http://www.uptodate.com/contents/overview-of-obstructive-
sleep-
apnea-in-adult
s?source=search_result&search=SLEEP+APNEA&selectedTitle=1%
7E150
#H760186

2) http://emedicine.medscape.com/article/295807-overview#a4


****************************************************************
*********


xxxxxxx
Signed: 02/15/2019 12:51

Edited by JaeNobe
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