CUE for Denied claim?

[blahsaysme2u]

I have been debating on posting my first entry into the forum for about a week now. I had previously just been scanning and reading everyone’s posts, but hadn’t created a profile. So here we go.

I joined the army in 2003(National Guard to be truthful) and did 1 tour in Iraq in 2007-2008 providing convoy security. Without going into too much detail,(not needed for this question-maybe ill post more later) my company did 3x wk. missions and were hit with IED just about every time we went out the wire. But again that doesn’t really apply to my question here.

In 2008, when I first returned home, I had my first experience with the VA and my dr sent me for a C&P exam. One of the claims I was seeking treatment for was sleep apnea that my PC thought I had.

Long story short, the claim was denied (actually all my claims were) due to lack of evidence. My medical files from the army had been lost and I was told there wasn’t much I could do. After my C&P though, my dr did send me for sleep study and I was officially diagnosed with sleep apnea and given a cpap machine. I have used it ever since (changed my life)

Fast forward to 2012, my medical records magically showed, the VA did a review of my previously denied claims and I was approved for a few. But my sleep apnea was denied again. I didn’t appeal and I forgot all about it until recently, since I have reopened some claims due to needing increases.

Soooooooooooo, I did reopen my claim for sleep apnea but now I realize I may have CUE because I was actually diagnosed while still in my contract (I didn’t get out until 2009 and was still in selective reserve until 2011)

Anyone have advice or pointers on this?

Thanks in advance
 

[vetquest]

Sounds like you need to reopen with new and material evidence.

[Vync]

1 hour ago, blahsaysme2u said:

they are in service records from my out processing...i just happened to find my personal copy. they say they "lost" my service records and dont really have anything from when i was in(good ole national guard losing everything).

but i am sure there are more records to be found but until i get my C-file i am just playing the waiting game to figure it out. but this is great info i will definitely refer back to once i have everything in hand.

non-VA doc meaning private doctor, not military docs right?  its a "statement of Medical Examination and Duty Status" form stating i have sinusitis. its dated 4/24/2008. i was discharged from active duty 5/23/2008.

Glad it was from when you were in service.

Just keep in mind sinusitis and allergic rhinitis rating criteria is completely different from each other.

§4.97   Schedule of ratings—respiratory system.

Quote

6510   Sinusitis, pansinusitis, chronic.
6511   Sinusitis, ethmoid, chronic.
6512   Sinusitis, frontal, chronic.
6513   Sinusitis, maxillary, chronic.
6514   Sinusitis, sphenoid, chronic.
General Rating Formula for Sinusitis (DC's 6510 through 6514):
Following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries	50
Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting	30
One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting	10
Detected by X-ray only	0
Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.

 

 

[blahsaysme2u]

it looks like Rhinosinusitis is the same as sinusitis, code 6510. per analogous ratings table here:

http://www.militarydisabilitymadeeasy.com/analogous.html

http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#f

what you think of this?

[Vync]

On 2/1/2020 at 1:32 AM, blahsaysme2u said:

it looks like Rhinosinusitis is the same as sinusitis, code 6510. per analogous ratings table here:

http://www.militarydisabilitymadeeasy.com/analogous.html

http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#f

what you think of this?

Always double-check the VA's official rating criteria. Although militarydisabilitymadeeasy.com is a relatively informative resource and easy to read, it is not always 100% current. I recently saw some criteria that was dated and somewhat inaccurate.

https://www.ecfr.gov/cgi-bin/text-idx?SID=bbc63ebff2664bce41d30a3bf505352d&mc=true&node=pt38.1.4&rgn=div5

Rhinosinusitis could go a number of ways depending on the symptoms, testing that is performed to determine any underlying factors, and then analogous assignment of the rating most appropriate to the situation:

6510 through 6514 = sinusitis
6522 = allergic or vasomotor rhinitis
6523 = bacterial rhinitis
6524 = granulomatous rhinitis.

For me, I am SC for both sinusitis and allergic rhinitis. The VA looked at the criteria for each. To avoid pyramiding, they assigned the allergic rhinitis rating because it had a higher rating.

[blahsaysme2u]

update on my case on this thread: