Why would the RO differ sleep apnea?

[ShrekTheTank]

So I got tension headaches at 30% today but sleep apnea got differed.  What is going on with this?  

[ShrekTheTank]

1 hour ago, paulstrgn said:

Look at it this way, a differ is better than a denial. It is like brokensoldier244t they just need a C&P.

That is a great point!  Thanks!

[doc25]

5 hours ago, shrekthetank1 said:

It is secondary to ptsd and they never gave me a c&p exam. I submitted the evidence and now they might be backtracking.  I have my doctor saying my ptsd aggravates my sleep apnea.  

I got a C&P exam for sleep apnea secondary to PTSD.

Here's how my case went:

1. First submission denied because they said there wasn't evidence in-service for Sleep Apnea. Which I wasn't trying to direct-service connect. I had sleep study confirming I was diagnosed after service. Didn't have CPAP at the time. So, duh it's going to get denied.

2. Re-opened with VA diagnosis of sleep apnea and I had a "medically necessary" CPAP at that time. Denied again. WTH?

3. Re-opened again, but the third time I had a Sleep Apnea DBQ..THEN...I was sent to the C&P exam and I received a favorable nexus of opinion.

If you get denied and you weren't provided a C&P, then the VA failed to apply duty to assist. A BVA or CVAC judge would see that.

Did your doc provide you with a nexus of opinion?? Saying it vs. documentation are two different things.

[ShrekTheTank]

5 hours ago, doc25 said:

Did your doc provide you with a nexus of opinion?? Saying it vs. documentation are two different things.

I did get the va doctor to document as likely as not that ptsd is aggravating sleep apnea.  I just find it interesting they were about to close my case, went all the way to pending notification and they rate one and send the other back to gathering of evidence.  

[broncovet]

A deferral is often done because:

  The VA has completed the development and can decide issue one BUT

issue 2 is missing something significant.  (That is, maybe missing a Caluza element).  

     Its a favor to you..take it that way.  Here is why.  You get some income with the decision.  And, someone in the Va recognizes claim number 2 is good, but not quite good enough.  There is something missing.  

    The nexus statment may not be up to VA standards.  It needs to state the examiner read your records.  Further, the examiner must opine that your cpap is "medically necessary".  The examiner needs to demonstrate he is an expert witness..that is, he has significant training and/or experience in sleep medicine.  A phd in sociology will hardly be sufficent to establish one is an expert in sleep medicine.  You may need a CV for the doc.  

    Lastly, the examiner needs to give a medical rational as to "why" he said your sleep apnea was "at least as likely as not" related to your PTSD.  The examiner could, for example, cite studies that have linked PTSD and OSA in his exam report.  

[ShrekTheTank]

4 minutes ago, broncovet said:

A deferral is often done because:

  The VA has completed the development and can decide issue one BUT

issue 2 is missing something significant.  (That is, maybe missing a Caluza element).  

     Its a favor to you..take it that way.  Here is why.  You get some income with the decision.  And, someone in the Va recognizes claim number 2 is good, but not quite good enough.  There is something missing.  

    The nexus statment may not be up to VA standards.  It needs to state the examiner read your records.  Further, the examiner must opine that your cpap is "medically necessary".  The examiner needs to demonstrate he is an expert witness..that is, he has significant training and/or experience in sleep medicine.  A phd in sociology will hardly be sufficent to establish one is an expert in sleep medicine.  You may need a CV for the doc.  

    Lastly, the examiner needs to give a medical rational as to "why" he said your sleep apnea was "at least as likely as not" related to your PTSD.  The examiner could, for example, cite studies that have linked PTSD and OSA in his exam report.  

Looks like I have some work to do and this will push me over that hump!  ty

[broncovet]

 

    Lack of a c and p exam is NOT sufficient, in its self, to show that VA failed to DTA.  A C and P exam is "discretionary" for VA.  There are some instances where VA would not order an exam.  

    Example:  You have no in service event that you had a sleep disorder in service.  

    A c and P exam wont fix this.  Your doctor can not opine that an event in service caused your OSA if you had no event in service.   In this example, the Va would have 2 choices:

    1.  Ask you to document an event in service (more information). 

    2.  Deny it.  

Edited May 25, 2019 by broncovet