Supplemental Claim Denied - Sleep apnea

[captfire0311]

Hello All,
So I am currently diagnosed with "adjustment disorder with depressed mood, unspecified anxiety disorder, unspecified insomnia disorder, alcohol use disorder in sustained remission (previously rated as major depressive disorder with medication induced sleep disorder)" and in Nov 2018 I filed for Sleep Apnea secondary to what was then MDD. It was denied after no C&P. After talking with my psychologist I got a sleep study ordered. I was then diagnosed with Obstructive Sleep Apnea so then in May 2019 I filed a Supplemental Claim to provide new evidence since I was actually diagnosed with OSA. Well I also had another C&P for the depression and they kept the rating at 50% but changed MDD to the above (in bold) diagnoses. For the Sleep Apnea I had a C&P with LHI (locally) and the doctor and nurse both seemed that the OSA could most likely be from my depression and medication that caused the depression. Well my claim was closed at the end of July with a denial. I will attach the document explaining the denial but in short, LHI said "less likely than not proximately due to primary disorder" and also stated OSA cannot be caused by depression of mental disorders....  

I'm seeking input as to what my next steps would be. After research it looks like I could get an IMO and then another supplemental claim with "new evidence" or a "higher-level review?" Thanks in advance!

DenialLetter.pdf

[broncovet]

My advice: 

File a nod disputing the denial of OSA, and do so within a year.  

Next, get an IMO with an opinion that your OSA is "at least as likely as not" due to SC depression/other SC causes.  

Also, make sure its documented that your CPAP is "medically necessary".  

IN your NOD do NOT elect a "higher level review", but instead opt for "supplemental claim lane" which allows new evidence.  If you do the HLR, you can not submit new and relevant evidence, and its a virtual certainty that your claim will be denied again, absent a favorable nexus statement.  

If you are not working, and unable to work due to sc conditions, also file for tdiu.  

[GBArmy]

Bronc is right on. Couldn't agree more with EVERYTHING he advised. File nod, supplemental. You have plenty of time to get someone to give you a favorable IMO. You can do this.

[captfire0311]

So then I would have to get an IMO then file by mail correct? I'm not seeing a way to file a NOD just a Supplemental Claim by VA Form 20-0995. Also in this case I would just make clear what I would like my sleep doctor to do, as in nexus? Cause I thought the last doctor (LHI) but a local and I were on the same page but I guess not.