Reopening Sleep Apnea Claim- Options?

[Willy P]

Good Evening Everyone,

I'll make the background story as clear as I can before I get to my situation:

Active Duty 9.5 years, 2006-August 19, 2015.

Six Months after separating, diagnosed with central and obstructive sleep apnea (February 2016).

No previous diagnosis in service, but in 2013 I complained to my doctor about trouble falling sleep, sleep trouble, and starting to snore.  He prescribed decongestants to try and open my nasal passages better.  I never followed up.

Submitted a claim in May 2016 and included a DBQ, Sleep Study records, and the 2013 doctor's record mentioned above.

C&P Exam went well, and the examiner opined that my sleep apnea was "at least as likely as not" caused by military service.

Va denied the claim in August 2016.  I did not appeal because I had nothing else to provide.

Fast forward to present, and I've been realizing that an IMO nexus letter may be all that I was missing.  My current doctor will not write one, so I've had a couple of emails/calls with Dr. Anaise and Dr. Bash.  Both have offered a nexus letter/IMO and said that I should have a decent chance of getting it approved.

My questions are as follows:

1- Dr. Bash mentioned that I should win a CUE based on the positive C&P and the evidence that I provided that I complained of the symptoms in 2013 while still on active duty.  Reading about CUEs has me pretty nervous on this, and I don't want to jeopardize a positive decision just for back pay.  Should I pursue a CUE, try to reopen the claim, or just submit a new FDC after receiving the IMO/Nexus letter?

2- Dr. Anaise offered the Nexus letter for about 1/3 of the price.  I've read that Dr. Bash was expensive but worth it.  Do you think it's worth spending the extra money in this case?  Dr. Bash also said he would fill out the DBQ for me.

3- Is it a reasonable goal to go after back pay to the first claim?  I figured since I missed the appeals window that I would have no shot, but have seen a couple of success stories on here with CUE or a notice of disagreement.

[Fat]

Congrats......

 

[Willy P]

6/4 Update

The HLR has sat with no updates since it first showed up in March.  I figured this is pretty normal timeline (within 120 days) so no reason for alarm.

Today, the va.gov site says that there is a new claim received.  I have no idea what this means and of course details are lacking.  Hopefully I'll get a letter in a few days or something.  When I select the claim files tab, it shows what appears to be all of my claim documents previously submitted.  Ebenefits has no updates.

[GBArmy]

Willy If you have a VSO, see if they can see what is up in the system by viewing the VBMS. Or, you can cally Peggy yourself and see if you can get insight. 800-827-1000. Caution though; it isn't very reliable and up to date often. It is possible that the VA has opened up another item as a disability claim based on evidence found. For example, a new sinus condition. Who knows?

[Fat]

NEVER GIVE UP........

[Willy P]

Well I have an interesting update now...

Yesterday 6/27 I received my informal phone conference that I requested for the HLR.  The senior rater Agreed with my statement in the HLR that the 2016 denial was in fact a mistake.

He made two points:

1) The denial letter I received stated that there was no evidence in service.  This is incorrect because I did in fact complain of sleep problems and snoring during active duty.

2) The rater should not have overruled the VA examiner.

This is exactly what I was hoping for- the senior reviewer went back and looked at all the details in the 2016 claim and found the error.  I honestly thought I had little to no chance of getting this decision, but I'm glad I went this route.

Great day yesterday!

[Berta]

WONDERFUL!!!!

That is exactly what a VA HLR person should do,and it even helps if the claimant files CUE as soon as they get a decision that they feel is legally wrong,  andthey should also ask for HRL review.

That saves some vets who do have clear and unmistakable errors in their recent  decisions, not to have to go the LONG  BVA route.