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.

[GeekySquid]

2 hours ago, Willy P said:

but I submitted the (also attached) record where I brought this up to my doctor.

here is part of your problem,

as best as I can read that it said you are snoring MORE and were told to nasal decongestants.

Snoring, or snoring more, is not by itself triggering factor for SA. Most of us with SA snore like freight trains.

If that is the only in-service evidence you submitted, there is what they hung their hat on. This makes your CUE possibility some what limited but a well crafted CUE will smack them around for placing the rating persons opinion over the VA Dr's medical opinion.

The good news is both those MD's can craft an IMO based on your record and research papers that do support your claims.

If you have buddy letters from in service now is the time to add them.

[paulstrgn]

10 minutes ago, GeekySquid said:

here is part of your problem,

I was assuming that was from his service medical records. I am assuming he never uploaded anything from the doctor that diagnosed him with OSA. But I could be wrong, but I agree that either doctor can write an excellent IMO.

12 minutes ago, GeekySquid said:

If you have buddy letters from in service now is the time to add them

I had three buddy letters that I submitted with my claim and it was approved at the BVA.

[Willy P]

19 minutes ago, GeekySquid said:

here is part of your problem,

as best as I can read that it said you are snoring MORE and were told to nasal decongestants.

Snoring, or snoring more, is not by itself triggering factor for SA. Most of us with SA snore like freight trains.

If that is the only in-service evidence you submitted, there is what they hung their hat on. This makes your CUE possibility some what limited but a well crafted CUE will smack them around for placing the rating persons opinion over the VA Dr's medical opinion.

The good news is both those MD's can craft an IMO based on your record and research papers that do support your claims.

If you have buddy letters from in service now is the time to add them.

I was worried about the wording in the record, but it was unfortunately all I could find.

This Dr. was my primary care provider while I was on recruiting duty, so I was enrolled in Tricare Prime Remote.  Basically, a civilian doctor while on active duty.  So I submitted this record, along with my sleep study documentation and DBQ for my claim.  There is really nothing in my military medical record to reference, so that was another concern of mine.

[GeekySquid]

5 minutes ago, paulstrgn said:

I was assuming that was from his service medical records.

i am too and if it is the only in-service evidence he has, then he has a problem.

based on what the OP has written here, his best bet is the IME/IMO route. We all know VA hates SA claims and find all sorts of reasons to deny..fat neck, didn't get a CPAP in service, etc. and we know most of that is B.S.

We also know there has to be a in service evidence in almost every claim but presumptives.

If he can document burn pits, etc then he might get it on presumptive coupled to in the first year after discharge requirement.

[paulstrgn]

I agree Geeky, but he said he was diagnosed with OSA with one year of getting out of the military.

11 hours ago, Willy P said:

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

Now the way I read the regs (I may be wrong so please correct) that as long as it is within one year of discharged it is considered as if it happened in the military.

As always thanks Geeky

[GeekySquid]

9 minutes ago, Willy P said:

I was worried about the wording in the record, but it was unfortunately all I could find.

This Dr. was my primary care provider while I was on recruiting duty, so I was enrolled in Tricare Prime Remote.  Basically, a civilian doctor while on active duty.  So I submitted this record, along with my sleep study documentation and DBQ for my claim.  There is really nothing in my military medical record to reference, so that was another concern of mine.

so buddy letters are going to be your evidence. Find them. Old roommates, sleeping partners, camping friends etc. That and the IMO's you may chose to get from either or both of those doctors.