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.

[Oceanbound]

And do you have your C-file. If you don't then you will continue to be denied no matter what. Because your C-file is the book and you can not do a book report (remember doing it in school) with out the book.

[Willy P]

15 hours ago, Oceanbound said:

Not one mentioned getting a new sleep study. Because the VA can say that the VA test was invalid, any way to deny you and waste your time until you're dead. Open up the online card catalog called google and type in your city (with) sleep study, pick an office and setup an appointment. Sleep Apnea test start at $150. 

This test will show that your SA is chronic and the VA won't be able to deny you a second time with this where the Sleep doctor says that you need a SA machine, then file your CUE with the results. You were diagnosed 6 months after getting out by the VA then you're solid, they don't expect you to file a clean well written CUE that includes a Writ of Mandamus.

Dr. Anaise doesn't do payment plans.

Buddy letter(s) NEED to be Notarized Affidavit. An Affidavit is a legal document that is taking very seriously in court, because "you" lie you're going to pay for lying. The only time I did a buddy letter was that he actually witnessed when I had my symptom and he graduated from law school. Other than that I don't believe in them for that I tried to get them and they don't want to go through all that process of writing it, going to their credit union to have it notarized in front of the Notary, mailing you a copy etc etc.   

I had not thought of a new sleep study.  If it helps with the claim, then I don't mind to get another one.  My only concern is that introducing new medical evidence may make it impossible to get an earlier effective date...

15 hours ago, Oceanbound said:

And do you have your C-file. If you don't then you will continue to be denied no matter what. Because your C-file is the book and you can not do a book report (remember doing it in school) with out the book.

I don't have the C-file.  I guess I figured that this is a relatively simple claim, and I have every document that is needed.  I'm glad you put it that way, I'll call and request it.

So I guess my process will go something like:

-Request C-File

-New Sleep Study

-Nexus Letter

-Reopen Claim in eBenefits

-If approved, file a NOD for earlier effective date

-If denied, CUE?

[paulstrgn]

I had OSA approved after getting out of the military. The evidence I used was two sleep studies (done 3 years apart), the second sleep study was performed only because my PCM stated I should have one every few years. I had three lay statements, one from my wife, one by my adult daughter, and a third from my last NCOIC (only the this last statement was notarized). I also submitted a lay statement describing my issues. In the BVA decision they mentioned that my IMO had reviewed the lay statements as well as my service medical records. Both doctors that did the sleep studies did DBQs and the last one included a medical opinion.

I am not sure how many sleep studies you have actually had. Did you have a private sleep study or one by the VA or even both?

I agree if you can afford the two IMOs (one from Dr. Bash and one from Dr. Anaise) then you may want to, but it is up to you.

It took the BVA to approve my OSA, the VA kept denying me. The last HLR had the same evidence as I used for the BVA.

[Oceanbound]

12 hours ago, Willy P said:

I had not thought of a new sleep study.  If it helps with the claim, then I don't mind to get another one.  My only concern is that introducing new medical evidence may make it impossible to get an earlier effective date...

So I guess my process will go something like:

-Request C-File

-New Sleep Study

-Nexus Letter

-Reopen Claim in eBenefits

-If approved, file a NOD for earlier effective date

-If denied, CUE?

Yes that is the path you should take. You do not need to have two IMOs because you have the evidence, I would go with Dr. Anaise because his book mentioned SA, after you get the private sleep study test. 

One thing I learned way afterwards is the "Thomas Jefferson essay." You had to do a report on anyone ever in the history of humans in 2nd grade. At this point its pretty simple TJ was president, had a dog name spot, and what ever, your in second grade so its a starting point. 4th grade comes along and you have to do another report, well being older now you still have the one from 2nd grade and you you just add more to it as a 4th grader level. Well Well Well you're in JR high now and have to do another report by now you're an expert in TJ life, why reinvent the wheel. So start preparing to write that CUE because the VA doesn't expect you to do so. 

You CUE should be the what you have now--diagnosed for SA six months post separation  with the denial letter VA sent you , plus the new private sleep study which now shows that you were not a one hit wonder song from the 70s, and the new IMO. So go to the CUE section and start reading how to write one.

“Let your plans be dark and impenetrable as night, and when you move, fall like a thunderbolt.” ― Sun Tzu, The Art of War

[Oceanbound]

After this new sleep study be like a senator, do one every six years, this makes you proactive on sending the VA a very clear message that you will give them a Mike Tyson KO every six years and they know that SA isn't curable.

[GeekySquid]

6 minutes ago, Oceanbound said:

You CUE should be the what you have now--diagnosed for SA six months post separation  with the denial letter VA sent you , plus the new private sleep study which now shows that you were not a one hit wonder song from the 70s, and the new IMO.

Ocean, while I love the Sun Tzu quote, and agree with your intent, I want to make sure that the OP does not misread something in the way you structured the sentences.

his CUE, as of now, CANNOT involve the new private sleep study or IMO.

He would have to get rejected again on his Appeal that included those pieces of documentation for them to enter a CUE. He may then have a different CUE, just not the potential one he has now.

I am sure you did not to imply that, but I had to read that sentence a couple times to make sure.

Posting this just to make sure the OP does not have the same misreading of what you wrote.