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]

1 minute ago, Willy P said:

I also believe they would deny based on no new evidence being submitted.  Maybe I'm misreading, but you still think I have a medium to strong case for the CUE?

you mean if you file an appeal?

without looking at your other records and that you state that Dr. Bash mentioned one.

2 minutes ago, Willy P said:

Elaborating on the Dr. Bash conversation- He said that the rater put their opinion over the opinion of the C&P Doctor that opined a service connection.  That is the reason for the CUE.

it is a valid reason. This statement suggests he reviewed your entire record or just the Decision letter?

3 minutes ago, Willy P said:

Sorry- What's an STR? 

service treatment records

3 minutes ago, Willy P said:

that I want to avoid a CUE unless there's no other way to get the earlier effective date. 

this is a decision you have to make as only you have all the data.

4 minutes ago, Willy P said:

I don't know how effective calling out the VA after getting a new claim approved with new evidence will be, either. 

depends on the new evidence. An IMO from either doctor will go far particularly if they write that that the VA doc said you had it, but VA rater overrode the medical opinion and substituted their own.

You have to make these choices I am not trying to influence you either way.

[Willy P]

6 minutes ago, GeekySquid said:

it is a valid reason. This statement suggests he reviewed your entire record or just the Decision letter?

Dr. Anaise reviewed my records.  Dr. Bash was only over the phone.

8 minutes ago, GeekySquid said:

depends on the new evidence. An IMO from either doctor will go far particularly if they write that that the VA doc said you had it, but VA rater overrode the medical opinion and substituted their own.

If I get this statement in the IMO, would a CUE be the only way to trigger the earlier effective date?  Or could I use it in the supplemental claim, potentially followed by a NOD on the effective date?

My claim consisted of:

• The 1 Page Medical Record from active duty- complaint on snoring/sleeping (2013)
• The 2016 Diagnosis and DBQ filled out by the sleep Dr.
• Sleep study records

[GeekySquid]

6 minutes ago, Willy P said:

If I get this statement in the IMO, would a CUE be the only way to trigger the earlier effective date? 

depends on that date sequence of your claims. If you are supplying new and relevant information for a claim decided prior to Feb 2019, if you are allowed to and the VA agrees with you, then you should be able to get your EED.

That said VA is having hiccups with the change to AMA and how that affects legacy claims. you might have to fight for an EED

8 minutes ago, Willy P said:

The 1 Page Medical Record from active duty- complaint on snoring/sleeping (2013)

this is and was your weak point. snoring is not basis for service connection or proof of SA.

What you needed then and need now are Buddy Letters saying "he died in his sleep 50 times an hour" or similar type statements. Add in the IMO, and other stuff, and you "should" be a good candidate to be SC'd for SA.

[Willy P]

5 minutes ago, GeekySquid said:

depends on that date sequence of your claims. If you are supplying new and relevant information for a claim decided prior to Feb 2019, if you are allowed to and the VA agrees with you, then you should be able to get your EED.

That said VA is having hiccups with the change to AMA and how that affects legacy claims. you might have to fight for an EED

this is and was your weak point. snoring is not basis for service connection or proof of SA.

What you needed then and need now are Buddy Letters saying "he died in his sleep 50 times an hour" or similar type statements. Add in the IMO, and other stuff, and you "should" be a good candidate to be SC'd for SA.

Thanks!

Sorry for all the back and forth.  This stuff is really confusing.  I'll work on getting the IMO and buddy letters so I can get the claim reopened.  I think I'll just start there and worry about the EED when it comes.

[GeekySquid]

3 minutes ago, Willy P said:

I think I'll just start there and worry about the EED when it comes.

yes getting SC'd is the first step in all this.

[Willy P]

Quick update for the group.

This week I received the IMO from Dr. Anaise.  I was very satisfied with how detailed and concise it was.  I really liked how he used all of my evidence submitted as exhibits, so they are all accounted for.

I also got a lay statement from my wife.

Today I submitted the fully developed supplemental claim.  I decided this time that I would submit each document with its correct file name (sleep study named "diagnosis" and doctor visit "in-service complaint") and submitted everything.

Now we just wait.