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.

[Willy P]

Another update.

Even though the VA.gov website let me submit a supplemental claim online, I was sent a letter in late December that it was filed on the wrong form.  So I filled out the correct form and mailed all documents in to the VA on 12/24.

VA website updated to show that the claim was received on January 4th.

January 29th, my claim was closed and now ebenefits is showing a 50% rating for sleep apnea with an effective date of January 4th.

I think this is a huge win- diagnosed after separating and using the Nexus letter from Dr. Anaise.

 

My only decision left is whether to fight for the back pay, which is probably in the neighborhood of $50K.  The only way that I can seem to do that is via the CUE.  Since the only evidence that I sent was another medical opinion that agreed with the VA C&P examiner, maybe I have a shot at CUE. 

[Willy P]

Another Update,

I checked the VA.gov site again because to this point, there has been no status where I'm used to seeing "we sent you a development letter".  Under the status tab is the status that the VA has made a new decision.

However under the issues tab it is displaying CURRENTLY ON REVIEW- "Compensation Issue"

I'm not sure what that means but I will keep the updates coming.

[Willy P]

Update Again.

Today I received the decision letter.  50% granted for sleep apnea, effective 1/04/2020 for a payment effective date of 2/01/2020.

Now the only thing left to answer is "how" I can request earlier effective date.

To summarize: I missed the appeals window of the 2016 denial.

The IMO was the only new evidence submitted with the supplemental claim.  The IMO used the same evidence to concur with the C&P examiner's opinion.

Is there another avenue besides CUE to request the earlier effective date?

[Willy P]

Bumping the thread, hoping there is another way besides CUE.

[Willy P]

Another update.

Based on some light reading I decided to use my HLR option instead of going after the CUE.  I faxed the HLR request over a couple of days ago, and now it's just time to wait.

[Willy P]

Another Update.

VA.gov site updated to show my HLR claim on Friday.  I faxed it in February 19, so that's a little over 2 weeks to populate on the website.  I requested a phone conference- I get a ton of robocalls, so it looks like I'll be answering a lot of junk until it's finally the VA that's reaching out.

I'm keeping this going just to keep an accurate track of my claim progress, in case any one needs it someday...