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I believe Errors and Mistakes may have resulted in denial


ROMAD

Question

I submitted a claim for Sinusitis, OSA,, and Tinnitus. My claim was denied for all 3. 

The tinnitus they claim was neither occurred in nor was caused by service. My job on active duty exposed me to gun fire, explosions, tanks, and tracked vehicles. I submitted the Duty Noise Exposure Spreadsheet that displayed my AFSC was rated as highly likely to be exposed to loud noise. In the first Exam they claimed I said my hearing loss was from jets flying overhead. Never said that, so they scheduled a second exam. This one they acknowledged the correct job but I was still denied. The evidence listed on the second decision dd not include the MOS Noise exposure chart I included on the first claim. I never went to sick call for ringing ears because that is just silly (had I known then) and was not something you did. I have had quiet office jobs since separating from The Air Force. What am I missing?

For the OSA claim, I submitted Lay statements from my current wife and my ex-wife as well as explained to the doctor my symptoms and  that when I was on Active Duty i had no idea sleep apnea was a thing. I assumed I just snored and was tired because I was working hard. I had a sleep study this past year and was deemed to have severe OSA.  In my claim I listed that I believed my osa was related to my cluster headache disability. They responded Cluster headaches do not cause OSA even if there are many people with cluster headaches and also OSA.  I experienced a stuffy nose during my headaches  on the left side. This was completely different from the closing of my airway when I would sleep. It was just worst if both occurred at the same time. They claimed I have other risk factors such as being male, obesity, and advancing age. Something I did not include in my claim was the fact that I was on the Fat Boy program at one point on Active Duty and my SMR made a reference to obesity. Would this help support my claim. Also in the second decision they said I was a 73 year old male and I am no where near 73 so they probably mixed my records with someone else. What can I do about this?

And Sinusitis, I have a couple diagnosis in my SMR's specifically listing sinusitis. I have had sinus issues since I was on Active Duty. I use a Netti Pot and have been diagnosed post active duty with sinusitis. The DBQ from the QTC Medical  Doc claims I have rebound sinusitis because I mentioned using Afrin. I have always been aware of the danger of over use and in my VA records I discussed this concern whenever the VA would prescribe a nasal spray. What am I missing and how can I get this  corrected. The errors on the 2 decisions make it seem as if they are not very organized and I have to suffer from their disorganization. Are they supposed to review all of the evidence from the initial claim when you submit a supplemental, or should I have resubmitted all  the documents from the initial claim. Are the documents that contain research that supports your claim supposed to be on the evidence list as well? They were not on there and if they did not give those documents equal consideration what is my recourse. Any assistance would be appreciated Thanks for listening.

 

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I do feel your pain brother. I do not understand as to your tinnitus did not get serviced connected due to your job and loud noise that you were exposed to. My hearing has went down while in service and  the military did do an MRI of my head. I do believe thats how I was serviced connected. In my opinion, that me be the only way to get that SC'd.

Did you have any head trauma? Diagnosed with TBI? Tinnitus could be a secondary claim as to that if you get and IMO.

Contractors do not have access to all of your SMR. Just what VA allows for them to see which may have happened in your case? did your bring supporting documents, 214, job descriptions, etc? Did you study your decision letter as to what evidence was submitted? Thats very important do do because if the VA did not include it in the decision letter, then that is new and material evidence because they did not even look at it. If VA did, then you have to find new and material evidence.

On the OSA, I am assuming that you are diagnosed with it. Not sure. Did the VA issue you a CPAP? Did your PCP state that it is needed, the VA is looking for specific wording.

 

A wise man once told me, once you file for a claim, file it for direct service connected then file that same claim for secondary. Lets us OSA for example. You filed for Direct SC. Now lets just say that you have bad feet or back or something that you cannot exercise from. Being that you cannot exercise, you have gained weight. If I am not mistaken, weight gain can cause sleep apnea. You have to connect the dots. VA knows but will not do it for you. Also look at all of the medications that you are taking. May cause for weight gan too.

 

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Yea the tinnitus decision threw me for a loop as well. In my initial claim the evidence included the Noise Exposure chart  but the second decision  did not have it listed. No TBI  just loud noises . I have very minimal hearing loss, just the ringing. As far as the contractor goes I brought the questionnaire typed and complete with all the basic information. None of the initial claim evidence was listed on the second decision letter, do they not review all the evidence when you submit a supplemental?  I am diagnosed with OSA 60 plus events per hour so pretty severe. I do have a VA issued CPAP. Prior to getting a VA CPAP I had purchased my own to see if it would help with my sleep and it did, so I requested a sleep study and filed a disability claim because it was obvious I had sleep apnea. The same thing with the sinusitis  or rhinitis. I may not know the correct name but I know I have pain in my face and head, as well as regularly have a stuffy nose making it difficult to breath and use my CPAP. Also I end up breathing through my mouth then you wake up with a sore throat.  And I am currently overweight which the doctor doing the first DBQ listed as the more likely cause of my sleep apnea. So it seems one affects the other, I just don't see whay the VA can't see that. Sleep Apnea was not something I remember even hearing about in the 1980's  My SMR's have references to sinusitis, and obesity, so some of the risk factors, but I never complained about being tired after work and coming home and taking a nap in my recliner. The fight continues.

   

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What the VA is looking for is was sleep apnea diagnosed and were you on AD during the diagnosis. If not, you will need a medical opinion stating that is was caused by military service. That is one of the post that I discussed today. There are no doctors out there that are willing to state that because they do not know what you have done in the service. Buddy statements usually work but there is a certain way that buddy statements need to be written.

The VA probably can see it but they will not connect the dots for you. It is up to you. I do not know your rated disabilities. I think that maybe you should look at your rated disabilities and see how you can tie sleep apnea to your rated disabilities. I was in the same boat, I filed a claim for TBI, migraines secondary to TBI and other service connected disabilities. Get my drift.

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43 minutes ago, ROMAD said:

Yea the tinnitus decision threw me for a loop as well. In my initial claim the evidence included the Noise Exposure chart  but the second decision  did not have it listed. No TBI  just loud noises . I have very minimal hearing loss, just the ringing. As far as the contractor goes I brought the questionnaire typed and complete with all the basic information. None of the initial claim evidence was listed on the second decision letter, do they not review all the evidence when you submit a supplemental?  I am diagnosed with OSA 60 plus events per hour so pretty severe. I do have a VA issued CPAP. Prior to getting a VA CPAP I had purchased my own to see if it would help with my sleep and it did, so I requested a sleep study and filed a disability claim because it was obvious I had sleep apnea. The same thing with the sinusitis  or rhinitis. I may not know the correct name but I know I have pain in my face and head, as well as regularly have a stuffy nose making it difficult to breath and use my CPAP. Also I end up breathing through my mouth then you wake up with a sore throat.  And I am currently overweight which the doctor doing the first DBQ listed as the more likely cause of my sleep apnea. So it seems one affects the other, I just don't see whay the VA can't see that. Sleep Apnea was not something I remember even hearing about in the 1980's  My SMR's have references to sinusitis, and obesity, so some of the risk factors, but I never complained about being tired after work and coming home and taking a nap in my recliner. The fight continues.

   

Well, I just have the 50% for cluster headaches, 10% Pseudo foliculitis, and 10% GERD... nothing connected to OSA or Sinusitis.

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In order for me to have my OSA approved (had to go to the BVA to get it approved) I a DBQ from my first sleep doctor and an IMO (which was done two years later) from a secons sleep doctor. The IMO indicated how he reviewed all my medical records and how my obesity (I listed all my weight while in the USAF) where it showed I was over weight as well as my hypertension which went undiagnosied while in the servie. Those two as well as a buddy letter form my NCOIC, a letter from myseld, ex-wife and adult daughter helped get me approved for OSA. I went through serveral denielas and finally the BVA in order to get it apprved. I did the leg work byproviding my doctor a spread shet with all my weights while in the service as well as a chart for my hypertension. 

My original claim was filed in 7/2015 (I retired in 1995) and was approved by the BVA on 7/2/2019. So don't give up, just go through all your SMR and list all your weight of when ever you went to the doctor while in the service, with the weight and your height also list you BMI (body mass index) this is what indicates if you are obiest or not. Bottom line is do your homework and go back to the doctor who said you had OSA and see if they will write an IMO for you, if it was the VA then you may need to find a civilian doctor to write one for you.

I would do this for all your denied disabilities.

Good luck

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That's great info, I see many of my weight entries and a couple BMI numbers. Also one entry where the word obesity was actually used. I may be able to reference your BVA appeal as precedent  along with my excel sheet and IMO  to get this done! I will search the BVA site for Jul 2019. Thanks a lot for the info. 

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