historic diagnose will VA Accept one 10 years old?

[Buck52]

Question

Will the va take an older diagnose that was in the veterans medical records? say 5/10 years ago?

Like a Veteran was diagnose for Sleep apnea back in 2010...but never filed a claim for it   now this veteran wants to put in a claim for it.

He uses  the VA PRESCRIBE  C-PAP

He has a Mild Diagnose for Sleep Apnea  but no where in his records does it say is medically required...so under the M-21  it says must necessary medically to use''

the manual now says,

“Use absent a medical determination that the device is necessary does not qualify.  The regulation requires that the device be necessary and this is a medical question.

He never had OSA in military  but has it now years later after separation due to his PTSD. 

His VA M.H. Phyistrist Suggested he see the VA sleep clinic & he did a sleep study  and they diagnose him with the Mild OSA and gave him a  C-pap TO USE (*THIS WAS 10 YEARS AGO*) But no where I can find in his records the Dr said it is medically necessary to use''??

I mention to him they will go by the date he filed his claim for sleep apnea  but we have not filed it yet...I am trying to get all his T's  and I's crossed  we don't want a denial.

How will he over come the new regulation in M-21 below

“Use absent a medical determination that the device is necessary does not qualify.

I am thinking he needs a Sleep Dr  or a Qualified Dr to render his medical opinion that the C-pap machine is medically ''REQUIRED'' this veteran is necessary to use his c-pap machine prescribe by the VA

We are going to file a secondary to his PTSD. AS SOON AS I CAN GET HIM TO SEE A SPECIALIST OPINION FOR THE C-PAP MACHINE REQUIRED USE AND MEDICALLY NECESSARY TO USE FOR HIS WELL BEING 

Need some opinions on this please.

[blahsaysme2u]

following

[blahsaysme2u]

following

[JKWilliamsSr]

Normally it would be assumed that using a CPAP is medically necessary.  The reason for this is you can only get one via a prescription.  

I have Asthma and Sleep Apnea.  I see a Pulmonologist for both of them for treatment.   A pulmonologist is a specialist in conditions that affect the lung and respiratory tract and since Sleep Apnea is considered an upper respiratory condition you do not not have to see someone that specializes in sleep conditions only. 

It does not matter what the M21-1 says since it is not law.  The law that pertains to sleep apnea is 38 CFR 4.97 under diagnostic code 6847 and it does not have a requirement of "medical necessary" it only says "requires use of breathing assistance device such as continuous airway pressure (CPAP) machine".   

A CPAP machine is used to treated the symptoms of Sleep Apnea and VA disability compensation is based on symptoms. 

Edited January 21, 2020 by JKWilliamsSr

[GBArmy]

Buck52 I agree completely with your tract; get a diagnosis from a current specialist NOW, and just tie it back to his 10 year ago medical suggestion/direction to use the CPAP machine.

[brokensoldier244th]

VA didn't just give away cpaps, they are expensive. If he has one, it's medically necessary.

[Buck52]

jK Williams Sr 

Quoted

''Normally it would be assumed that using a CPAP is medically necessary.  The reason for this is you can only get one via a prescription''

But since the change or added to the M-21  ( The VA Playbook)

the change or added to the m-21 is

''

How will he over come the new regulation in M-21 below

“Use absent a medical determination that the device is necessary does not qualify.''

I only know that he may need a specialist to give his medical opinion that it is ''Required Medically necessary to use for his well being''  

That may fly  over the red flag  for=“Use absent a medical determination that the device is necessary does not qualify.''