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Denied Claim


Easy E
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My original claim for sleep apnea was denied stating that PTSD does not cause sleep apnea.  My HLR was denied stating the same thing.  My claim is that  my PTSD aggravates my sleep apnea.  My supplemental claim was denied and did not address the situation.  It states that I didn't have new and relevant evidence which is incorrect.  But my question is, have anyone gotten a denial letter stating that the medical person completing the DBQ did not use a VA approved form and that person did not live in my state.  If so, what's my next move?  

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No, I have not heard of a denial "the medical person completing the DBQ did not use a VA approved forma and that person did not live in my state".  

However, there are 2 types of medical exams:

1.  An "in person" exam where the doctor sees you and renders his opinion on your condition.  

2.  An IMO where the doctor does not see you personally, but "reviews" other doc's exams, and then he makes an opinion regarding that.  

     If your DBQ "was from a doctor in another state", well on your appeal I would explain that.  For example, you may well have a good reason for traveling out of state to an in person  exam.  VA loves to deny first, ask questions later (only if you appeal).    Take note, however:  The criteria for service connection "does not" require you be examined by a doctor in YOUR state.    And, the VA is required to rate you "on the criteria".  For example, they cant make a decision on your claim based solely on whether you have purple hair, or listen to Led Zepplin.  That is, this is a "bogus' denial, which should be overturned at the board "providing that" you have the Caluza elements documented.  

    My advice:  File a Nod, and go directly to the Board of Appeals.  You will need to choose "hearing or no hearing" and "new evidence or no new evidence".  It would take a review of your file, to know if you needed to submit new evidence or not.  I dont know if you have a nexus or your caluza elements documened, BUT the "requirement" your doc be in your state is simply bogus.  You may choose a doctor in any state, as long as he is "competent" to give an expert opinion.  For example, "Doctor Hoffstedder" from Big Bang theory, with his degree in physics is not competent to opine whether your sleep apnea is related to PTSD or not.  Instead, you need a doctor with experience and training in the diagnosis and treatment of either PTSD or sleep medicine.  (Preferrably both).  

Edited by broncovet
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Easy E I agree with Bronc; you submitted and were denied, you went to HLR and was denied. So you options are an additional supplemental claim with NEW evidence, or, BVA. On a secondary disability it is very important to have a good IMO from a doc, especially if you can get one in the required area of specialty. Being objective, how solid was your doc's rationale and decision letter? Did he/she state medical data/evidence of studies showing the connection between OSA and PTSD? Did he opine at a minimum that your disability was "at least as likely as not" caused by the PTSD? The VA tries very hard to deny SA because it can be rated at 50%. If you have weighed the facts and are convinced you have a strong case, go BVA. Otherwise, get more relevant facts/evidence and submit a supplemental claim within a year IMHO.

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 Did they use this in there reason and bases of their decision? if you can put a redacted copy of your decision on here   that would help us help you better. cover black out your personal information name claim #address ect,,ect,,

I believe all Veterans that file a PTSD CLAIM Rather a secondary claim that PTSD IS RELATED TO FOR THE CAUSE OF A NEW CONDITION.

HE/SHE WILL NEED TO HAVE A C&P,  THE EXAMINER WILL READ YOUR RECORDS  BACK WHEN YOU WERE ADJUDICATED FOR THE PTSD AND READ THAT C&P REPORT AS WELL  AND THE EVIDENCE TO SUPPORT THIS CLAIM,

REMEMBER WE NEED PROBATIVE EVIDENCE TO SUPPORT WHAT WERE CLAIMING  AND THERE'S NO BETTER EVIDENCE  THAN TO USE A QUALIFIED Dr to render his medical opinion that  HE HAS READ YOUR MEDICAL RECORDS AND EXAMINED YOU AND RENDER HIS PROFESSIONAL MEDICAL OPINION THAT IT IS LIKELY AS NOT THAT YOUR PTSD AND THE MEDICATIONS (name them) YOU ARE PRESCRIBE FOR YOUR PTSD  IS LIKELY AS NOT THE CAUSE OR RELATED TO YOUR NOW DIAGNOSED SLEEP APNEA. and nexus the two.

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When did you submit your DBQ?  Were you examined in person my the doctor who completed your DBQ?  I can possibly see the VA not giving weight to your DBQ if it doesn't show they you were examined in person.  

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I posted in your other post (FYI, next time just post your stuff in the original post- it helps keep the forum cleaner, and its easier for future people to follow what you have going on)

You are going to need an in person exam from someone to connect the SA to the PTSD. You are going to potentially also need a buddy statement or something to indicate that you had SA of some kind in service. Its not vital to the claim because SA can present later after discharge, but if you had one it would help establish element 2 of caluza (in service event). 

In any case you are going to need either a sleep doctor or MH therapist IN PERSON to establish a causal link between the SA and PTSD. Since the PTSD is already rated you would't need an in service event to prove the SA- that is satisfied by the fact that your PTSD is already SC. The evidence you resubmitted apparently was used in your first claim. I can't really opine anything for that since I have no idea what that evidence was. Still, the link between SA and PTSD that you are trying to prove is the sticking point that that is what your doctor is going to need to address. Not a PA. The research, etc that you submitted on your own doesn't establish a link by itself- veterans can't make diagnoses connections for conditions, only lay statements that say you think it may be connected. It takes the doctor to draw the conclusion. 

 

As for the DBQ- I don't know what form you used but you don't use PTSD or SA forms- those are for establishing the initial diagnosis. You need a DBQ form for a general medial opinion. Absent that you will need a private statement from an MD that opines a clear connection between your PTSD and your SA. They are going to have to say that they reviewed your medical file, also, or provide evidence of what medical records they DID review. Use the attached as a GUIDE only, don't just have your doctor fill it out. This gives them an idea of what they need to write up in whatever way they do it. 

Medical Opinion dbq.pdf

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 brokensoldier244th mention

In any case you are going to need either a sleep doctor or MH therapist IN PERSON to establish a causal link between the SA and PTSD. Since the PTSD is already rated you would't need an in service event to prove the SA-

Just to add

 Also known as qualified Dr's  or Specialist in this field of medicine.

This is why I always mention ''qualified Dr's

you certainly don't want a foot specialist to render his opinion about your sleep apnea secondary to your ptsd

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Just my two cents............

1. A sleep study confirming sleep apnea. Preferably at a sleep center or the VA.

2. statement from sleep apnea doctor confirming sleep apnea and the medical necessity of a CPAP for treatment.

3. Nexus statement detailing how PTSD causes or aggravates sleep apnea. If it's based on aggravation, he needs to state the pre level of disability (sleep apnea) before PTSD aggravated it to the current state.

4. IMO (specialist in sleep disorders or functions of the respiratory system, ie ENT, pulmonologist, certified respiratory therapist, etc ) stating the same as #3.

5. Gather information and file appeal to BVA.

 

NEVER GIVE UP.............

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