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Denied Claim


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  • HadIt.com Elder

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  or snoring or sleep disturbance, lateness to formations, chronic drowsiness- something 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 necessarily need a direct in service event to prove the SA- that is satisfied by the fact that your PTSD is already SC. Non SC conditions can be linked to already SC issues. 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 which you would have gotten originally from Dr. Whats her Name. 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. Best course, follow Bronco's advice after mine about the appeal stuff, but get a copy of that DBQ she filled out and have your doctor refute it if they can. 

 

Medical Opinion dbq.pdf

Edited by brokensoldier244th
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Your decision states that you are missing 2 elements of the Caluza triangle required for service connection. 

1.  The decision says Yes, you have a current diagnosis of sleep apnea.  Good to go. 

2.  The decision indicates you dont have an "in service event" which led to sleep apnea.  

3.  The decision indicates you have no nexus, which is a doc opinion that your current diagnosis of sleep apnea is at least as likely as not related to you in service event.  

My advice:  

1.  You are going to need to appeal to the BVA.  I dont suggest you mess around with HLR or SCL.  File a NOD.  

2.  You still need 2 things, but there are 2 routes to sleep apnea SC.  Choose which applies to you.

a.  You dont need an in service event "if" your doctor will opine that your sleep apnea is at least as likely as not related to your SC PTSD. (I seem to recall you are SC for PTSD).  This would be knows as sleep apnea secondary to PTSD.  This may fly if you have a medical opinion stating same. 

b. If you go the Direct SC route you will need:

    1) Buddy letters stating things like "they heard you snoring".  Evidence of loud snoring sometimes works to document an inservice occurance of sleep apnea.  

    2.)  You will need a doctors nexus linking your snoring in military to your OSA.  

My best guess?   Go for secondary.  Many doctors beleive PTSD and sleep apnea are related "including" my sleep doctor.  

When you appeal to the BVA you will need to decide if you want a hearing, and if new evidence will be needed.  Often, you already have evidence, but VA cant read.  This means you will need a copy of your cfile, or Access to your VBMS file.  

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Broken soldier has given good advice, he said similar to what I said but in different words.  To get SC you are going to need a nexus statement.  Best would be an in person exam, however, if your medical records support it, an IMO should suffice. You see, a doctor can not review your records, if you dont have applicable medical records sufficient for him to render this opinion.

 This means a doctor reviews your records, and makes an opinion that your sleep apnea is at least as likely as not related to your PTSD WITHOUT an in person exam.  

Edited by broncovet
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  • HadIt.com Elder

If you go the route of IMO, your doc is going to HAVE to say they reviewed your records. No way around that, and they HAVE To say that they did. 

CAS

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Correct, broken Soldier.  Even in "in person exams" the examiner reviews your history, and must so state.  

The examiner also needs to supply a CV demonstrating he is compentent to render an opinion, as well as a medical rationale as to why he made said opinion. 

As an example. "Dr. Hofstedder" (a physist on Big Bang Theory) is not competent to make an opinion on how your sleep apnea is related to your ptsd.  It probably should be a sleep medicine doctor, or at least a Doctor who treats PTSD.  

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  • HadIt.com Elder

^^^^^^^^ this ^^^^^^^^^

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