Higher Level Review for Sleep Apnea secondary to Allergic Rhinitis.

[Sancheezy05]

Hello all,

I am new to the forums and looking for some guidance. I was denied service connection for sleep apnea through a claim that provided a Physicians Assistant nexus letter and dbq linking sleep apnea to my service connected conditions of allergic rhinitis, hypertension and bilateral plantar fasciitis. I went with the higher level review route and now my VA.gov site shows:

The Veterans Benefits Administration is correcting an error

During their review, the senior reviewer identified an error that must be corrected before deciding your case. If needed, VA may contact you to ask for more evidence or to schedule a new medical exam.

 

Not sure if this is a good think or just standard. I felt like my informal conference was literal 2 minutes and just explained what the HLR was. When I requested my C-File a few months ago, I noticed that the VA was originally going to rate me at 100% with sleep apnea being service connected to my allergic rhinitis referencing my IMO as the favorable evidence, than five days later they redid the final approval letter and denied the service connection. My C&P Nurse Practitioner stated that Allergic Rhinitis doesn't cause Sleep Apnea but I have seen Board of Appeals be granted and other veterans as well get Sleep Apnea as a Secondary to this condition. Just seeing if anyone else knows what the next stage in the process will be and what an unofficial timeline for something like this would be? I am roughly around day 110 for the HLR and overall this claim dates back to December of 2019.

 

Thank you again and sorry if this is posted in the wrong forum.

[pacmanx1]

I don't even know what my last examiner's credentials were. I just ask why I was there and why did the VA make the appointment. The examiner said to give an opinion if my Sleep Apnea was cause by my service-connected fibromyalgia. I stated that I just got an IMO from my treating VAMC Rheumatologist. Yes, I took it with me and handed it to her and she read through it and said she did not know why the VA scheduled the appointment since I already had a favorable opinion. I did send this to the VA with my FDC claim but they made the appointment, and my claim was filed, processed with an exam and granted all within thirty (30) days.  

Sorry, I did not answer your post.  Hard to say, yes, the BVA may have granted similar claims but the local VARO may continue to deny your claim. You may have to file an appeal to the BVA. Some HLRs are just rubber-stamped denials, not even reviewing the veteran's evidence or medical opinions but the BVA is a lot better. Unfortunately, only time will tell. At one time the VA was saying about 125 days but due to the COVID-19 and many offices closing that 125 days is out the window, and no one knows.

Edited April 25, 2021 by pacmanx1

[ShrekTheTank]

So they are taking a look at what is not there so they can hopefully make a good decision.  Just have to wait for them to resolve it and see what they deciede to do.  

 

[pacmanx1]

2 hours ago, Sancheezy05 said:

The Veterans Benefits Administration is correcting an error

Not sure what the outcome will be, but this is a lot better than a straight-out denial. In other words, the VA is given your claim a second look before they make a decision and even though you may get a denial, the second look that they are crossing their (T)s and dotting their (I)s is better than a denied rating. 

[benenlow]

Hopeful this works out. I'm in the process of appealing my sleep apnea due to allergic rhinitis. Where did you get your nexus letter laying out the rhinitis caused the sleep apnea?

[Buck52]

I have a VA Diagnosed for sleep apnea   and use a C-pap I have not yet filed a claim for that secondary to PTSD I use the C-Pap machine every night, I might file for it   .. but .later. ...> no more $$ in the pot for me  I am 100% P&T With 2 SMC's

But  what you need is a Quailed Dr to give his medical opinion that it is medically necessary for you to use the C-pap Machine every night due to your service connected ALLERGIC RHINITIS , you need to get your Sleep Apnea Link to one of your service connected conditions  that is likely as not the cause or related to your Sleep Apnea  This needs to come from a qualified Dr   and a sleep study record to show the details  severity of your VA DIAGNOSE SLEEP APNEA.

Just because a veteran is prescribe a Sleep Apnea Machine   don't qualify him for compensation  you need a link from something from your military service to nexus the S.A.   Or file a secondary claim to your S.C. Rhinitis...but we can't say that , We need a qualified Dr to  opine his medical opinion in your favor   that he has read your medical records and it is his medical opinion that your c-pap is medically necessary to use. AND HE NEEDS TO GIVE AN EXPLANATION as to why ITS MEDICALLY NESSESSARY  for you to use the C-Pap Machine.

You need to have  all this and maybe some more evidence to send in, secondary claims for sleep apnea they go over the claim with a fine tooth comb. its one of my reason I have not yet filed for it.

[Sancheezy05]

@Buck52 thank you for the information. I am learning this as well is one of the harder claims to get approved. I had a pretty detailed nexus letter and dbq but since it's the word of a physician assistant vs a nurse practitioner I have decided to work with a Doctor PH.D in this matter who is a specialist in sleep disorders. He is currently working to get me a second IMO submit for this claim as supporting evidence just in case this HLR does not go in my favor. If you look at my service records and VA records everything is pretty squared away as far as an active sleep study from the VA themselves showing Moderate to Severe obstructive sleep apnea, history of nasal blockage, headaches, hypertension etc. 

I think for me I am just upset finding out that it was originally granted than someone went back and denied it removing all the information.