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.

[Buck52]

Sancheezy05

Roger That

Sleep Apnea renders a 50% rating for the use of a C-PAP as long as a Qualified Dr says it medically Necessary.

Although a Higher rating is considered depending on the severity of the OSA?

Not sure how they will go with a N.P. & or PA?? but they too could be qualified  if their certified? under Dr's Orders.

I have seen a lot of Sleep Apnea Claims denied because these type Dr's were not qualified.

Yes , PH.D  Specializing  in Sleep/OSA  Disorders Is great. 

Looks good to me...very favorable  

I don't like the L.H.R.  WE CAN'T SUBMIT NEW EVIDENCE  AND FOR THAT REASON THE DRO USUALLY JUST REVIEWS THE CLAIM AND SEES NO CHANGE IN THE DECISION AND DENY..BACK TO APPEALS  & STRAIGHT TO THE BVA.

AFTER THE  S.R.L. DENIED , For some Veterans they just skip the H.R.L. And head straight to the BVA.

Use to before this NEW AMA SYSTEM  We could request a DRO Hearing   (Formal or Informal)and have it in person at our R.O..  FACE TO FACE WITH A DRO AND USUALLY A RATING SPECIALIST...and we could bring new evidence.

Edited April 7, 2021 by Buck52

[Sancheezy05]

Got called today for a new C&P for sleep apnea next month, different company from the first. Another 30 days of anxiety followed by another 2 weeks of anxiously checking ebenefits for a report.

[Sancheezy05]

Welp.. Got rescheduled for a C&P on May 3rd, wish me luck! Hopefully my Nurse Practitioner who primarily specialized as a labor and delivery/gynecologist can properly diagnose my sleep apnea.... for my HLR reexamination. Fought with QTC who told me originally I couldn't bring in a nexus letter to the provider for review and than changed their stance once I told them I verified with the VA that I could present an updated nexus from a neurologist with 50 years dealing with sleep disorders/mental health for the examiner to use.

[benenlow]

Ha! It's like when I had a psychologist do an ENT exam on me.  On the bright side,  my PTSD reading went up. 

[Sancheezy05]

@pacmanx1 Hopefully it goes smooth this go around this is my second C&P for the same issue. First C&P, the nurse practitioner stated that sleep apnea could not be impacted by allergic rhinitis, plantar fasciitis and hypertension, which contradicts other claims that were decide through the BVA. I got granted this through the higher level review because the senior rater identified she failed to consider my IMO that I had from a physician which was uploaded with my FDC. I am going to do what you said and actually bring the physical documents with me this appointment and I even went above and beyond to prove the connection by getting a 2nd IMO from a Doctor who was highly recommended this time.  Like you said only time will tell, one week till my appointment I will keep this thread updated and hopefully be posting great news next month! 

[Buck52]

I  Wish You The Best Outcome Sancheezy05 , you might be surprised at your rating  I will take a Guess say they give you the 100%  Rating for the OSA.!!!

And if they do that will help you meet the SMC S criteria for some more compensation pay : 100% Plus a 60% separate rating from the original rating/condition   and your 90% now  that should make you meet the Requirement for the statutory rating for SMC -S.

 

I hope you get it .

Edited April 26, 2021 by Buck52