Higher Level Review for Sleep Apnea secondary to Allergic Rhinitis.

[Sancheezy05 0]

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.

[Sancheezy05 0]

@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. 

[Buck52 3,045]

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 Wednesday at 01:03 AM by Buck52

[Sancheezy05 0]

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.