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.

[Vync]

@Sancheezy05 Sometimes the VA forgets how to properly apply benefit of the doubt (i.e. relative equipoise). You are not supposed to have two opinions in your favor vs. one against. They are supposed to review the evidence in favor and the evidence against. If it is in balance, they are supposed to find in favor of the veteran. Part of determining the balance is examining each opinion. I had the exact same thing happen with a heart attack claim where the HLR reviewer granted my claim and said the VA's C&P NP failed to properly consider my positive IMO, despite merely listing it as evidence.

Personally, I think that the VA contracting C&Ps out is a big mistake. There's no real accountability. Those companies focus mostly on the numbers instead of being thorough and following the law.

[benenlow]

@Vync Couldn't agree with you more on the contracting of C&P's. I did have one excellent contracted C&P doctor that had enough experience with my allergic rhinitis and immediately agreed it was service connected after fighting forever with the VA. Exception to the rule, I do believe, but I want him to do all my C&P's with the common sense he appeared to have. 

[Vync]

@benenlow Yeah, it stinks, but I am glad you were able to get a competent examiner.

My last C&P was done by LHI. Luckily, I obtained a copy of it before the VA changed the rules preventing release for 30 days. I immediately sent an IRIS to the VA notifying them that the examiner failed to even mention my IMO, but it was ignored and I received a denial. I did win via HLR though, but it took forever. The sad part is the same thing is repeatedly happening over and over again to other veterans.

I did some follow up with LHI management. They simply hire examiners and get them to take training by the VA on how to do exams. The VA feeds them claims. The examiner completes the exam and then sends it back to the VA. There does not appear to be any mechanism in place to inform the contracted company or examiner of  the errors. That means that they potentially will continue to make the same mistakes. Of course, our only options are to file supplemental, HLR, or go to the BVA. 

[benenlow]

@Vync VES isn't much better at the start. Sent me to a psychologist for the rhinitis.

[GBArmy]

I'd like to add that at least some of the contractors now send you a card asking what you thought about your C&P exam. Was it clean and orderly, did they see you on time, etc. The biggie is what did you think of the examiner, which is the real reason for the follow up questionare. You can also indicate if you want a follow up discuss further. That is what VES did nor me on my last one in January. So maybe some of the contractors are trying to improve the system. Mine was just there to provide ammo to deny.

[Vync]

@GBArmyThat's a step in the right direction, but only matters if it ends up making a positive difference instead of rubber stamp denials