Higher Level Review for Sleep Apnea and Hypertension

[Wico1337]

Current service connections

Tinnitus - 10%

Retained Renal Calculus (Kidney Stones) - 30%

Adjustment Disorder (with anxiety and depression) - 50%

 

I had filed for both Sleep Apnea and Hyptertension before, but got denied. Sleep Apnea they said that I got it from being obese. I tried arguing that I went from being fit to being obese the year I seperated from the military. While honorable, I had a lot of bad stuff happen due to the military to me. All stuff out of my control, just bad luck. Affected mental health and gained like 100 pounds in first year out. Down 40 now, a lot to go. Anyway, the C&P doctor said that she did not see any link from Depression and anxiety and it causing weight gain/obesity. So claim was denied.

That was a few years ago. I am giving it another shot and made a new claim in October. They randomly closed it two month later. I called to ask why, they have no idea why. They reopened it, closed it again, then reopened it again. This time saying that they found a lot of errors in how it was handled and are sending me to a 3rd party to get an official outside opinion as a Higher Level Review.

A couple of points I plan on making for the claims.

 

Sleep apnea nexus - Been using Bi-pap for 3 years now provided by the VA. Sleep study provided by VA which is what got me it.

- .gov and .edu website publications on studies that link depression and anxiety to weight gain.

- .gov and .edu website publications on studies that link Effexor (Venlafaxine) (my med) to weight gain.

- History of sleeping issues with report of extreme exhaustion during my last 4 months of service when mental health declined. Same time I sought mental health assistance in Military and was prescribed stuff. (I did not get my Bi-pap until after 2 years of being out... When my wife first started sleeping in same bed as me and told me it sounded like I was choking at night. I never slept with anyone for years before due to wife being from Philippines. So noone ever told me this fact.)

- I am registered in the VA as someone who spent half a year in close proximity of burn pit. In Burn Pit Registry. Squadron sleeping quarters in deployed base was right on other side of wall of a base burn pit. Which could be causing the breathing issues.

 

Hypertension nexus - Been prescribed high blood pressure pills for 3 years now.

- .gov and .edu website publications on studies that link depression and anxiety to weight gain which is associated with high blood pressure.

- .gov and .edu website publications on studies that link Effexor (Venlafaxine) (my med) to weight gain which is associated with high blood pressure.

- I am going to connect it to my current Service Connection of Retained Renal Calculus. I pass 5-6 Kidney stones per year. Probably 1-2 per year I have to go to ER it seems due to extreme pains. Last month I was sick and dehydrated and passed one. One week later, I am passing a second one. Too painful, had to go to ER. Pass it next day. Week later pass a 3rd. It takes a week to pass, bringing me to hospital twice for it. On final visit, I was calm. 1 Hour prior it was moving and I was screaming in pain. So while I was calm after it had stopped moving for an hour, they took my blood pressure and it was at like 210/140. My argument is that I had gone nearly an entire month with this extreme pain due to VA service connection with this high of Blood Pressure. 

 

Does it sound like I am approaching this ok? Does anyone have any advice on things I may need to do to strengthen my case or does this all sound sufficient?

[GBArmy]

Wico 1337 Welcome to Hadit. Once the VA denies a claim it's like 5X harder to win on appeal. It's the way they roll. I would suggest that you are not a qualified med person, so your opinion on drugs and causing weight gain isn't going to fly. Take the easy road and get a IMO from a qualified person who can offer their own med opinion as to cause. If you got eval within a year of discharge you should be able to get presumption. There are also many who can argue that depression can and does cause weight gain. Get a qualified IMO/opinion from a specialist. You can win this.

[Wico1337]

4 minutes ago, GBArmy said:

Take the easy road and get a IMO from a qualified person who can offer their own med opinion as to cause.

Thank you for this one. I am wondering what your thoughts are on the 3rd party called "LHI" that they are sending me to for this "3rd party review"? I am hoping that it is the case that while the VA does not like to make ANY judgement call/IMO call that is not already documented. Do you think that these 3rd partys will be a little more reasonable about things that should be conceded as common medical knowledge? IE - depression/anxiety causing weight gain.

[GBArmy]

Wico1337 LHI is one of several contractors that do C&P exams for the VA. They may or may not be "better" than the VA, but they pretty much are the only game in town. If the C&P schedules a exam, yo must go. Bring any documents that are relative/import as evidence that was already submitted. They don't have to take anything since it should already be avail to them, but sometimes they do. Be polite but to the point with the contractor. 

[Carl the Engineer]

I just had 5 issues examined by LHI Care for my recent VA claims.  While I thought the examiner was nice and everything looked favorable, one issue was affirmed, one denied, and three referred for further work.

So, too early for me to make the call on LHI Care,

Hamslice

 

[john999]

Now I got a very beneficial report from LHI on my neuropathy.  The report they wrote was used to radically increase my ratings. However, to tell the truth I thought the examiner was incompetent.  Hey, you get lucky sometimes. The examiner added two new conditions to service connect.  That is a first.  I would not expect them to stick their necks out in the future.  They are probably not going to go the step further and make logical connections between conditions. 

[pawmbi]

The VA simply does not know the law as it relates to obesity and sleep apnea.  I had a client denied for the same reason, VA pointed to his obesity/weight gain as the cause of his sleep apnea and denied him.  I provided the attached memo on a supplemental and it was overturned.  Now the caveat is he had a IMO as to his back condition or one of his other service connected conditions as causing the sleep apnea.  Anyway, I provide the same VA memo to you to use.  Be sure to include it in the supplemental

VAOPGCPREC1-2017.pdf