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New VA Regulations with Sleep Apnea Being Secondary to PTSD


Arty123

Question

I'm rated since 2008 at 50% for PTSD.  Also, 10% for tinnitus.   I was just diagnosed at the VA with sleep apnea and prescribed a CPAP.  

I was wanting to file for sleep apnea secondary to PTSD.  I have the diagnoses but need to find a doctor to write a nexus letter.  The pulmonologist and my PCP said that they could not write the nexus so thinking of using something like valor for vets and would like opinions using a service like that. 

My second question is I know the VA is changing the percentages from 50% if you're prescribed a CPAP to 0%.  I don't know exactly when the changes go into effect but when they do and if I do file will they go by file date or decision letter date? For example if I file April 1st, the VA officially makes the changes May 1st, and my decision is June 1st will they go by the filing date or decision date?

Thank You,

Chad

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I think this may be what you are looking for.

From the Federal Register: Schedule for Rating Disabilities-Ear, Nose, Throat, and Audiology Disabilities; Special Provisions Regarding Evaluation of Respiratory Conditions; Schedule for Rating Disabilities-Respiratory System

https://www.federalregister.gov/documents/2022/02/15/2022-02049/schedule-for-rating-disabilities-ear-nose-throat-and-audiology-disabilities-special-provisions

PDF version here https://www.govinfo.gov/content/pkg/FR-2022-02-15/pdf/2022-02049.pdf

Veterans Affairs (VA) proposes to revise sections that address the ear, nose, throat, audiology, and respiratory systems. The purpose of these changes is to update medical terminology, incorporate medical advances that have occurred since the last review, and provide well- defined criteria in accordance with actual clinical practice. VA will also rename the body system currently designated for conditions related to hearing and the ear, to include the nose and throat. VA will also consolidate within the scope of otolaryngology several diagnostic codes (DCs) currently listed within the respiratory system.

 

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Supposedly the comment period ends on April 16th, 2022 ????.  I have heard recently from knowledgeable others that they will use the effective date of the claim that is they day they received the claim from you.  So if the changes take effect after you filed and VA received your claim then you should be evaluated under the present/old rating schedule and not the new changed one.

You should confirm my comment with other persons and resources such as a VSO.  

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

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Dustoff11 What should happen is if changes take place after you filed you should should be evaluated by using both the current and the proposed and be rated the most favorable. That is what is supposed to happen. HLR or appeal is the next action to be considered by the veteran if it is not the case.

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This is correct. If you file before the new regulations take effect while your claim is in a pending (pre-rating) status before they take effect, you would be rated under both and then most favorable outcome applied.

 

Just saying, though- even though the comment period ends in late April its going to be likely months after that before something like this would begin to take effect. This stuff takes a long time before it filters down to us as new policy.

 

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Remember, if your notes are extensive and/or detailed there may be something in there already linking the two. 
 

also, the changes to the rating proposed are not taking cpaps to 0%. They are adding less intensive treatments to the ratings schedule. Right now it’s basically BAM- CPAP! and has been for years. Not every one needs a cpap, or can tolerate one. There are other options now, and they are updating the rating (potentially) to reflect that. 

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    All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

    Tips on posting on the forums.

    1. Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.
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    Post clear questions and then give background info on them.

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      • was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?
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