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HLR sleep apnea secondary to ptsd


XIbodybag

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sleep apnea secondary to ptsd

Good afternoon all.

 I had a question about a higher level review that returned a duty to assist error. The VA determined that they did not take into account all the medical studies I uploaded as well as an IMO from a pulmonologist stating that my sleep apnea is more likely than not caused and aggravated by my service connected ptsd.   The senior rater who determined that the VA must provide me C&P exam and the examiner must take into account the IMO from my pulmonologist as well as the studies I uploaded.   Is fast forward to a couple weeks ago and VES  Set me up for C&P exam but it was an Ace review.   I received my results last week by calling  The regional office and they stated that the examiner stated that there is no evidence that that sleep apnea and PTSD are connected And that my sleep apnea is less likely than not connected to my service connected PTSD.  


 How can the examiner say there is no evidence when when I uploaded about 15 different studies connecting the two, some of which were from the VA themselves, as well as a board of veterans appeals ruling connecting the two?  It seems that the examiner didn't even follow the senior raters instructions to take my evidence into account because he stated "no evidence" linking the two and did not refute the studies...so i filed a complaint with the white house hotline and the 1800 number and told them that due to the verbage in the examiners notes it seems he did not even address the duty to assist error and that i am requesting a new IN PERSON exam so i can make sure the examiner reviews all medical evidence/studies/imo from my specialist.  Is it possible that they will set me up for a new c&p before closing out the HLR?

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The examiner has rendered "an opinion", and opinions vary widely, even among doctors.  

Did you get a copy of this exam, as well as the rest of your medical records?

I agree with you, that there has been found a PTSD/sleep apnea link, but you need to demonstrate, with credible evidence there is a PTSD sleep apnea link IN YOUR CASE, not the participants in a study.  

My advice is, therefore:

Wait for a decision, and appeal if its unfavorable to the BVA.  It was a good idea to get a copy of the exam, half the battle is knowing what the problem is, and it sounds like you identified the problem:  Conflicting doctors disputing and confirming a nexus.  

The VA can still award, or deny OSA secondary to PTSD.  Are you using a cpap, and I assume you have had a sleep study, indicating you have OSA and use a cpap.  

If the applicable evidence warrants same, you may need an IMO/IME to win this, "if" VA denies it again.  

You see, the VA can favor one doc opinion over another, but they must give a reasons why they so stated.  For example, one doc may have done a more thorough exam, or may have known you for years, while another doc may have only seen you 5 minutes.  

Or, one doc may be a sleep specialist, with PTSD experience, and the other doc not so much.  

I think you should find out the c and p doc (the unfavorable exam), name, and experience.  Was he a sleep specialist, or has he zero experience in sleep medicine and or PTSD.  

VA sometimes sends you to an unqualified examiner..I was sent to a MD but with no sleep med experience.  

If your unfavorable examiner has no sleep medicine experience, you may want to challenge the competency of the examiner:

https://cck-law.com/blog/how-to-challenge-va-cp-exam/

IT MAY save you some time by filing CUE, "if" they based a denial on an examiner who was not qualified.  However, you may well need to appeal also.  

So, wait for the envelope, if denied, you can post the reasons and bases for denial, and we can help more then.  

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50 minutes ago, broncovet said:

The examiner has rendered "an opinion", and opinions vary widely, even among doctors.  

Did you get a copy of this exam, as well as the rest of your medical records?

I agree with you, that there has been found a PTSD/sleep apnea link, but you need to demonstrate, with credible evidence there is a PTSD sleep apnea link IN YOUR CASE, not the participants in a study.  

My advice is, therefore:

Wait for a decision, and appeal if its unfavorable to the BVA.  It was a good idea to get a copy of the exam, half the battle is knowing what the problem is, and it sounds like you identified the problem:  Conflicting doctors disputing and confirming a nexus.  

The VA can still award, or deny OSA secondary to PTSD.  Are you using a cpap, and I assume you have had a sleep study, indicating you have OSA and use a cpap.  

If the applicable evidence warrants same, you may need an IMO/IME to win this, "if" VA denies it again.  

You see, the VA can favor one doc opinion over another, but they must give a reasons why they so stated.  For example, one doc may have done a more thorough exam, or may have known you for years, while another doc may have only seen you 5 minutes.  

Or, one doc may be a sleep specialist, with PTSD experience, and the other doc not so much.  

I think you should find out the c and p doc (the unfavorable exam), name, and experience.  Was he a sleep specialist, or has he zero experience in sleep medicine and or PTSD.  

VA sometimes sends you to an unqualified examiner..I was sent to a MD but with no sleep med experience.  

If your unfavorable examiner has no sleep medicine experience, you may want to challenge the competency of the examiner:

https://cck-law.com/blog/how-to-challenge-va-cp-exam/

IT MAY save you some time by filing CUE, "if" they based a denial on an examiner who was not qualified.  However, you may well need to appeal also.  

So, wait for the envelope, if denied, you can post the reasons and bases for denial, and we can help more then.  

Thanks! So the IMO i recieved was from a pulmonologist who works in a sleep clinic and the examiner in the C&P was a GP, geriatric doctor with 0 to 5 years experience as an examiner.  The problem was that my pulmonologist did not cite the studies he reviewed in his IMO.  So the HLR turned up a duty to assist error that said that the C&P examiner must take into account my IMO AND included studies as that my pulmonologist had reviewed it and opined on my sleep apnea being caused by my ptsd due to said studies.  And it appears that this GP did not do that

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Posted (edited)

good information

 

Edited by Dustoff 11
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Posted (edited)

duplicate post

Edited by Dustoff 11
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Posted (edited)

It sounds like your doc (IMO) was more qualified to venture an opinion, but make sure VA knows this!  This means including the doctors cv in the medical opinion.  It may not be too late to add it.  

I had a similar situation:  VA sent me to a c and p examiner, (MD) who admitted to me she did not have sleep medicine training or experience.  This was a c and p exam for sleep apnea.  The VA gets away with this, you, however can not.  

Understand, the role of the doctor in VA benefits is as an "expert witness".  You can only be an expert witness if you can demonstrate you are an expert with medical training and experience.  

Unfortunately, whenever the VA sends you to a c and p exam, "the examiner is presumed competent" absent a challenge from you or your representative.  

The VA doc who exams you gets a pass here, but when you hire an IMO/IME, your doc gets no such presumption.  

Its one of those reasons why "the VA system" is not as claimant friendly as the VA often makes it sound like.  

Edited by broncovet
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