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IMO was very Comprehensive but OSA Supplemental Still Denied


GulfWarVet1990

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Good afternoon, I just received the denial letter from VA for OSA supplemental claim (added new evidence).  Even with a very comprehensive IMO from Dr. Anaise, OSA diagnosis and CPAP prescription VA denied.  I am SC for Chronic Sinusitis (10%), Tinnutis (10%), Allergic Rhinitis (0%), and PTSD (50%), the IMO included these conditions linking to OSA.  No go, the VA still noted the VES Examiners write up was more persuasive.  Also as usual, they state no evidence of OSA while in service. 

The supplemental denial letter also indicated a DBQ review on June 3, 2022 which did not require my attendance.  Just disappointing how the VA keep taking the cheap route hiring the lowest bid contractor (my perception anyway).  I question the validity of the VES examiners credentials, the examiner who reviewed my file and completed the DBQ for the supplemental claim had no credentials for the specialty.  

As stated, Dr. Anaise wrote an excellent IMO and several on this forum have hired his services, so I have confidence in his work.  The denial letter was a disappointment however, I do not plan to give up.  I was denied twice for cancer and wanted to give up but my VSO convinced me to pursue and I eventually I was granted sc with retro.  

Has anyone ever experience a supplemental claim for OSA and after appealing to BVA won your case. BVA is the route we are taking, I just cringe at the delay and amount a days before my case may be considered.  Positive words of encouragement and advice are welcome. Thank you. 

 

 

 

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You could file a complaint with your local VARO and contest the VES examiners credentials and exam.  This probably will trigger another C&P with a different examiner.  I've done this in the past.  It worked out for me.  I guess you have nothing to lose by filing an HLR, but they'll probably rubber stamp the VES examiner.  But you never know.

I believe Dr. Anaise is also a lawyer.  You may want to contact him again to see if he can represent you.  I imagine he might take interest since his exam is being dismissed.

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Here we go again. All of this hooblah about nexus letter, now vets are financially struggling as is, paying all of their money to get a nexus just to get shot down. 

I just received a pm from a member stating that legacy appeals are extended for another 3 years. I have not found anything on that but if it is true, then think about how long AMA claims will take. 

Nexus or not, VA is doing to take advantage of people that have sacrificed their lives for their country. 

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2 hours ago, GulfWarVet1990 said:

Good afternoon, I just received the denial letter from VA for OSA supplemental claim (added new evidence).  Even with a very comprehensive IMO from Dr. Anaise, OSA diagnosis and CPAP prescription VA denied.  I am SC for Chronic Sinusitis (10%), Tinnutis (10%), Allergic Rhinitis (0%), and PTSD (50%), the IMO included these conditions linking to OSA.  No go, the VA still noted the VES Examiners write up was more persuasive.  Also as usual, they state no evidence of OSA while in service. 

The supplemental denial letter also indicated a DBQ review on June 3, 2022 which did not require my attendance.  Just disappointing how the VA keep taking the cheap route hiring the lowest bid contractor (my perception anyway).  I question the validity of the VES examiners credentials, the examiner who reviewed my file and completed the DBQ for the supplemental claim had no credentials for the specialty.  

As stated, Dr. Anaise wrote an excellent IMO and several on this forum have hired his services, so I have confidence in his work.  The denial letter was a disappointment however, I do not plan to give up.  I was denied twice for cancer and wanted to give up but my VSO convinced me to pursue and I eventually I was granted sc with retro.  

Has anyone ever experience a supplemental claim for OSA and after appealing to BVA won your case. BVA is the route we are taking, I just cringe at the delay and amount a days before my case may be considered.  Positive words of encouragement and advice are welcome. Thank you. 

 

 

 

Just curious, did the imo state in detail that he reviewed your Cfile, and all SMR?

Edited by Stayfocus
Miss spelled (see edit history)
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2 hours ago, GulfWarVet1990 said:

Good afternoon, I just received the denial letter from VA for OSA supplemental claim (added new evidence).  Even with a very comprehensive IMO from Dr. Anaise, OSA diagnosis and CPAP prescription VA denied.  I am SC for Chronic Sinusitis (10%), Tinnutis (10%), Allergic Rhinitis (0%), and PTSD (50%), the IMO included these conditions linking to OSA.  No go, the VA still noted the VES Examiners write up was more persuasive.  Also as usual, they state no evidence of OSA while in service. 

The supplemental denial letter also indicated a DBQ review on June 3, 2022 which did not require my attendance.  Just disappointing how the VA keep taking the cheap route hiring the lowest bid contractor (my perception anyway).  I question the validity of the VES examiners credentials, the examiner who reviewed my file and completed the DBQ for the supplemental claim had no credentials for the specialty.  

As stated, Dr. Anaise wrote an excellent IMO and several on this forum have hired his services, so I have confidence in his work.  The denial letter was a disappointment however, I do not plan to give up.  I was denied twice for cancer and wanted to give up but my VSO convinced me to pursue and I eventually I was granted sc with retro.  

Has anyone ever experience a supplemental claim for OSA and after appealing to BVA won your case. BVA is the route we are taking, I just cringe at the delay and amount a days before my case may be considered.  Positive words of encouragement and advice are welcome. Thank you. 

 

 

 

 

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Dr. Anaise is the greatest.  Thanks to his very detailed explanation and list of medical references to support his contentions I won on BVA appeal OSA Sleep Apnea secondary to PTSD and PTSD medications in their December 2021 decision.  The BVA cited his nexus medical opinion as a key piece of evidence in granting my appeal and also found the sorry VA C&P examiner denial of my OSA due only to 30 lbs overweight opinion as "defective".

Dr. Anaise also opined that my overweight condition of many years was due to PTSD and PTSD plus other VA medications.

He also won a BVA remand for me on appeal of a VARO denial of my claim for increase in Agent Orange heart disease known as IHD/CAD.  This remand is still pending.

You have an excellent chance of winning your claim on appeal.  It is unfortunately typical for VARO raters to deny vets claims with strong supporting evidence to include good quality doctor's medical nexus opinions.  It is their game and rules.

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

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4 hours ago, Whodat said:

Here we go again. All of this hooblah about nexus letter, now vets are financially struggling as is, paying all of their money to get a nexus just to get shot down. 

I just received a pm from a member stating that legacy appeals are extended for another 3 years. I have not found anything on that but if it is true, then think about how long AMA claims will take. 

Nexus or not, VA is doing to take advantage of people that have sacrificed their lives for their country. 

Thank you for your positive words of encouragement and advice.

Edited by GulfWarVet1990 (see edit history)
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5 hours ago, El Train said:

You could file a complaint with your local VARO and contest the VES examiners credentials and exam.  This probably will trigger another C&P with a different examiner.  I've done this in the past.  It worked out for me.  I guess you have nothing to lose by filing an HLR, but they'll probably rubber stamp the VES examiner.  But you never know.

I believe Dr. Anaise is also a lawyer.  You may want to contact him again to see if he can represent you.  I imagine he might take interest since his exam is being dismissed.

Thank you 

 

3 hours ago, Stayfocus said:

Just curious, did the imo state in detail that he reviewed your Cfile, and all SMR?

Yes. May I ask the reason behind your question. Thanks

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  • HadIt.com Elder

Just appeal, appeal and then appeal some more.  I was DX'ed with a heart condition. The VA rated me at Zero.  I appealed and got 60% just because I appealed it and got some new evidence from the VA itself.

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8 hours ago, GulfWarVet1990 said:

Thank you 

 

Yes. May I ask the reason behind your question. Thanks

Because you mentioned the va sided with its own c&p examiner.
It’s all in the way the C&P Dr writes his report.

Certain statements within his report need to be highlighted…”I have received and reviewed veterans entire cfile, and all private records and lay statements”.

You said your Dr addressed this in his report, so I don’t know what else to say but appeal, appeal, appeal.

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Ok here is n my 2 cent in the issue.

Ok you have two imo did they address both in the decision and give a reason and base for choose one over the other.

If they only address there own imo I would appeal. Based on this.

Va eplain there decision to choose one imo or others.

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9 hours ago, GulfWarVet1990 said:

Thank you for your positive words of encouragement and advice.

I do apologize, maybe wrong choice of words. Just a little frustrated on how the vets get treated. 

Stay in the fight. 

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15 hours ago, El Train said:

You could file a complaint with your local VARO and contest the VES examiners credentials and exam.  This probably will trigger another C&P with a different examiner.  I've done this in the past.  It worked out for me.  I guess you have nothing to lose by filing an HLR, but they'll probably rubber stamp the VES examiner.  But you never know.

I believe Dr. Anaise is also a lawyer.  You may want to contact him again to see if he can represent you.  I imagine he might take interest since his exam is being dismissed.

Thank you 

 

14 hours ago, Stayfocus said:

Just curious, did the imo state in detail that he reviewed your Cfile, and all SMR?

Yes. May I ask the reason behind your question. Thanks

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Thank you everyone I will keep you posted. 

I definitely plan to appeal. 

If there is any new development that might help anyone on this site, I will be sure to post.  We need all the support we can get. 

54 minutes ago, Whodat said:

I do apologize, maybe wrong choice of words. Just a little frustrated on how the vets get treated. 

Stay in the fight. 

All good Whodat. 

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10 minutes ago, GulfWarVet1990 said:

Just curious, did the imo state in detail that he reviewed your Cfile, and all SMR?

The simple answer is it should carry or hold more weight when the VA decides your claim, without it the VA may go with their own medical opinion. It is possible that even with this statement the VA could still choose to go with their own medical opinion.

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I am sorry to hear about your denial. I am also waiting on my supplemental claim for OSA. I added my civilian PCP's IMO. We will see what happens. I'm only a month in on my wait though. Good luck with your appeal. 

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  • HadIt.com Elder

Someone high up in the VA has decided they just don't want to approve claims for OSA.  Many of these guys have a low opinion of vets.  They think all vets are just freeloaders.  They would never admit to this prejudice but I think it is there.

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11 hours ago, john999 said:

Someone high up in the VA has decided they just don't want to approve claims for OSA.  Many of these guys have a low opinion of vets.  They think all vets are just freeloaders.  They would never admit to this prejudice but I think it is there.

If you are married, did your wife submit a lay statement? How about any of your battle buddies, did you get a lay statement from them?

Are you trying for direct sc, or seeking osa secondary?

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  • HadIt.com Elder

No, I am not trying for OSA as service-connected.  I am at 100% now .  Unless I can connect OSA to DMII, High Blood and heart disease I don't think I can get OSA service connected.  I have been out of the service for over 50 years.  In those days I don't they even knew what OSA was.

 

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