Hypothyroidism and Sleep Apnea Denied

[Gunnerdad]

Last entry I had submitted claim for AO SC Hypothyroidism with Sleep Apnea 2nd, and COPD 2nd.  All were denied because Hypo was caused by Hyper (Graves Disease) treatment. Saw no bases for DNA.

8-16-23 Filed claim for Hyper with evidence of studies at Buffalo University on over 200K Vets that showed AO exposed developed Graves Disease at 3X the rate of unexposed.  Claims check showed all claims referencing that study were approved.  Claim was closed within 4 hours and said letter was sent.  Only letter I've received was on 8-24 which stated they had reached out to the doctors I listed for treatment. Can't find any letter stating it was denied.  If it was closed on the 16th why the doctor letter and why no letter of denial?  So I have asked for a higher level of review and requested a conference with the reviewer so I can explain my claim.  Wondering if I have taken the proper route?  If approved it clears the Hypo claim as well.

Second part of same issue is the denied Sleep Apnea.  VA diagnosed me with a sleep study as moderate to severe and prescribed a CPAP machine. Because my COPD causes difficulty to exhale, I have struggled thru several versions and am now being fitted for the mouthpiece VA accepts as treatment.

I am now SC 50% PTSD.  Can I refile the Sleep Apnea as secondary to PTSD.

ClaimLetter-2023-8-24.pdf

[pacmanx1]

The main thing with any secondary disability, you are going to need medical opinions that connect/link (nexus statement) your secondary disability to your already service-connected disability.  It should say something like "it is as least likely as not your (name disability) is caused by or related to your already service-connected disability."  

[Dustoff1970]

In 2017 I filed a claim for OSA Sleep Apnea due to/secondary to long term Nam PTSD and use of strong PTSD medications long term.

Both the chicken chit VA C&P examiner and the VARO raters said no and denied my claim saying I was overweight and this caused my OSA.  I was not obese but overweight about 25 lbs.  This is the standard BS reason they use for denying OSA due to PTSD or MH issues.

However, like many overweight vets I won my appeal at the BVA due to honest board Judges and their attorneys by submitting a private heart doctor's medical opinion or nexus letter in great detail explaining how and why PTSD causes and aggravates Sleep Apnea.  Thanks to him and the BVA I was awarded 50% with CPAP and also this automatically entitled me to extra SMC-S award.  You will probably need such a nexus opinion from a doctor or qualified specialist and appeal the claim to the BVA.

I believe Hypothyroidism is now a presumptive service connected condition under the recent PACT ACT and if your service records show you were exposed to Agent Orange at the time and place that is recognized by VA.  You should consult an experienced VSO found at VA regional offices for assist on your claims.  Under the PACT ACT and Agent Orange ACT you need only a diagnosis and proof of in service exposure.  It worked for me on a heart disease claim and also Hypertension, etc.

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

 

[Gunnerdad]

Can't appeal since claim is over 1 year.  But PTSD is new so assume I can now file 2nd to PTSD or is not allowed?  I live in the wild wild West of AZ and don't have a doctor that would handle the needed Nexus letter, that I'm aware of.  My VSO out of Phoenix is not at all helpful and not responsive because she doesn't seem to understand my issues.  How does one find a doctor educated in AO issues? 

My claim for Hypo was denied because of the Graves Disease treatment caused me to be Hypo so since the Graves isn't SC there wasn't anyway I could see to file a NOD.  Since I found that study connecting AO exposure with increased Hyperthyroidism I felt I had a chance to get it AO SC which then opens the door to the rest of my original claim.  I'm hoping the higher level review and my interview will get that accomplished.

I'm at 90% and by VA math need 40% more to get to 100%,  I thought I had made it when they approved the PTSD at 50% that I've had my whole life but was afraid to address for various reasons. On that claim I had filed for an increase to my Neuropathy claim because it has certainly gotten much worse in my legs 20% each and my hands 40% and 30%.  The C&P doctor seemed sympathetic and said it had obviously gotten worse without touching me.  When the decision came back it approved the PTSD but denied the Neuropathy and said it had showed signs of "improvement" but kept the same rating level.  I have filed a FOIA request for a copy of the recent C&P as well as the original C&P that gave me the current rating.  If it is what I am hoping for when I review it, I will file for a higher level review and use the C&P file as evidence.  Should the report be different than the discussion I had with the doctor, can I request another C&P exam?  If so how do I do that?

[Dustoff1970]

Dr. David Anaise of Tucson is a 30 year heart surgeon and wrote two successful medical nexus opinions for me that won BVA appeals for Sleep Apnea due to PTSD at 50% with CPAP and also increase to 60% for my AO Heart disease appeal.

He charged me for two separate back to back nexus opinions a total of $1500.00 in 2019.   He has a website and does everything by phone, mail, email and fax.  He is also a veterans attorney accredited by both the CAVC court and BVA and won many claims and appeals for vets like us.

You may have to file a new reopened claim using his nexus opinion letter as new medical evidence for the VA raters and if they deny then appeal with an excellent chance of winning the BVA appeal.

[pacmanx1]

Can you please explain? Your attachment states that the VA sent you a letter around 08/24/2023 and that has not been a year yet. You still have several months to get a copy of the progress notes from you doctors and submit them as evidence. Even though the VA requested this information/evidence, you can get a copy of it and send it to the VA but make sure you keep the original for your personal copy.

Please delete your personal information like your name and claims number. 

[Gunnerdad]

Thanks Dustoff.  I'll look into him.

Be safe.