What should I do now?

[pacmanx1]

I know that you are focusing on your decision that you disagree with and that is not a problem but if you did not file a claim for depression, you may want to consider it. Filing a claim for depression does not mean you are crazy, or you need to be watched or you need to be in a padded room. It only means that you have service-connected medical conditions/handicaps/disabilities that the average person does not have to deal with or limit their ability to work and or interfere with daily (lifestyle) activities.  If you did file a claim for depression, and it was denied, you may want to appeal that to. Most individuals that suffer from chronic pain also suffer from some form of depression. 

[badta00]

I still don't know how to scan or attach photos but I can copy and paste.  Here's the Nexus letter that I sent that doesn't appear to have been considered with the the other evidence.  There was also a DBQ filled out with this Dr. and it doesn't appear to have been included with the evidence stated on the denial. :

 

Nexus letter for *********************((( May 17, 2024

 My name is ************************ MD. I have been a Primary Care Physician for 40 years. My last 13 years were spent as a Primary Care Provider for the Department of Veteran's Affairs,.

 Diagnosis:

GERD. K21.9 Sleep Apnea G47.30

 Interviewed via Telehealth Medical Records reviewed

 History:

This veteran served in the US Navy (1991-99) and reserves (1999-2005). He was a hull maintenance technician.

 He has a servicer connected disability for Sleep Apnea. His sleep apnea began while in active service, approximately 1994. He had surgery for it while in active service in 1998. (Removal of part of his soft palette). This was helpful for about 1 year. He was prescribed a CPap machine by his private PCP in 2005.

 His GERD symptoms began occasionally in 1996-97. It became much worse in 2001. He has daily heartburn, epigastric pain radiating to his left arm, reflux and regurgitation of stomach acid to the back of the throat. He also has nausea and occasional vomiting. His GERD symptoms can wake him up to 5 nights per week. Unfortunately records

 He had an upper endoscopy in 201 1, showing gastritis and esophagitis. Unfortunately records are not available as provider retired from practice. He has had to miss work because of GERD symptoms.

 Sleep apnea and GERD are two conditions which appear unrelated. Research shows that sleep disturbances may induce GERD, A 2023 study found that people with sleep apnea have a higher risk of developing GERD, due to pressure changes caused by sleep apnea. Pressure changes within the esophagus may increase the risk of acid reflux. 58-62% of patients with sleep apnea also have GERD,

 Various factors might increase GERD symptoms in patients with OSA. These include lower esophageal sphincter function, increase in transdiaphragmatic pressure gradient, reduced esophageal clearance.

 Is it therefore my professional opinion that this veteran's GERD is more likely than not related to his service connected diagnosis of Obstructive Sleep Apnea.

 Thank you for your time in this matter

 

 

`arnsworth, Carolyn "Is There a Connection between Sleep Apnea and GERD? "Medical News Today 3-19-2024 Vasta, Chris. Sleep Gare Online Jung, H., et al "'Gastroesophageal Reflux Disease and Sleep Disorders". NIH. 2010 Morse, Chad et al. "I|s there a relationship between OSA and GERD." Clinical Gastroenterology and Hepatology. September 2004

[badta00]

5 hours ago, pacmanx1 said:

I know that you are focusing on your decision that you disagree with and that is not a problem but if you did not file a claim for depression, you may want to consider it. Filing a claim for depression does not mean you are crazy, or you need to be watched or you need to be in a padded room. It only means that you have service-connected medical conditions/handicaps/disabilities that the average person does not have to deal with or limit their ability to work and or interfere with daily (lifestyle) activities.  If you did file a claim for depression, and it was denied, you may want to appeal that to. Most individuals that suffer from chronic pain also suffer from some form of depression. 

One of the recommendations from Veterans Benefits Evaluations base on my medical history and current ratings, was PTSD/ Depression: 

New Potential Claims:

 

Disability: PTSD / Depression and Anxiety due to Chronic Pain

Type of Service Connection: PTSD - Direct; Depression and Anxiety due to Chronic Pain – Secondary to lumbosacral strain, radiculopathy left and right lower extremity, left and right ankle and left and right knee

Medical Evidence Needed: Mental Health Evaluation $ (discounts may be available, speak to your Veterans Benefits Expert to find out more)

Potential Rating: 10, 30, 50, 70, 100% depending on severity of symptoms

Disability: Migraine / Headaches (requires diagnosis)

Type of Service Connection: Secondary to Tinnitus

Medical Evidence Needed: Diagnosis Service (Diagnosis + DBQ + Nexus Letter) $

Potential Rating: 10, 30, 50% depending on severity of symptoms

 

Disability: GERD (requires diagnosis)

Type of Service Connection: Secondary to Obstructive Sleep Apnea

Medical Evidence Needed: Diagnosis Service (Diagnosis + DBQ + Nexus Letter) $

Potential Rating: 10, 30, 50 or 80% depending on severity of symptoms  

[pacmanx1]

4 hours ago, badta00 said:

Disability: PTSD / Depression and Anxiety due to Chronic Pain

IMHO (IN MY HUMBLE OPINION), before you go down the road and paying anything out of pocket for an IMO (INDEPENDENT MEDICAL OPINION), you should try asking your VAMC PCP (PRIMARY CARE PROVIDER) to refer you to the mental health clinic due to depression and have them treat and diagnose you first. There is nothing wrong with getting a private IMO, but they can be expensive, very expensive.

I never personally paid any out-of-pocket money for a private IMO, my VAMC wrote all the IMOs I needed. Instead of asking for an IMO, just request to be treated and go from there. If you have PTSD, the VAMC is the ones to get it treated and diagnosed and if you have depression secondary to your already service-connected disability or disabilities, let them, The VAMC figure all that stuff out because that is where you could get your nexus statements. I say statement because when a veteran normally asks for a nexus letter, a lot of doctors do not want to get involved but when treating a patient, a doctor must give his/her medical opinion and write up some type of diagnosis before actually treating them with medication and that is the key of not paying out of pocket for a private IMO.

My VAMC treatment records and doctors helped with my service-connected fibromyalgia and my service-connected sleep apnea secondary to my service-connected fibromyalgia. It is possible, it just takes some time. If you are not working you should also consider filing for TDIU (TOTAL DISABILITY INDIVIDUAL UNEMPLOYABILITY). This is where the VA would pay you at the 100% rate if you cannot work due to your service-connected disabilities.

If you are working  and don’t want to go down that road just yet, you can try to get service connected for a depression disability (keep in mind that the VA will only grant one type of depression disability in that category) and migraine headaches to see if the VA will grant you 100% schedular and you can continue to work as long as your symptoms would not interfere with your duties. Whereas with a TDIU rating it would preclude you from continuing working in a full-time position.

Now before I upset some readers, A TDIU veteran can legally work as long as the veteran does not make over a certain income but in my opinion, it would not be worth the risk of losing the TDIU benefits. Yes, it is a big difference being rated 100% schedular than being rated TDIU. They pay the same monetary benefits but there are no legal restrictions with the 100% schedular rating.

Either way, 100% schedular or TDIU veterans can both receive SSDI if they cannot work if they file a claim with the SSA Social Security Administration Office. If you have any questions Hadit.com is a good place to ask. There is always someone willing to try to help and if we get it wrong, there will be someone to correct us to steer you in the right direction.

Hope the best.

Edited July 28 by pacmanx1

[pacmanx1]

As to appealing your current decision, you have one full year from the date of your decision to file your appeal.  Unfortunately, appeals right now are somewhat difficult, it seems that supplemental and HLR appeals are taking six months to a year, and some are granted but most are rubber stamped denied and then an appeal direct to the BVA are running about three (3) years and counting.

Just to be clear, I filed a simple request for an EED (EARLIER EFFECTIVE DATE) of an already service-connected disability and VARO denied my request and told me if I file a supplemental, my request would be granted because I had VAMC medical records that was not considered in my original decision, but my supplemental claim was also denied and my direct review appeal has been at the Board for almost three years and there is no light at the end of the tunnel and no one can say when it will get reviewed. This is on top of the VA website that says a direct review will only take less than 365 days and my appeal is well over a 1000. So much for a simple request. 

 

Edited July 28 by pacmanx1

[Rattler]

On 7/28/2024 at 1:05 PM, badta00 said:

One of the recommendations from Veterans Benefits Evaluations base on my medical history and current ratings, was PTSD/ Depression: 

New Potential Claims:

 

Disability: PTSD / Depression and Anxiety due to Chronic Pain

Type of Service Connection: PTSD - Direct; Depression and Anxiety due to Chronic Pain – Secondary to lumbosacral strain, radiculopathy left and right lower extremity, left and right ankle and left and right knee

Medical Evidence Needed: Mental Health Evaluation $ (discounts may be available, speak to your Veterans Benefits Expert to find out more)

Potential Rating: 10, 30, 50, 70, 100% depending on severity of symptoms

Disability: Migraine / Headaches (requires diagnosis)

Type of Service Connection: Secondary to Tinnitus

Medical Evidence Needed: Diagnosis Service (Diagnosis + DBQ + Nexus Letter) $

Potential Rating: 10, 30, 50% depending on severity of symptoms

 

Disability: GERD (requires diagnosis)

Type of Service Connection: Secondary to Obstructive Sleep Apnea

Medical Evidence Needed: Diagnosis Service (Diagnosis + DBQ + Nexus Letter) $

Potential Rating: 10, 30, 50 or 80% depending on severity of symptoms  

First off you don't get PTSD due to Chronic Pain. 

Some of us hear have a dual diagnosis of PTSD an MDD. 

Depression and Anxiety due to Chronic Pain will not fly if you are going for PTSD as paxmanx1 has stated you can only have one primary MH diagnosis

The question is did you submit any medical records or did you just submit the Nexis letter above.

You will need the medical records to backup the Nexis letter.

If it was me I would file a supplemental claim VBA-20-0995-ARE-Supplemental Claim and use the following form VBA-20-10208-ARE Document Evidence Submission to resubmit your Nexis letter and and any medical evidence.  I would submit VBA-20-10208-ARE with each piece of evidence you submit. (One for the Nexis, One for each piece of evidence, etc.)

I would submit it via access.va.gov if you can scan it and submit it because you know the VA will get right away. 

By doing it this way the VA will have to admit it either had the information in your file or not. If they did they have committed a clear and mistakable error. (CUE)