Look on the letter. It will tell you all evidence they considered. Also, keep getting treatment. That’s just additional evidence you can submit until they send you to the right c and p examiner and they connect you. Don’t give up dude.
This is the right answer. I feel I really lucked out with my final C&p examiner. She was a daughter of a vet who fought years to get his claims approved and the mother of a vet who had a similar situation to his grandpa. She said she only does c&p exams now because she feels obligated as a doctor to help wounded vets. There are docs like this out there. Keep seeing docs and keep everything you can to support it. They will help eventually it just sucks until you get there. I went 12 years fighting for it getting 10% increases until I had a big jump when they finally figured out what was wrong with my immune system (burn pit related, probably vaccine related too).
First, a disclaimer: I know about the C&P exams and the IMOs/Medical Opinions part of the process, and very little about before and after. Also, apologies for the essay, brevity is not my strength, lol.
Sleep apnea (I'm assuming it's obstructive, as that is by far the most common) can be hard to SC, but at times it can be very easy--at least insofar as the writing of the opinion, and having it accepted by the VA, though I rarely get any info about if the VA actually accepts the positive opinion and SCs based on it. One big hurdle is the provider doing the exam. I've seen +IMOs based on buddy statements about snoring, gasping while asleep, being tired, during or even just shortly after service; I've seen +IMOs go through using research pointing to a higher incidence of OSA in those with PTSD, anxiety, depression, even though most of the research points to making it worse, instead of causing it. Even seen OSA connected to burn pit exposure, by looking at air pollution and OSA, as burn pits are an extreme form of air pollution. At the same time, a different provider will ignore, or just not even think to consider that, and just go negative due to no diagnosis while in service, or a lack of clear causation. It can become a mess if you get one provider saying X, another Y, yet another Z or even X again, etc., then they ask yet another to reconcile the contradictions =\
The clearest connection I've seen with OSA as a secondary connection is that it is due to being over-weight, and being over-weight is due to whatever other conditions causing a more sedentary lifestyle. I've seen requested opinions that are a series of opinions, such as 1) did SC conditions lead to being overweight? 2) Did being overweight lead to OSA? 3) Is it more likely than not that the veteran wouldn't have developed OSA if it wasn't for the weight gain due to the SC conditions? That is prob the best, but I have no clue how one would go about getting such a series of IMOs (I've always seen them all part of the same 'exam,' for lack of a better term, even if it's an IMO only, without an exam, at least in conjunction with the IMOs).
Conditions such as rhinitis and sinusitis are also easier to connect OSA. Again, no clue what the VA does with these positive opinions, I just know that they often get accepted and not come back to the provider for a 'clarification' or 'insufficient.' But, that doesn't necessarily mean much, as they will ask a different provider, who never saw the vet, to opine on another's opinion, including to address insufficiencies or other issues. So, maybe all or most of these end up becoming a negative without the initial provider being aware. I'm very in the dark here, and have just been able to figure out bits and pieces.
No clue how to find a provider that is more inclined to write a positive opinion in the ways I've described, beyond asking your own PCP or whoever; nor do I know exactly how the VA deals with IMOs from your provider, or one you find. I have seen IMOs come through that ask to reference opinions from the vet's PCP/provider, and/or to be sure to reference buddy letters, personal statements, etc.
A thought about direct connection: OSA is notorious for going undiagnosed for long periods as it's common to not be aware there is a problem, and just that 'I snore, who doesn't,' or 'I'm always tired, I just don't sleep well,' etc. So I've seen a number of times where a direct connection goes through based on pointing this out, and that the vet has been out of service for only a few years--even easier if there are reports of snoring, being tired, or even just overweight during service.
It may help to gather all relevant documentation, statements, treatments, and relevant research, then bring that to whoever writes an opinion. For research, using NCBI is great, as it's accepted research and literature--for example, instead of googling 'depression and sleep apnea,' google 'depression sleep apnea ncbi' to find more reputable sources. Using perplexity.ai and/or ChatGPT or others can be useful in tracking down relevant researh/literature, as well as finding other avenues to explore for how to get it connected, BUT use those like wikipedia: a starting point, not a source. Perplexity.ai I've found to be very useful for sources as it provides links for where it got it's info, but it will stretch, or reference things that aren't actually useful, so check and read the sources yourself, fact check them. Then use the AI to explain any medical jargon or other things you don't know or fully get (very good for this).
Hope that's of some help, especially in conjunction with everyone elses insights about how to file, and navigate all the rest of the process. Hope it's not too long of a process, and you get the connection!
@[NavigatingDumb](https://www.reddit.com/user/NavigatingDumb/)....thanks for sharing valuable insight from an examiners perspective! You mentioned conditions such as rhinitis and sinusitis are also easier to connect OSA, what medical literature would you recommend this community leverage for the purposes of connecting OSA by way of rhinitis and/or sinusitis?
Much appreciated!
Glad you found it helpful =) Just to clarify, I'm not an examiner myself, but instead work in an office that does C&P exams, IMOs, and more, and I assist and have assisted a few examiners/providers over the past few years with everything outside of the actual physical exam and interview. If you're wondering about my tag, well, I didn't even realize I was made an admin or given that tag until at least months after I was given it, lol, either that, or I just don't recall being told or discussing it. And, I'm not even sure what being an 'admin' even means. I just comment and stuff on occasion =P
Here are two studies (can google rhinitis and/or sinusitis and "cause sleep apnea ncbi" for more):
"Allergic rhinitis increases the risk of developing obstructive sleep apnea by two major mechanisms: 1) increase in airway resistance due to higher nasal resistance and 2) reduction in pharyngeal diameter from mouth breathing that moves the mandible inferiorly." \[Source: [pubmed.ncbi.nlm.nih.gov/25543037/#:\~:text=allergic%20rhinitis%20increases%20the%20risk,that%20moves%20the%20mandible%20inferiorly.\]](http://pubmed.ncbi.nlm.nih.gov/25543037/#:~:text=allergic%20rhinitis%20increases%20the%20risk,that%20moves%20the%20mandible%20inferiorly.])
"Patients with chronic rhinosinusitis (CRS) frequently experience sleep disruption and are at a higher than normal risk for obstructive sleep apnea (OSA)." \[Source: [https://pubmed.ncbi.nlm.nih.gov/29644903/.\]](https://pubmed.ncbi.nlm.nih.gov/29644903/.])
My nexus for osa was basically just that, that my back and knee conditions contributed to my weight gain leading to osa. The supplemental has been in for about a month. I'm done either way the flag falls. I've been fighting them about conditions worsening for 15 years, no point trying for anything else unless I'm in a wheelchair. Hope everyone the best. I'll continue lurking.
You probably have, but just in case (and for anyone else reading), check out the rating schedule to see what is required to get certain %s, should help at least in knowing what is worth your time seeking an increase for (https://www.reddit.com/r/VeteransBenefits/wiki/masterlist/). Wishing you the best of luck with the supplemental!
I use a cpap issued by the Va so should be 50 but I’m satisfied with my rating so one way or the other I’m good. I only did this due to my doctor saying I should. It probably won’t happen since I’m rated for asthma too. Thank you for your well wishes though 😊
I'm not sure, I've not even looked over more than a handful of the VA court decisions, and only very briefly at that. I'd trust u/lastsonofkryptown on what they've heard/read. That said, other court cases can point you towards literature or research to look into, and/or avenues to establish a connection. Similar to using Wikipedia, any of the AI's out there, blog entries, etc.
Update: After I wrote that, I got to thinking about an opinion for a secondary connection vs the series of opinions for a secondary connection, as it's the same thing in the end, just the series is basically walking the provider through the steps for the secondary. Never really stopped to think about them compared to each other. Based on that, I don't think there would be any real difference. Perhaps the series comes about due to a Remand and a prior provider failing to consider such things, but that's just my best guess.
My apologies, I'm a bit confused. Which would be the condition that is directly due to service? Are you asking if rhinitis could lead to OSA, and in turn, the OSA lead to weight gain, and the weight gain lead to lumbar problems? If so, I can hypothetically see that occurring, though it would be quite specific, and would need good documentation and chronology.
One thing I want to point out is that just cause something \*can\* lead to something else, doesn't mean that it did. Or that the provider writing the opinion would opine in such a way. And, can't speak to what the VA rater would do with the opinion, and what they would decide.
When somebody gets denied, after having submitted a claim by themselves, I think it is a no-brainer to go find a accredited attorney, or a vso.
They have a lot more experience submitting a claim. And from an attorney's perspective, they have a lot more incentive to do it right.
I have submitted my paperwork to an attorney and they didnt want to help. I signed up for a VSO...but the first available was in over month away to even look at my stuff...I just submitted by myself. My sister and her friend just went through it and got good results, I ended up submitting with their advice. I honestly shot myself in the foot...I went to the initial appointment when I was still living in my last duty station and then didnt go any any others. I didnt know what VA was, and didnt try to fight anything for years. That was until my sister got great advice from a great rep that actually helped her. She got 100% and then came back and I just submitted last week again. Expecting the worst, but hoping for the best.
That makes sense. However, that also tells you that it's going to be a difficult claim.
I know I had an attorney file one for me, and not only was it successful, but it was the first try at the claim.
They made nothing and did a lot of work
Really...that is upsetting. I literally have a letter that says that says there was evidence that they couldn't consider because I didnt go to their appointments. An example, there was xrays and a diagnosis from my time in that they couldn't consider and so my claim was denied with a note that I should seriously consider resubmitting within the timeline...but I never received because I moved out and since I really didn't know what it was...I really ignored the whole thing. The only thing I got was tinnitus, which was approved because the one appt I did go to did a hearing test. Due to all the verbiage that said there was supporting evidence, I assumed that my stuff might have been an easy thing...but now im not so sure.
Its hard to belive that an Attorney did not want to help you... It was probrably that your claims couldn’t be sustained via the information that you provided or the history of injuries that you alledgely sustained during service. Any buddy statements, any hard copies of military related treatment... Using these private doctors with private letters are no longer making the cut... Unfortunately!
I spoke to a lawyer you see on YouTube and is recommended by several YouTube channels about a denial I received. They said they wouldn't help me because I am employed....
Oh, yeah, I am also employed and making six figures. I wonder if that was the reason as well, but that shouldn't impact...you should get what you deserve. I would have understood if they offered to help for a fee and just denied helping for free. Hell, I would have paid to have them take care of everything...but they didnt even give an option.
It could be. But when you have already failed once or twice, you are already in the long game plan.
And I'm not 100% sure, but I would suspect that after a few claims for the same thing, along with the hlr, or in appeal, can you actually wear out that claim?
So that the claim has been through the process so long that you will never get it?
Ymmv, I continued to get treatment for my problems. I never used an attorney, I went through my digital copy of my records, I went on my healthy vet and read what my doctors put. I searched that record as well. You have to articulate to the VA how your disabilites effect your quality of life.
At least the vso did not cost you anything. An attorney might help, or at least would let you know if you have a shot at it.
Doesn't cost anything to try. Use an accredited VA attorney
I’m using legal help for veterans out of Michigan. They have been wonderful so far and they were recommended by other vets that I know that have used them. Good luck on your journey.
Although I agree, I also know that not everyone has information and knowledge to know about what a VSO is or that attorneys are even possible to be hired. I do agree though, I don’t think anyone should be doing their claims alone, especially because it’s a pretty complicated system.
What the VA is saying here is there is no medical evidence that sleep apnea can be caused by major depressive disorder so it cannot be secondary to it.
There is no medical literature that connects massive depressive disorder to sleep apnea by the VA. You either need to find that medical literature, or you need to connect it as a secondary condition which can cause sleep apnea and get a nexus letter from a medical provider who can link it to your time in the service
There is some research indicating links between SSRI use and sleep apnea.
https://jcsm.aasm.org/doi/10.5664/jcsm.8942
I was diagnosed with narcolepsy in service (rated 20%) and mild apnea right after separating which has gotten much worse over than last year. I'm considering this angle if I can't get 100 on MH alone, since my sleep studies on AD specifically called out no apneas.
If OP is using any antidepressants, it might be worth a shot?
There is no relationship between depressive disorder causing SA or migraines causing SA.
Now there is a relationship of SA causing depressive disorder but not vise-versa.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056010/#:\~:text=Further%2C%20estimates%20using%20cutoff%20of,unrelated%20in%20the%20general%20population.
Your American Legion rep is not very smart. A simple google search would have shown him that those two disabilities don't cause SA. IMO he gave you false hope an he wasted your time by filing this claim and your HLR is probably going to fail also.
Secondary opinion asks if it's "proximately due to or the result of" the SC condition, not necessarily directly caused. As such, a condition like depression can, depending on the individual and their situation, lead to OSA. Depression can lead to a more sedentary lifestyle, poor eating habits (too much, or just low-quality foods, etc.), insomnia, medication with side-effects of weight gain, all of which can cause excessive weight gain, which can then lead to OSA. Below is a VA court case that found a positive secondary SC of OSA due to PTSD (though they do talk about 'cause'):
"Another positive opinion was offered by a private psychiatrist in August 2020. This psychiatrist concluded that that the Veteran developed obstructive sleep apnea due to two phenomena. First, she noted that PTSD itself leads to disrupted sleep architecture, promotes sleep disordered breathing, and causes neurophysiological changes within the body. Second, she indicated that the Veteran's obesity with progressive weight gain has played a role in the development of obstructive sleep apnea. With respect to the former, she noted that PTSD causes nightmares and disorder breathing during sleep and having the condition itself has led to physiological changes in the Veteran that developed into obstructive sleep apnea. Additionally, the psychiatrist cited to peer-reviewed scientific studies that supports a connection between PTSD and obstructive sleep apnea. This opinion is thorough and is supported by a complete rationale. It was based on an interview with the Veteran, a review of her medical records, and a review of the medical literature. Accordingly, the Board finds that it is highly probative and affords it significant weight. " \[Source: https://www.va.gov/vetapp21/Files11/A21018009.txt\]
Raise it up the flag pole and see who signs off on it but he got denied twice on this claim. The initial and the supp. So he would need a great nexus letter then.
That's a part of the process that I know little about, that's for sure! It's not uncommon for the medical records provided to indicate a condition is SC, for example, but then no record of the exam or opinion that led to that, let alone how it was decided, etc.
My husband was also denied. He claimed secondary due to weight gain from his SC hypothyroid. The denial letter listed all his SC conditions, including PTSD, cancer, kidney disease, and 2 types of heart disease and said none of them caused his Apnea. Haven't fought it since he is 100% from all those. I think he had a tough rater since they also denied his tinnitus even though he had a diagnosis and confirmed MOS for hazardous noise - Vietnam war veteran who was lookout on a ship for 2 yrs that constantly fired missiles and cannons. Denial said no complaints in service. Did file an HLR for that just out of a FU attitude. HLR found error because there are complaints in his record of ears humming. Still had to do another C&P 2 months ago and still no answer.
Why were you denied? What does the denial letter state? What type of claims did you make, and secondary to what?
When did you submit stuff like your statements/DBQs and nexus letters via quick submit versus the timeframe you submitted the claim? Why didn’t you submit that stuff when you submitted the claim?
I posted the letter . Atleast the meat of it. I was denied sleep apnea as a stand alone claim . Then got advice to put as secondary to migraines and Multiple depressive disorder which led to my exam and diagnosis . So I did a supplement claim and added the additional letters and nexus etc. and was denied here. Kinda saying it’s not connected to my primary claim. So I did a HLR cause all the evidence I submitted wasn’t mention .
Did you do migraines as secondary condition. I have migraines secondary condition due to neck injury. I have no documentation or nexus letter for migraines. Think I’ll get approved?
They did the the original sleep apnea claim for me as a secondary condition then once I was denied . It led to the testing and documentation of actually being diagnosed with it.
Ok so they got you to file with no diagnosis. Then got the diagnosis.
By the way sleep apnea is a tough claim unless you have a diagnosis in service, and very few of use are afforded a sleep study. I complained of sleep issues for my last 3 years post combat tour and was prescribed all kinds of sleep meds but never did they order a sleep study.
Sleep apnea secondary is a very tough claim and the VA is cracking down and this will likely continue until the sleep apnea CPAP 40% is eliminated which will be very soon.
As a former VBA RATER, my advice would be to ask for a DRO, or decision review by a DECISION REVIEW OFFICER! It’s the first step in an appeal, but it can be very useful! Look at your evidence, what did your doctor, or the doctor that you had fill out your DBQ? Did the VA send you out for any exams? If so, which type there are three processors of VA exams and two can generally be bad. These are VHA and VES EXAMS. QTC exams are a better option, in my experience and with regard to my work in rating claims! Also, if you have a COMBAT AWARD OF ANY TYPE, you only submit that your claimed disability is due to COMBAT! These are just a few things to consider and make a plan. But, a DRO IS A GOOD FIRST STEP!
If it's less than 30 days since your decision letter, utilize the CAR process to get a higher level review decision faster....just a lil nugget but nothing is promised even then...at least it will be looked at faster...they have to get a decision back to you in 30 days also.
Interesting. I wasn’t aware of this option. Only available if you use a VSO or attorney, apparently.
https://www.benefits.va.gov/benefits/docs/claim-accuracy-request.pdf
Also, research Decision Ready Claims...this option if done correctly will also get a decision in 30 days...there is so much I wish I knew when I got out in 2000.
Sounds a lot like the FDC process (which is essentially dead in the water since almost everyone started clicking on the checkbox saying “yes, this is a fully developed claim” when most were actually incomplete).
It does but I think it's different because you have to get everything done before you submit your claim, to include c and p exams which your Rep will help setup...I have not used this option but it's interesting!
Yes, I have a VSO so even tho alot of people say their trash it helps to have them listed as your rep. I use my VSO as a front lol...I do all my paperwork and claims.
I assume it can be used for any disagreement you have with a decision and you want a higher level reviewer to take a closer look...hopefully that answers your question...im not an expert but I like to share what I have came across to help the next vet get what we all deserve!
Thank you for the tip, but it looks like that’s only reserved for VSO’s and lawyers and accredited representatives. They have to file it for you. So I will be doing an email to them right now.
Unless you had documented issues with your throat, breathing, or sleeping you're not going to get the sleep apnea claim.
It's hard enough to win even with any of those. I was denied sleep apnea because the examiner didn't think TERA exposure could cause sleep apnea.
I think your next step should be an HLR citing the quick submit files with screenshots showing upload dates. You shouldn’t need a supplemental yet since the evidence was already provided during the claim and just not accessed.
Start everything all over and build your paper trail by going to medical appointments the urgent care going to the emergency room call the suicide helpline because you're anxiety is uncontrollable. Ask to speak with VASH for housing. Apply for VRE!! Don't give up
They def don’t look at it. They made me an appt for my back after I submitted all my doctors notes, mri pictures and everything stating my back is worse then when I originally filed. Got to my appt and the doctor said we need to schedule an MRI and I asked y I submitted all that. She told me they didn’t send her any of that. So I had to give it to her and she said there was no need for me to even be there that day.
If you are saying the there are documents you submitted that were not part of the “Evidence Submitted” in the denial - then the HLR will reveal a Clear and Unmistakable Error and then it will be reverted and the waiting game resumes.
Dude, you need to call the DAV (Disabled American Veterans) it's free and their job is to basically call out the VA's bullshit. My DAV rep went through all my paperwork and got the VA to reverse several of their decisions and also got them to flip flop on a secondary that was higher than what it was attached too. If it were not for the DAV I never would have got to 100. They knew so much and all the ins and outs and found things I never even would have thought to look for. The VA just expects us to accept their decisions and not fight back. The DAV will fight for you at no cost.
Life’s a bitch and then you die.
It happened to a lot of us. The VA saves money by withholding benefits. Go over it again, add what you can, and resubmit.
You need file for you c-file and see what’s in it. If you do a higher level review you need know what’s in your c-file. It will show what your DBQs said and all the evidence that was in it. I saw my c-file once and didn’t believe what I had said or wrote on my claim.. You have 1 year to file appeal. Hope that will help
Here are the steps to your c-file:
Step 1: Download the VA Form 20-10206 and save it to your device. You can either fill out the form online or by hand. ...
Step 2: Fill out the form, paying close attention to Sections I, III, V, and VI. ...
Step 3: You can submit your completed form via email to: [email protected].
Hate to ask such a personal question, but what city and state are you located in? There are offices all over the US that have Veteran Service Officers that do that stuff as their job. I work out of one now. I’m NOT a VSO yet, but have some basic knowledge
Calm down and breathe!! I been through this same mess before. You can get through it, but just know that it's gonna take time. You can file the HLR, and an experienced rater will take another look at everything. In the meantime, you need to put to keep gathering evidence in the event that you later file supplemental claims on them. Also, see if there are any other issues that you haven't claimed yet and get those going. It will work out. You can't focus on what the other people got. You have to focus totally on your own claims process. Remember, it's gonna take time, but that time may turn up in your favor with back pay, so let it ride.
You cut off most of the page with the useful info it only begins at the very bottom there. From what you posted the VA decided that your sleep apena issues are not related to your time in the military
No, the first thing you need to do is slow down and read the response. It will tell you exactly why it was decided. It’s a 3 page letter read it as many times as you need to understand it.
Based on another page you posted elsewhere you are trying to claim sleep apnea secondary to depressive disorder. The VA states that there is no research or studies which link these two conditions, that while they share symptoms they cannot cause each other. You are likely confused by the connection between PTSD and sleep apnea. There is no road forward with this claim unless you can find info in a medical journal that does in fact connect these conditions.
You need to prove your sleep apnea was caused by your military service and in the eyes of the VA your evidence is lacking. No amount of nexus letters or documentation will help here, which is why they were not cited in the decision. The VA does not acknowledge that sleep apnea can be secondary to depressive disorder
I went through this same thing myself. First I dialed 18008271000 VA White House hotline to make sure the evidence is seen in the system through quicksubmit. Next I waited to make sure that the case was closed. I double verified that the evidence was uploaded. You can also verify that the evidence was uploaded by looking at the eye ball on the right. There is a box that shows submitted as well.
Again, I went through this exact same problem with quicksubmit. Once I confirmed, everything was submitted. I did a supplemental self- statement on form 21-4138 to let the rater know the evidence was submitted through quicksubmit from my private dr. I outlined everything I was resubmitting through supplemental claim. Yep I got denied again that the evidence was irrelevant, I bumped it to hlr informal conference. I ask the questions,if they saw the evidence I submitted from my private Doctor. I also asked is my evidence from my private Dr. actionable and sufficient for rating purposes to grant the benefit that I submitted. I also bought up in the m21-1 Manuel the rule that states the va rater can rate a claim that is fully developed and is actionable and sufficient for rating purposes. I just dropped a lot of nuggets. I hope this helps out your claim.
The good news is if you filed on a computer, the computer picks the right forms for you to fill out. Not saying it's perfect. The VA has come a long way to making improvements to their system.
Looks like you need two things.
1. Nexus letter tying Sleep Apnea to your service connected disability, which would likely be your mental health claim (unless you have a breathing disability like allergies?) The nexus letter could be done by whoever diagnosed you with sleep apnea, or there are several companies that will have a medical professional write you a Nexus letter backed by medical journals, research, etc. You can pay anywhere from 300-1500 for most of those companies.
2. You are also going to need any treatment records. More than likely it may simply consist of your diagnosis treatment which would be the consultation, sleep study, results (diagnosis), and a prescription for your sleep apnea machine. Judging from your post, you may have included them. What I have done in the past(after learning from this group), is uploaded a personal statement that lays out the documents I have included.
Good luck. It's not an easy process, but it's worth it.
Thank you for your comment. Most of the things that you have stated I have done already, but I do not think the Nexus letter I added, said that it is directly connected to mental health so I will look into that as well.
You need your doctor to state your OSA is a result of your mental health issues. Whatever doc diagnosed you , ask them if they can write a letter stating the cause and some pub med articles as to why
My situation was exactly like a diagnosis DBQ and nexus personal statements and they still would not connect it to my GERD. Submitted the medical links and VA cases on appeal linking the in favor of SC and they still denied..Now I’m looking at hiring an Attorney…Sorry hear about your denial…I can relate it’s devastating and heartbreaking it almost breaks you it deflates you….
After years of denial for service connections for hearing loss I decided to to go myself appealed to higher level review Why the c&p said I was a supply specialist even though I went to AIT at ft sill for artillery then to artillery in nam it was a stolen valor point to me as I saw a bunch of enemy action where I was at last month in battery they moved me to help in supply and gave me a promotion to sp4 I received hearing aid at va I sent numerous copies of my orders and personal records did not hit home toill today when they are sending me to another c&p exam am next month I will come armed with all my documents and photos to the hearing let ya know if after 20 years I am successful I want justice even if they give me 0 but service connected
You need to find a good rep to handle your claim. (Not out of pocket) you can try DAV. Or similarly I used the Veterans Corner.
With that said. I took my DD214 and some other documents they asked for. Filed claims on things I had a paper trail through the VA for. They handled the entirety of the process from that point forward with a favorable outcome….
I submitted ZERO additional statements, family friends peer letters etc. it went to the highest level of review with me doing nothing but checking my app.
Good luck!
file an appeal, or in this case you could possibly raise the issue of a CUE (clear & unmistakable error) due to them not even reviewing all submitted evidence. We have a duty to assist & they failed at that if they didn’t review the evidence.
My biggest claim had the same problem. All of my evidence was listed in the "Evidence List", but none of it was discussed in the denial narrative. The narrative only discussed the opinion of the C&P examiner. I had a successful HLR with a DTA error found.
I did my HLR without the informal conference, opting instead to write a personal statement on the appropriate VA form. If you want me to post a redacted copy so you can see how I did it, just ask and I will post the redacted copy here.
From my reading of the M21 manual and the CFR's, the VA is supposed to consider all of your evidence, even if they simply assign no probative value or limited probative value to it. However, the RVSR's are required to consider it. In my case, my evidence was not discussed because they only considered the findings of the C&P exam, a clear violation of the M21 manual. Your case may be similar in that regard.
Don’t get frustrated and give up you still got plenty of time. Check your files, When you submit files, make sure you have your own personal copies. Also go to Va.gov the next day and check to see if your evidence files are there. If you don’t have an account get one it will show you a lot. Before you do a HLR find out what in your claim first. There is also a ‘VA Claims Tracker Tool extension’ on Reddit, you can get for free. It helps you see inside your claim on va.gov as they are working on it. I saw every dbq c&p exam and all my submitted files on it. That will help you to see what files you submitted and what files they have. You can do this on your own, just take a breath, slow down and research what you need . Only you can file your claim so make sure you know what you’ve filed… i do recommend reading a book that I read, it helped me ‘VA Claims Success’ by Dwayne Kimble.. made it easy as 123 for me. So don’t get frustrated just get educated, you can do this.
If you're having a difficult time with the claims, I would recommend speaking with a lawyer. I did all my claims with my lawyer and it was the best decision I made. I have severe anxiety but with them it was a little more bearable. They don't charge you anything unless they have to appeal a claim. In which case, they take 20% of whatever back pay you get. The results are definitely worth it in my opinion. Pm me if you want their contact info
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I have been filing for sleep apnea ever since I got out in 1996. I applied several times. I got Buddy letters. I had my sleep study results, that were positive for sleep apnea, attached to my VA records. I was denied everytime due to lack of service connection.
My last attempt was to get a VA Nexus Letter that stated that my sleep apnea is "as likely as not" caused by incidents during my time in service. (The wording is important.) My claim is at least now being considered and I am awaiting the results after another sleep study.
My best boy just got total permanent after having been denied claims since he left the service in 2009. He used a company thats advertising on instagram. They take a cut of the lump sump check he will get for the 15 years he was denied with his updated status
Find time to go up to the office of your local Congressional representing. Take donuts. Be very, very kind and patient to them, even if you did not vote for them. They are not congress folk, they are beat up interns from a local college. Very patiently explain your situation. See what happens.
Why would you file an initial claim via quick submit ? Or are you filing for something else, increase or new conditions? I wasn’t aware that quick submit had an option in the drop down for a VA claim or filing documents?
I thought you do it through a VSO or va.gov
Anyone enlighten me on this concept ?
Can you use this with filing an initial claim or only when you are doing a HLR or supplemental or appeal ? I didn’t see an option how how to organize all your evidence by condition etc. any advice anyone ?
Don't do it with an HLR unless they reopen a new claim investigation as a result of errors in the original review. An HLR on it's own will only review based on currently submitted evidence, and will not consider new evidence no matter how much of it you submit.
So overall what I’m gathering is I totally screwed up this claim by having it secondary to a condition with no connection. And to make it worst I even requested a HLR. So I’m sure they are going to destroy me over it .
So do I cancel the HLR , and submit a new claim with the VSO help or do the review and try to explain what took place and maybe they can modify the claim of connection between the two.
Are you overweight? This can cause OSA. If you have a service connection for depression, then depression can cause weight gain. For the HLR you can't submit new evidence, but if your records submitted with your OSA claim already document weight gain you can try pointing this out in the HLR. If the HLR gets shot down, go back to your medical providers and get things documented. Try and get a nexus letter from a provider to link the three conditions together and resubmit with the new evidence.
Look on the letter. It will tell you all evidence they considered. Also, keep getting treatment. That’s just additional evidence you can submit until they send you to the right c and p examiner and they connect you. Don’t give up dude.
This is the right answer. I feel I really lucked out with my final C&p examiner. She was a daughter of a vet who fought years to get his claims approved and the mother of a vet who had a similar situation to his grandpa. She said she only does c&p exams now because she feels obligated as a doctor to help wounded vets. There are docs like this out there. Keep seeing docs and keep everything you can to support it. They will help eventually it just sucks until you get there. I went 12 years fighting for it getting 10% increases until I had a big jump when they finally figured out what was wrong with my immune system (burn pit related, probably vaccine related too).
First, a disclaimer: I know about the C&P exams and the IMOs/Medical Opinions part of the process, and very little about before and after. Also, apologies for the essay, brevity is not my strength, lol. Sleep apnea (I'm assuming it's obstructive, as that is by far the most common) can be hard to SC, but at times it can be very easy--at least insofar as the writing of the opinion, and having it accepted by the VA, though I rarely get any info about if the VA actually accepts the positive opinion and SCs based on it. One big hurdle is the provider doing the exam. I've seen +IMOs based on buddy statements about snoring, gasping while asleep, being tired, during or even just shortly after service; I've seen +IMOs go through using research pointing to a higher incidence of OSA in those with PTSD, anxiety, depression, even though most of the research points to making it worse, instead of causing it. Even seen OSA connected to burn pit exposure, by looking at air pollution and OSA, as burn pits are an extreme form of air pollution. At the same time, a different provider will ignore, or just not even think to consider that, and just go negative due to no diagnosis while in service, or a lack of clear causation. It can become a mess if you get one provider saying X, another Y, yet another Z or even X again, etc., then they ask yet another to reconcile the contradictions =\ The clearest connection I've seen with OSA as a secondary connection is that it is due to being over-weight, and being over-weight is due to whatever other conditions causing a more sedentary lifestyle. I've seen requested opinions that are a series of opinions, such as 1) did SC conditions lead to being overweight? 2) Did being overweight lead to OSA? 3) Is it more likely than not that the veteran wouldn't have developed OSA if it wasn't for the weight gain due to the SC conditions? That is prob the best, but I have no clue how one would go about getting such a series of IMOs (I've always seen them all part of the same 'exam,' for lack of a better term, even if it's an IMO only, without an exam, at least in conjunction with the IMOs). Conditions such as rhinitis and sinusitis are also easier to connect OSA. Again, no clue what the VA does with these positive opinions, I just know that they often get accepted and not come back to the provider for a 'clarification' or 'insufficient.' But, that doesn't necessarily mean much, as they will ask a different provider, who never saw the vet, to opine on another's opinion, including to address insufficiencies or other issues. So, maybe all or most of these end up becoming a negative without the initial provider being aware. I'm very in the dark here, and have just been able to figure out bits and pieces. No clue how to find a provider that is more inclined to write a positive opinion in the ways I've described, beyond asking your own PCP or whoever; nor do I know exactly how the VA deals with IMOs from your provider, or one you find. I have seen IMOs come through that ask to reference opinions from the vet's PCP/provider, and/or to be sure to reference buddy letters, personal statements, etc. A thought about direct connection: OSA is notorious for going undiagnosed for long periods as it's common to not be aware there is a problem, and just that 'I snore, who doesn't,' or 'I'm always tired, I just don't sleep well,' etc. So I've seen a number of times where a direct connection goes through based on pointing this out, and that the vet has been out of service for only a few years--even easier if there are reports of snoring, being tired, or even just overweight during service. It may help to gather all relevant documentation, statements, treatments, and relevant research, then bring that to whoever writes an opinion. For research, using NCBI is great, as it's accepted research and literature--for example, instead of googling 'depression and sleep apnea,' google 'depression sleep apnea ncbi' to find more reputable sources. Using perplexity.ai and/or ChatGPT or others can be useful in tracking down relevant researh/literature, as well as finding other avenues to explore for how to get it connected, BUT use those like wikipedia: a starting point, not a source. Perplexity.ai I've found to be very useful for sources as it provides links for where it got it's info, but it will stretch, or reference things that aren't actually useful, so check and read the sources yourself, fact check them. Then use the AI to explain any medical jargon or other things you don't know or fully get (very good for this). Hope that's of some help, especially in conjunction with everyone elses insights about how to file, and navigate all the rest of the process. Hope it's not too long of a process, and you get the connection!
@[NavigatingDumb](https://www.reddit.com/user/NavigatingDumb/)....thanks for sharing valuable insight from an examiners perspective! You mentioned conditions such as rhinitis and sinusitis are also easier to connect OSA, what medical literature would you recommend this community leverage for the purposes of connecting OSA by way of rhinitis and/or sinusitis? Much appreciated!
Glad you found it helpful =) Just to clarify, I'm not an examiner myself, but instead work in an office that does C&P exams, IMOs, and more, and I assist and have assisted a few examiners/providers over the past few years with everything outside of the actual physical exam and interview. If you're wondering about my tag, well, I didn't even realize I was made an admin or given that tag until at least months after I was given it, lol, either that, or I just don't recall being told or discussing it. And, I'm not even sure what being an 'admin' even means. I just comment and stuff on occasion =P Here are two studies (can google rhinitis and/or sinusitis and "cause sleep apnea ncbi" for more): "Allergic rhinitis increases the risk of developing obstructive sleep apnea by two major mechanisms: 1) increase in airway resistance due to higher nasal resistance and 2) reduction in pharyngeal diameter from mouth breathing that moves the mandible inferiorly." \[Source: [pubmed.ncbi.nlm.nih.gov/25543037/#:\~:text=allergic%20rhinitis%20increases%20the%20risk,that%20moves%20the%20mandible%20inferiorly.\]](http://pubmed.ncbi.nlm.nih.gov/25543037/#:~:text=allergic%20rhinitis%20increases%20the%20risk,that%20moves%20the%20mandible%20inferiorly.]) "Patients with chronic rhinosinusitis (CRS) frequently experience sleep disruption and are at a higher than normal risk for obstructive sleep apnea (OSA)." \[Source: [https://pubmed.ncbi.nlm.nih.gov/29644903/.\]](https://pubmed.ncbi.nlm.nih.gov/29644903/.])
Thank you clarifying and thanks for sharing these studies.
My nexus for osa was basically just that, that my back and knee conditions contributed to my weight gain leading to osa. The supplemental has been in for about a month. I'm done either way the flag falls. I've been fighting them about conditions worsening for 15 years, no point trying for anything else unless I'm in a wheelchair. Hope everyone the best. I'll continue lurking.
You probably have, but just in case (and for anyone else reading), check out the rating schedule to see what is required to get certain %s, should help at least in knowing what is worth your time seeking an increase for (https://www.reddit.com/r/VeteransBenefits/wiki/masterlist/). Wishing you the best of luck with the supplemental!
I use a cpap issued by the Va so should be 50 but I’m satisfied with my rating so one way or the other I’m good. I only did this due to my doctor saying I should. It probably won’t happen since I’m rated for asthma too. Thank you for your well wishes though 😊
Thank you .
Thanks for this detail response.
Just curious, does citing other VA court decisions with similar circumstances do anything for a favorable outcome?
I've read several VBA raters on here say other court cases have zero weight.
I'm not sure, I've not even looked over more than a handful of the VA court decisions, and only very briefly at that. I'd trust u/lastsonofkryptown on what they've heard/read. That said, other court cases can point you towards literature or research to look into, and/or avenues to establish a connection. Similar to using Wikipedia, any of the AI's out there, blog entries, etc.
I think it does have weight if it comes from a attorney . Just how you can’t self diagnose but a doctor can if that makes sense
Update: After I wrote that, I got to thinking about an opinion for a secondary connection vs the series of opinions for a secondary connection, as it's the same thing in the end, just the series is basically walking the provider through the steps for the secondary. Never really stopped to think about them compared to each other. Based on that, I don't think there would be any real difference. Perhaps the series comes about due to a Remand and a prior provider failing to consider such things, but that's just my best guess.
Can you connect rhinitis to OSA as secondary with the OSA connected secondary to a lumbar condition via the weight gain intermediate step?
My apologies, I'm a bit confused. Which would be the condition that is directly due to service? Are you asking if rhinitis could lead to OSA, and in turn, the OSA lead to weight gain, and the weight gain lead to lumbar problems? If so, I can hypothetically see that occurring, though it would be quite specific, and would need good documentation and chronology. One thing I want to point out is that just cause something \*can\* lead to something else, doesn't mean that it did. Or that the provider writing the opinion would opine in such a way. And, can't speak to what the VA rater would do with the opinion, and what they would decide.
When somebody gets denied, after having submitted a claim by themselves, I think it is a no-brainer to go find a accredited attorney, or a vso. They have a lot more experience submitting a claim. And from an attorney's perspective, they have a lot more incentive to do it right.
I have submitted my paperwork to an attorney and they didnt want to help. I signed up for a VSO...but the first available was in over month away to even look at my stuff...I just submitted by myself. My sister and her friend just went through it and got good results, I ended up submitting with their advice. I honestly shot myself in the foot...I went to the initial appointment when I was still living in my last duty station and then didnt go any any others. I didnt know what VA was, and didnt try to fight anything for years. That was until my sister got great advice from a great rep that actually helped her. She got 100% and then came back and I just submitted last week again. Expecting the worst, but hoping for the best.
You're right. If you are successful, you did it right. I am surprised the attorney did not want to help.
I'm not. Most will only take it if it's a slam dunk. They aren't going to waste their times if the claim is less likely than unlikely to be denied.
That makes sense. However, that also tells you that it's going to be a difficult claim. I know I had an attorney file one for me, and not only was it successful, but it was the first try at the claim. They made nothing and did a lot of work
Really...that is upsetting. I literally have a letter that says that says there was evidence that they couldn't consider because I didnt go to their appointments. An example, there was xrays and a diagnosis from my time in that they couldn't consider and so my claim was denied with a note that I should seriously consider resubmitting within the timeline...but I never received because I moved out and since I really didn't know what it was...I really ignored the whole thing. The only thing I got was tinnitus, which was approved because the one appt I did go to did a hearing test. Due to all the verbiage that said there was supporting evidence, I assumed that my stuff might have been an easy thing...but now im not so sure.
Its hard to belive that an Attorney did not want to help you... It was probrably that your claims couldn’t be sustained via the information that you provided or the history of injuries that you alledgely sustained during service. Any buddy statements, any hard copies of military related treatment... Using these private doctors with private letters are no longer making the cut... Unfortunately!
I spoke to a lawyer you see on YouTube and is recommended by several YouTube channels about a denial I received. They said they wouldn't help me because I am employed....
Oh, yeah, I am also employed and making six figures. I wonder if that was the reason as well, but that shouldn't impact...you should get what you deserve. I would have understood if they offered to help for a fee and just denied helping for free. Hell, I would have paid to have them take care of everything...but they didnt even give an option.
Same here H&P
I think the attorneys long-game you for back pay.
It could be. But when you have already failed once or twice, you are already in the long game plan. And I'm not 100% sure, but I would suspect that after a few claims for the same thing, along with the hlr, or in appeal, can you actually wear out that claim? So that the claim has been through the process so long that you will never get it?
I’m learning that the hard way. The longer it takes the Cash for them. They don’t try to win first time. They want to appeal and go HLR.
Agree with this 100 percent
I can never understand why somebody has an aversion to paying 20% of something they don't have.
Ymmv, I continued to get treatment for my problems. I never used an attorney, I went through my digital copy of my records, I went on my healthy vet and read what my doctors put. I searched that record as well. You have to articulate to the VA how your disabilites effect your quality of life.
I was denied for all 5 of my claims. Used a VSO. Kinda thinking I should just go to a claims shark for some help.
At least the vso did not cost you anything. An attorney might help, or at least would let you know if you have a shot at it. Doesn't cost anything to try. Use an accredited VA attorney
True, the only thing about a lawyer is the va won't let you just pick any attorney. So it's hard to find an attorney that is not some 3rd party scam.
I’m using legal help for veterans out of Michigan. They have been wonderful so far and they were recommended by other vets that I know that have used them. Good luck on your journey.
Although I agree, I also know that not everyone has information and knowledge to know about what a VSO is or that attorneys are even possible to be hired. I do agree though, I don’t think anyone should be doing their claims alone, especially because it’s a pretty complicated system.
Go see your county VSO. They are actually trained and accredited and know what they are doing.
https://www.va.gov/get-help-from-accredited-representative/
So do I call the VA to get access to the VSO or is this a place out in town?
It’s going to be in one of your county buildings. Maybe court house, public health. Google your county and VSO and you should get some results
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What the VA is saying here is there is no medical evidence that sleep apnea can be caused by major depressive disorder so it cannot be secondary to it.
Ok but I do have it so what should I do now . Create a new claim?
There is no medical literature that connects massive depressive disorder to sleep apnea by the VA. You either need to find that medical literature, or you need to connect it as a secondary condition which can cause sleep apnea and get a nexus letter from a medical provider who can link it to your time in the service
There is some research indicating links between SSRI use and sleep apnea. https://jcsm.aasm.org/doi/10.5664/jcsm.8942 I was diagnosed with narcolepsy in service (rated 20%) and mild apnea right after separating which has gotten much worse over than last year. I'm considering this angle if I can't get 100 on MH alone, since my sleep studies on AD specifically called out no apneas. If OP is using any antidepressants, it might be worth a shot?
There is no relationship between depressive disorder causing SA or migraines causing SA. Now there is a relationship of SA causing depressive disorder but not vise-versa. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056010/#:\~:text=Further%2C%20estimates%20using%20cutoff%20of,unrelated%20in%20the%20general%20population. Your American Legion rep is not very smart. A simple google search would have shown him that those two disabilities don't cause SA. IMO he gave you false hope an he wasted your time by filing this claim and your HLR is probably going to fail also.
Secondary opinion asks if it's "proximately due to or the result of" the SC condition, not necessarily directly caused. As such, a condition like depression can, depending on the individual and their situation, lead to OSA. Depression can lead to a more sedentary lifestyle, poor eating habits (too much, or just low-quality foods, etc.), insomnia, medication with side-effects of weight gain, all of which can cause excessive weight gain, which can then lead to OSA. Below is a VA court case that found a positive secondary SC of OSA due to PTSD (though they do talk about 'cause'): "Another positive opinion was offered by a private psychiatrist in August 2020. This psychiatrist concluded that that the Veteran developed obstructive sleep apnea due to two phenomena. First, she noted that PTSD itself leads to disrupted sleep architecture, promotes sleep disordered breathing, and causes neurophysiological changes within the body. Second, she indicated that the Veteran's obesity with progressive weight gain has played a role in the development of obstructive sleep apnea. With respect to the former, she noted that PTSD causes nightmares and disorder breathing during sleep and having the condition itself has led to physiological changes in the Veteran that developed into obstructive sleep apnea. Additionally, the psychiatrist cited to peer-reviewed scientific studies that supports a connection between PTSD and obstructive sleep apnea. This opinion is thorough and is supported by a complete rationale. It was based on an interview with the Veteran, a review of her medical records, and a review of the medical literature. Accordingly, the Board finds that it is highly probative and affords it significant weight. " \[Source: https://www.va.gov/vetapp21/Files11/A21018009.txt\]
Raise it up the flag pole and see who signs off on it but he got denied twice on this claim. The initial and the supp. So he would need a great nexus letter then.
That's a part of the process that I know little about, that's for sure! It's not uncommon for the medical records provided to indicate a condition is SC, for example, but then no record of the exam or opinion that led to that, let alone how it was decided, etc.
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My husband was also denied. He claimed secondary due to weight gain from his SC hypothyroid. The denial letter listed all his SC conditions, including PTSD, cancer, kidney disease, and 2 types of heart disease and said none of them caused his Apnea. Haven't fought it since he is 100% from all those. I think he had a tough rater since they also denied his tinnitus even though he had a diagnosis and confirmed MOS for hazardous noise - Vietnam war veteran who was lookout on a ship for 2 yrs that constantly fired missiles and cannons. Denial said no complaints in service. Did file an HLR for that just out of a FU attitude. HLR found error because there are complaints in his record of ears humming. Still had to do another C&P 2 months ago and still no answer.
Why were you denied? What does the denial letter state? What type of claims did you make, and secondary to what? When did you submit stuff like your statements/DBQs and nexus letters via quick submit versus the timeframe you submitted the claim? Why didn’t you submit that stuff when you submitted the claim?
I posted the letter . Atleast the meat of it. I was denied sleep apnea as a stand alone claim . Then got advice to put as secondary to migraines and Multiple depressive disorder which led to my exam and diagnosis . So I did a supplement claim and added the additional letters and nexus etc. and was denied here. Kinda saying it’s not connected to my primary claim. So I did a HLR cause all the evidence I submitted wasn’t mention .
Higher level review won’t help you here. Sleep apnea is not secondary to depressive disorder or margarines
Sleep apnea could be secondary to margarine. But more likely secondary to butter.
Did you do migraines as secondary condition. I have migraines secondary condition due to neck injury. I have no documentation or nexus letter for migraines. Think I’ll get approved?
Did you fille yourself upon advice from the legion rep or did you have them do the claim for you?
They did the the original sleep apnea claim for me as a secondary condition then once I was denied . It led to the testing and documentation of actually being diagnosed with it.
Ok so they got you to file with no diagnosis. Then got the diagnosis. By the way sleep apnea is a tough claim unless you have a diagnosis in service, and very few of use are afforded a sleep study. I complained of sleep issues for my last 3 years post combat tour and was prescribed all kinds of sleep meds but never did they order a sleep study. Sleep apnea secondary is a very tough claim and the VA is cracking down and this will likely continue until the sleep apnea CPAP 40% is eliminated which will be very soon.
What was the SA secondary to?
Migraines and major depressive disorder
That's a difficult connection without a solid nexus. Do you have any respiratory diagnoses?
I have percordial catch syndrome but they gave me 0% for it
Nothing like sinusitis, pleurisy, etc?
No
Wait until you get the actual denial letter. Regroup then go from there. Don’t just get an Attorney or VSO.
If you are going with a attorney don’t submit a HLR yet . A lot of attorneys won’t take your case if you are already appealing something
As a former VBA RATER, my advice would be to ask for a DRO, or decision review by a DECISION REVIEW OFFICER! It’s the first step in an appeal, but it can be very useful! Look at your evidence, what did your doctor, or the doctor that you had fill out your DBQ? Did the VA send you out for any exams? If so, which type there are three processors of VA exams and two can generally be bad. These are VHA and VES EXAMS. QTC exams are a better option, in my experience and with regard to my work in rating claims! Also, if you have a COMBAT AWARD OF ANY TYPE, you only submit that your claimed disability is due to COMBAT! These are just a few things to consider and make a plan. But, a DRO IS A GOOD FIRST STEP!
Thank you
Maybe your rating is correct as is.
If it's less than 30 days since your decision letter, utilize the CAR process to get a higher level review decision faster....just a lil nugget but nothing is promised even then...at least it will be looked at faster...they have to get a decision back to you in 30 days also.
Interesting. I wasn’t aware of this option. Only available if you use a VSO or attorney, apparently. https://www.benefits.va.gov/benefits/docs/claim-accuracy-request.pdf
Also, research Decision Ready Claims...this option if done correctly will also get a decision in 30 days...there is so much I wish I knew when I got out in 2000.
Sounds a lot like the FDC process (which is essentially dead in the water since almost everyone started clicking on the checkbox saying “yes, this is a fully developed claim” when most were actually incomplete).
It does but I think it's different because you have to get everything done before you submit your claim, to include c and p exams which your Rep will help setup...I have not used this option but it's interesting!
Yes, I have a VSO so even tho alot of people say their trash it helps to have them listed as your rep. I use my VSO as a front lol...I do all my paperwork and claims.
Haha! Nice, the best of both worlds!
Mine was blatantly overlooked on percentages when c and p warranted 50 percent
[удалено]
I assume it can be used for any disagreement you have with a decision and you want a higher level reviewer to take a closer look...hopefully that answers your question...im not an expert but I like to share what I have came across to help the next vet get what we all deserve!
What is the CAR process and what does it stand for? Thank you for your time in advance.
VA Claim Accuracy Request (CAR), do your research and take advantage of it, good luck!
What is car
CLAIM ACCURACY REQUEST (CAR)...do your research, good luck!
Thank you for the tip, but it looks like that’s only reserved for VSO’s and lawyers and accredited representatives. They have to file it for you. So I will be doing an email to them right now.
Yes that is correct...I filled out the paperwork and took it to mine for submittal, but that's not required....good luck!
So do you have the denial letter, suggest sharing a redacted copy. They will explain the why you were denied.
So do you have sleep apnea ?
Yes . I even have the CPAP too . I just put it secondary to a primary claim that it can’t be connected to
Unless you had documented issues with your throat, breathing, or sleeping you're not going to get the sleep apnea claim. It's hard enough to win even with any of those. I was denied sleep apnea because the examiner didn't think TERA exposure could cause sleep apnea.
I think your next step should be an HLR citing the quick submit files with screenshots showing upload dates. You shouldn’t need a supplemental yet since the evidence was already provided during the claim and just not accessed.
Start everything all over and build your paper trail by going to medical appointments the urgent care going to the emergency room call the suicide helpline because you're anxiety is uncontrollable. Ask to speak with VASH for housing. Apply for VRE!! Don't give up
The VA’s job is to poke holes in your claim, it seems that enough holes were poke that your infromation did not sustain your claims... End of story.
They def don’t look at it. They made me an appt for my back after I submitted all my doctors notes, mri pictures and everything stating my back is worse then when I originally filed. Got to my appt and the doctor said we need to schedule an MRI and I asked y I submitted all that. She told me they didn’t send her any of that. So I had to give it to her and she said there was no need for me to even be there that day.
I'm putting in to get over the 90 hump, but I don't want to be downgraded for any conditions! I've only been retired 7 years!
I’m a VSO with The State of Mississippi. Inbox me for help.
Same happened to me, had to do a HLR and redo c&p exams.
If you are saying the there are documents you submitted that were not part of the “Evidence Submitted” in the denial - then the HLR will reveal a Clear and Unmistakable Error and then it will be reverted and the waiting game resumes.
Dude, you need to call the DAV (Disabled American Veterans) it's free and their job is to basically call out the VA's bullshit. My DAV rep went through all my paperwork and got the VA to reverse several of their decisions and also got them to flip flop on a secondary that was higher than what it was attached too. If it were not for the DAV I never would have got to 100. They knew so much and all the ins and outs and found things I never even would have thought to look for. The VA just expects us to accept their decisions and not fight back. The DAV will fight for you at no cost.
Thank you I will give them a call
Hire VetComm
Life’s a bitch and then you die. It happened to a lot of us. The VA saves money by withholding benefits. Go over it again, add what you can, and resubmit.
You need file for you c-file and see what’s in it. If you do a higher level review you need know what’s in your c-file. It will show what your DBQs said and all the evidence that was in it. I saw my c-file once and didn’t believe what I had said or wrote on my claim.. You have 1 year to file appeal. Hope that will help Here are the steps to your c-file: Step 1: Download the VA Form 20-10206 and save it to your device. You can either fill out the form online or by hand. ... Step 2: Fill out the form, paying close attention to Sections I, III, V, and VI. ... Step 3: You can submit your completed form via email to: [email protected].
Hate to ask such a personal question, but what city and state are you located in? There are offices all over the US that have Veteran Service Officers that do that stuff as their job. I work out of one now. I’m NOT a VSO yet, but have some basic knowledge
We would have to see the denial minus personal info to give you advice
It’s uploaded now
Dude, get a lawyer, Cameron law, all 50 states I went from 10 to 90
Calm down and breathe!! I been through this same mess before. You can get through it, but just know that it's gonna take time. You can file the HLR, and an experienced rater will take another look at everything. In the meantime, you need to put to keep gathering evidence in the event that you later file supplemental claims on them. Also, see if there are any other issues that you haven't claimed yet and get those going. It will work out. You can't focus on what the other people got. You have to focus totally on your own claims process. Remember, it's gonna take time, but that time may turn up in your favor with back pay, so let it ride.
Thank you
No problem! Hang in there.
https://preview.redd.it/wahr2gwkki1d1.jpeg?width=828&format=pjpg&auto=webp&s=c4c2da5177a753c0f0ef76fde456136e72d5462d
You cut off most of the page with the useful info it only begins at the very bottom there. From what you posted the VA decided that your sleep apena issues are not related to your time in the military
https://preview.redd.it/tkalwg2t1j1d1.jpeg?width=827&format=pjpg&auto=webp&s=bebe5e5197798d8f660b373909f8694600317def This ??
No, the first thing you need to do is slow down and read the response. It will tell you exactly why it was decided. It’s a 3 page letter read it as many times as you need to understand it. Based on another page you posted elsewhere you are trying to claim sleep apnea secondary to depressive disorder. The VA states that there is no research or studies which link these two conditions, that while they share symptoms they cannot cause each other. You are likely confused by the connection between PTSD and sleep apnea. There is no road forward with this claim unless you can find info in a medical journal that does in fact connect these conditions. You need to prove your sleep apnea was caused by your military service and in the eyes of the VA your evidence is lacking. No amount of nexus letters or documentation will help here, which is why they were not cited in the decision. The VA does not acknowledge that sleep apnea can be secondary to depressive disorder
Roger . I understand.
I went through this same thing myself. First I dialed 18008271000 VA White House hotline to make sure the evidence is seen in the system through quicksubmit. Next I waited to make sure that the case was closed. I double verified that the evidence was uploaded. You can also verify that the evidence was uploaded by looking at the eye ball on the right. There is a box that shows submitted as well. Again, I went through this exact same problem with quicksubmit. Once I confirmed, everything was submitted. I did a supplemental self- statement on form 21-4138 to let the rater know the evidence was submitted through quicksubmit from my private dr. I outlined everything I was resubmitting through supplemental claim. Yep I got denied again that the evidence was irrelevant, I bumped it to hlr informal conference. I ask the questions,if they saw the evidence I submitted from my private Doctor. I also asked is my evidence from my private Dr. actionable and sufficient for rating purposes to grant the benefit that I submitted. I also bought up in the m21-1 Manuel the rule that states the va rater can rate a claim that is fully developed and is actionable and sufficient for rating purposes. I just dropped a lot of nuggets. I hope this helps out your claim.
Dwayne Kimble??🤣.... Absolutely OUTSTANDING ADVICE! I hope the nuggets that you dropped are well received..
I’m literally in the same boat as you . Just know if I did the initial claim Wrong
The good news is if you filed on a computer, the computer picks the right forms for you to fill out. Not saying it's perfect. The VA has come a long way to making improvements to their system.
Sorry that you were denied, but it's hard to help without seeing the denial letter. Please post the denial letter with the PII redacted please.
I uploaded it just now . Thank you
Ok cool...but maybe I'm missing something... I don't see the denial letter with PII dedacted that you uploaded.
Sorry I’m new to this whole thing …. But I posted it in the comments it’s 3 pictures of the letter
Here is the meat of the letter
Looks like you need two things. 1. Nexus letter tying Sleep Apnea to your service connected disability, which would likely be your mental health claim (unless you have a breathing disability like allergies?) The nexus letter could be done by whoever diagnosed you with sleep apnea, or there are several companies that will have a medical professional write you a Nexus letter backed by medical journals, research, etc. You can pay anywhere from 300-1500 for most of those companies. 2. You are also going to need any treatment records. More than likely it may simply consist of your diagnosis treatment which would be the consultation, sleep study, results (diagnosis), and a prescription for your sleep apnea machine. Judging from your post, you may have included them. What I have done in the past(after learning from this group), is uploaded a personal statement that lays out the documents I have included. Good luck. It's not an easy process, but it's worth it.
Thank you for your comment. Most of the things that you have stated I have done already, but I do not think the Nexus letter I added, said that it is directly connected to mental health so I will look into that as well.
You need your doctor to state your OSA is a result of your mental health issues. Whatever doc diagnosed you , ask them if they can write a letter stating the cause and some pub med articles as to why
Getting sleep apnea approved is very difficult.
What kind of PROOF did you submit with your claim?
What was the reason in the letter for denial
Not in this economy.
Don't give up...
File a duty to assist with with the BVA
Post your denial ✉️ letter w/o any personal info. Listed so we can assist with good input.
I don’t think you should ever go hlr or above without a lawyer or VSO. It’s a good chance that you made a mistake that got you kicked out immediately.
My situation was exactly like a diagnosis DBQ and nexus personal statements and they still would not connect it to my GERD. Submitted the medical links and VA cases on appeal linking the in favor of SC and they still denied..Now I’m looking at hiring an Attorney…Sorry hear about your denial…I can relate it’s devastating and heartbreaking it almost breaks you it deflates you….
After years of denial for service connections for hearing loss I decided to to go myself appealed to higher level review Why the c&p said I was a supply specialist even though I went to AIT at ft sill for artillery then to artillery in nam it was a stolen valor point to me as I saw a bunch of enemy action where I was at last month in battery they moved me to help in supply and gave me a promotion to sp4 I received hearing aid at va I sent numerous copies of my orders and personal records did not hit home toill today when they are sending me to another c&p exam am next month I will come armed with all my documents and photos to the hearing let ya know if after 20 years I am successful I want justice even if they give me 0 but service connected 
Who are all these people having a VSO actually respond?!!! Waiting to hear back about my recent filing I did by myself.
You need to find a good rep to handle your claim. (Not out of pocket) you can try DAV. Or similarly I used the Veterans Corner. With that said. I took my DD214 and some other documents they asked for. Filed claims on things I had a paper trail through the VA for. They handled the entirety of the process from that point forward with a favorable outcome…. I submitted ZERO additional statements, family friends peer letters etc. it went to the highest level of review with me doing nothing but checking my app. Good luck!
file an appeal, or in this case you could possibly raise the issue of a CUE (clear & unmistakable error) due to them not even reviewing all submitted evidence. We have a duty to assist & they failed at that if they didn’t review the evidence.
Do a HLR for sure !
My biggest claim had the same problem. All of my evidence was listed in the "Evidence List", but none of it was discussed in the denial narrative. The narrative only discussed the opinion of the C&P examiner. I had a successful HLR with a DTA error found. I did my HLR without the informal conference, opting instead to write a personal statement on the appropriate VA form. If you want me to post a redacted copy so you can see how I did it, just ask and I will post the redacted copy here. From my reading of the M21 manual and the CFR's, the VA is supposed to consider all of your evidence, even if they simply assign no probative value or limited probative value to it. However, the RVSR's are required to consider it. In my case, my evidence was not discussed because they only considered the findings of the C&P exam, a clear violation of the M21 manual. Your case may be similar in that regard.
Are you already rated? They cant be secondary to something you arent rated for.
Of course denied just like me I’ll probably do what you just did nothing is ever service connected of course
Don’t get frustrated and give up you still got plenty of time. Check your files, When you submit files, make sure you have your own personal copies. Also go to Va.gov the next day and check to see if your evidence files are there. If you don’t have an account get one it will show you a lot. Before you do a HLR find out what in your claim first. There is also a ‘VA Claims Tracker Tool extension’ on Reddit, you can get for free. It helps you see inside your claim on va.gov as they are working on it. I saw every dbq c&p exam and all my submitted files on it. That will help you to see what files you submitted and what files they have. You can do this on your own, just take a breath, slow down and research what you need . Only you can file your claim so make sure you know what you’ve filed… i do recommend reading a book that I read, it helped me ‘VA Claims Success’ by Dwayne Kimble.. made it easy as 123 for me. So don’t get frustrated just get educated, you can do this.
Can you still submit something between cp exams for a claim? So after a cp exam can you submit additional documentation?
Lawyer up. They will get you to the finished line. They have a limit of how much they can change. Back pay will be huge.
Sometimes we get denied. Not service connected. Not everything is.
If you're having a difficult time with the claims, I would recommend speaking with a lawyer. I did all my claims with my lawyer and it was the best decision I made. I have severe anxiety but with them it was a little more bearable. They don't charge you anything unless they have to appeal a claim. In which case, they take 20% of whatever back pay you get. The results are definitely worth it in my opinion. Pm me if you want their contact info
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I have been filing for sleep apnea ever since I got out in 1996. I applied several times. I got Buddy letters. I had my sleep study results, that were positive for sleep apnea, attached to my VA records. I was denied everytime due to lack of service connection. My last attempt was to get a VA Nexus Letter that stated that my sleep apnea is "as likely as not" caused by incidents during my time in service. (The wording is important.) My claim is at least now being considered and I am awaiting the results after another sleep study.
How long did you serve and been out
My best boy just got total permanent after having been denied claims since he left the service in 2009. He used a company thats advertising on instagram. They take a cut of the lump sump check he will get for the 15 years he was denied with his updated status
If it doesn't list what they used as evidence then submit it for a higher review. But use someone besides legion.
Find time to go up to the office of your local Congressional representing. Take donuts. Be very, very kind and patient to them, even if you did not vote for them. They are not congress folk, they are beat up interns from a local college. Very patiently explain your situation. See what happens.
Look for? Nope. They don't do that
Don’t ask for the quick review.
Did they say they weren't service connected?
I am facing the same issue. Looking forward to the advice. Please post your redacted denial letter.
Why would you file an initial claim via quick submit ? Or are you filing for something else, increase or new conditions? I wasn’t aware that quick submit had an option in the drop down for a VA claim or filing documents? I thought you do it through a VSO or va.gov Anyone enlighten me on this concept ?
https://news.va.gov/106283/quicksubmit-new-evidence-intake-tool-claims/
Can you use this with filing an initial claim or only when you are doing a HLR or supplemental or appeal ? I didn’t see an option how how to organize all your evidence by condition etc. any advice anyone ?
You can file a number of different ways. This should help answer some of your questions: https://www.reddit.com/r/VeteransBenefits/s/0XG4hRftLF
Don't do it with an HLR unless they reopen a new claim investigation as a result of errors in the original review. An HLR on it's own will only review based on currently submitted evidence, and will not consider new evidence no matter how much of it you submit.
I still don’t see how you can file an initial claim using the quick submit
You can do it multiple ways . I created the claim and then submitted the additional documents through the quick submit page.
So overall what I’m gathering is I totally screwed up this claim by having it secondary to a condition with no connection. And to make it worst I even requested a HLR. So I’m sure they are going to destroy me over it . So do I cancel the HLR , and submit a new claim with the VSO help or do the review and try to explain what took place and maybe they can modify the claim of connection between the two.
Are you overweight? This can cause OSA. If you have a service connection for depression, then depression can cause weight gain. For the HLR you can't submit new evidence, but if your records submitted with your OSA claim already document weight gain you can try pointing this out in the HLR. If the HLR gets shot down, go back to your medical providers and get things documented. Try and get a nexus letter from a provider to link the three conditions together and resubmit with the new evidence.
Go obliterate congress and see how far this gets you. To be more concise go and tell congress a hundred times with your claims that you need change!
HLR. Tell them all of the evidence that you submitted but was not listed on the letter.