Hi all,
I am currently diagnosed at 50% PTSD. A few years ago, prior to the PTSD diagnoses, I was diagnosed with mixed (central, and obstructive) sleep apnea.
I recently submitted a claim for sleep apnea secondary to PTSD with the assistance of the Disabled American Veteran's org (DAV). The VA called today and wants to schedule a C&P exam at the VA.
I have a few questions questions:
-Based on anyone here who knows, should I go through the VA for this exam, or should I insist on an outside contractor (which the lady who called said I could do)? Vet friends have said the VA and their doctors will do all the can to deny.
-Also, I do not currently have a nexus letter. I only have what is in my files which is a diagnosis for PTSD and one for Sleep Apnea. Should I get a nexus letter? If so, they cost like $1500. Anyone know of a cheaper source? Also, will submitting evidence (studies, articles linking sleep apnea and PTSD) on my own do the job?
Thank you in advance for all your help!
Welcome to the PEB Forum!
In retrospect a couple of years ago, I submitted a DoVA claim (with case studies & articles linking sleep apnea and PTSD but didn't have a nexus letter) via eBenefits requesting sleep apnea as a secondary condition to PTSD also. After my disability claim submission, the DoVA VBA scheduled me for two C&P exams; one for sleep apnea and one for PTSD. In short, the QTC civilian contractor performing the sleep apnea C&P exam didn't believe my PTSD caused my sleep apnea so a favorable nexus statement/letter wasn't written. Also, I declined the C&P exam for PTSD since I already had a "100% P&T rating" within the DoVA. Therefore, I didn't want to be involved in a situation where the VBA could potentially recommend lowering my PTSD 100% P&T rating due to any acceptance on my part in the performance of another PTSD C&P exam.
In my experienced opinion, the importance of a nexus letter or a written opinion from a medical doctor as to whether a condition is related to a specific incident during military service can't be overstated! As such, the medical doctor's opinion for nexus should be expressed as follows:
#1. “is due to” (100% sure)
#2. “more likely than not” (greater than 50%)
#3. “at least as likely as not” (equal to or greater than 50%)
#4. “not at least as likely as not” (less than 50%)
#5. “is not due to” (0%)
To an extent, it would seem that in order to potentially receive a favorable decision from the DoVA Rating Agency, the medical doctor needs to express his/her nexus opinion with key phrases #1, #2, or #3 as annotated above. Otherwise, it would seem that the DoVA Rating Agency will probably deny the sleep apnea secondary to PTSD disability claim.
Bottom line is that you will need a medical doctor's opinion for nexus since it wasn't provided with the submission of your sleep apnea secondary to PTSD disability claim. This can be accomplished by allowing the DoVA VBA to schedule a C&P exam either at the nearest VAMC or at a medical contractor's facility OR by scheduling your own medical appointment for the medical provider to complete the applicable DoVA DBQ at your expense. As such, there aren't any guarantees that you will receive any of the aforementioned nexus opinion key phrases needed for a favorable DoVA Rating Agency decision. So, it would seem far more financially beneficial to allow the DoVA VBA to schedule a C&P exam whether via a VAMC or a contractor-provided medical facility at least in my experienced opinion. Also, during my prior research, I read numerous articles/studies linking PTSD and sleep apnea. From the advise of a veteran who submitted such articles/studies and was eventually granted sleep apnea secondary to PTSD, I decided to submit the research articles also. It didn't help albeit that was in my own particular disability claim situation; yours will certainly be different.
With that all said, hmm, exactly what type of DoVA C&P exam does the VBA want to schedule for you? Is it a C&P exam for Sleep Apnea, a C&P exam for PTSD, or both? If they want to schedule a PTSD C&P exam, it's highly important to be aware of accepting another PTSD C&P exam to include the results it shall provide. Based upon the new C&P exam results, the DoVA Rating Agency may also either increase your PTSD rating, continue the current PTSD rating, or recommend lowering your PTSD rating. Are you willing to accept a lowered PTSD rating? Do your medical documentation also show symptomology which supports a potential lowering of your current PTSD rating? If so, then accepting another PTSD C&P exam isn't a favorable course of action at this point. If not, then there are not any concerns with accepting another PTSD C&P exam at this point. In relation to the Sleep Apnea C&P exam, the same principles as stated above could be applicable too if a current DoVA rating exist. Overall, I would suggest to ensure that there doesn't exist any unfavorable medical evidence/documentation in your medical records which could also support a potential lowering of your PTSD rating and/or Sleep Apnea rating (if any currently exist). Take care!
Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"
Best Wishes!
