Proposed ratings and I'm angry!

Jason thank you for the response.

Glad to help (and hope it helps....though, I am not sure it will. Seems, from what you have written, you will have to wait to fight out your main issues with the VA once you are retired).

The VA proposed ratings for my referred conditions are fair and accurate for the IDES portion, it is the VA I have an issue with.

I think, based on what you wrote, you have identified where your fight lies- it is with the VA. Unfortunately, you likely cannot get at this until you are retired.


When I made my list for the DoVA representative I took my med record from the PEBLO and went page by page with everything I have ever been seen for or had an outside provider diagnose. The for C&P exams they told me that a sleep study couldn't be conduct because there wasn't facility located near by. QTC made a psych, hearing, and general physician appointment for me. The psychologist reviewed my mental issues, but also my sleep study issues, which was odd to me but the issues did not relate and one was diagnosed way before the other. Hearing was a good exam and no issues there. General physician was the worst, the examiner just seem to not care about my case and ran through it, did touch my Q&A from QTC, and did not answer me when I was asking her questions. I knew my VA side of the case was going to be a battle at that point.

Sounds like you have some good basis for fighting the VA once you get to that point- when you are "out" and retired.

It sucks having to fight this issue when I am out now. I have taking all the evidence and will take all the evidence, until they finalize my case, and upload it to ebenefits as supporting documents. Do you think this will help at all Mr. Perry?

Yes, this is helpful, but remember that is must be related to something....which in your case will be the filing of a Notice of Disagreement. You must point or reference the evidence to support your NOD. So, uploading it may be a way of showing or presenting it to the VA, don't assume that they will get it right or understand what you are talking about just because you have uploaded the evidence. Make sure you either include or reference the evidence in your NOD (probably, better to include).

I will also ask for increases and reconsideration for all claimed and non service connected items also.
Claim or file for an increase for all you are due. (Probably, best through the filing of the NOD). Get all you are due!

Hope this helped. Sorry I didn't have a "magic bullet" to help you get there faster. Best of luck!

Jason
 
I am sorry for the stress this has caused. I am new to the board, but I think you should hire an attorney. Your financial future truly depends on it (IMO). All the best -
 
Chris, I was finally able to get my proposed ratings today. Very similar to your situation. 90% with a handful of conditions that aren't service connected and I've been in 14 years. I thought that the 8 year rule made pretty much everything service connected. I'm not sure what I'm going to do, because I just got the word and am letting it sink in. But I like what Jason said about approaching this after I'm out. If my math is right and DOD found all of my referring conditions unfit I will be retired.
 
Chris, I was finally able to get my proposed ratings today. Very similar to your situation. 90% with a handful of conditions that aren't service connected and I've been in 14 years. I thought that the 8 year rule made pretty much everything service connected. I'm not sure what I'm going to do, because I just got the word and am letting it sink in. But I like what Jason said about approaching this after I'm out. If my math is right and DOD found all of my referring conditions unfit I will be retired.
Sad to hear this has occurred to you as well. It literally boggles my mind, I literally have medical notes and doctor visits for these complaints and they were said to be not connected? I mean you and I have not separated from the service, so these conditions should all be service connected. I mean if the C&P did not cover the condition fully it should have been at least rated zero so that a rating increase request can be put forth later. I have 3 sleep studies stating I have central sleep apnea since 2015 and on Oct 24th I have a follow up for a CPAP. None of this is right and I hope that the final review of our VA records for the final rating changes somewhat from what the proposed rating is.
 
@Chris_USMC_E6

Do you have copies of those exams and if so, why werent' you issue a CPAP machine?
 
@Chris_USMC_E6

Do you have copies of those exams and if so, why werent' you issue a CPAP machine?
I was sent to a specialist for hypersomnia. When undoing the study he discovered I have central apnea episodes. He tried triazolam first and now is having me return for a CPAP discussion. I uploaded those documents to Ebenefits. They were also sent up with my C&P exams to the VA, I saw the notes in my medical records. What messed all this up in my mind is that the C&P examiner wrote that basically I was full of crap and never had a sleep study done, but she never asked nor talked about my sleep during her evaluation. I suppose the VA took her word and never reviewed my military records. I hope that they look at all my evidence for the final rating.
 
Triazolam is typically prescribed for insomnia, not sleep apnea. If you have not been prescribed a CPAP, then you do not meet the criteria for OSA at 50%.

I have seen trials of Triazolam for use with central apneas, but the evidence is inconclusive that there is a benefit. There is a possibility that they will look at all of the evidence during the ratings process, if it is left out, you can argue to the PEB that you believe you central apnea is unfitting.

Was your sleep study conducted by a Pulmonologist? If not, you will have difficulty getting it rated by the VA.

You may have to claim the condition with the VA once you are rated and out of the military. I know it may suck to wait to get paid, but you will get a sleep study conducted by the VA and that evidence will be used to determine your rating.
 
Triazolam is typically prescribed for insomnia, not sleep apnea. If you have not been prescribed a CPAP, then you do not meet the criteria for OSA at 50%.

I have seen trials of Triazolam for use with central apneas, but the evidence is inconclusive that there is a benefit. There is a possibility that they will look at all of the evidence during the ratings process, if it is left out, you can argue to the PEB that you believe you central apnea is unfitting.

Was your sleep study conducted by a Pulmonologist? If not, you will have difficulty getting it rated by the VA.

You may have to claim the condition with the VA once you are rated and out of the military. I know it may suck to wait to get paid, but you will get a sleep study conducted by the VA and that evidence will be used to determine your rating.
Yes it was conducted by Doctor Peter Manos who is a Pulmonologist. All my studies have been done through him. My next appointment is to discuss the CPAP. I hope to have one assigned to me before exiting the service. Triazolam was not effective it made my hypersomnia worse, on two occasions I almost slammed into a tree after 10 hours of sleep and 2 large monsters I was still falling asleep in the middle of the day. I suppose that I'm lucky to have been referred to a specialist for most of my issues. I took my reports from his patient portal and uploaded them to the Ebenefits as additional evidence. I also uploaded all the other evidence regarding the items they stated were not service connected.
 
In my opinion, you should attempt to get the sleep study conducted through the VA with Tricare paying for it. That is what I did while on active duty.

I had my PCM put in the referral, then once I got the referral from Tricare, I had it switched to the VA. All you really will need is the TIN for the VA.
 
In my opinion, you should attempt to get the sleep study conducted through the VA with Tricare paying for it. That is what I did while on active duty.

I had my PCM put in the referral, then once I got the referral from Tricare, I had it switched to the VA. All you really will need is the TIN for the VA.
When they put me through the C&P exams here in Beaufort, SC they told me I was not going to be evaluated because there wasn't a VA sleep facility in my area. I'm sure if I drove an hour or more I could find one. You would think a specialist would trump the other exam? I have 4 more referrals but I don't think they are going to provide a new study if I have already been diagnosed? What is your thoughts?
 
When they put me through the C&P exams here in Beaufort, SC they told me I was not going to be evaluated because there wasn't a VA sleep facility in my area. I'm sure if I drove an hour or more I could find one. You would think a specialist would trump the other exam? I have 4 more referrals but I don't think they are going to provide a new study if I have already been diagnosed? What is your thoughts?

Get your sleep study at the VA
 
I was sent to a specialist for hypersomnia. When undoing the study he discovered I have central apnea episodes. He tried triazolam first and now is having me return for a CPAP discussion. I uploaded those documents to Ebenefits. They were also sent up with my C&P exams to the VA, I saw the notes in my medical records. What messed all this up in my mind is that the C&P examiner wrote that basically I was full of crap and never had a sleep study done, but she never asked nor talked about my sleep during her evaluation. I suppose the VA took her word and never reviewed my military records. I hope that they look at all my evidence for the final rating.

W/O a sleep study on black and white nor a CPAP = no ratings. Get the study complete the soonest
 
W/O a sleep study on black and white nor a CPAP = no ratings. Get the study complete the soonest
You guys are not hearing me. I have not one, but three studies on paper that confirm central sleep apnea, hypersomnia, sleep paralysis, and insufficient sleep syndrome. I have those three write ups from the Pulmonologist uploaded to ebenefits. Hypersomnia with central apnea is 30% without a cpap and 50% with a cpap. That is what the rating states. My follow up is on Oct 24th for the CPAP discussion which I will press for. The VA should of rated me the 30% for apnea with hypersomia, but instead they wrote it off as not service connected and put my hypersomnia under anxiety???? My results are completely fubar and need to be redone by the VA.
 
Chris_USMC_E6,

Read below. I understand that you are frustrated. Just, my read, from what you have written, leaves you no recourse under IDES to address the non-unfitting conditions with the VA. Under IDES rules, if you have a beef with the VA for conditions that are not unfitting, you have to raise it with the VA- once you are out (retired).

You guys are not hearing me. I have not one, but three studies on paper that confirm central sleep apnea, hypersomnia, sleep paralysis, and insufficient sleep syndrome. I have those three write ups from the Pulmonologist uploaded to ebenefits. Hypersomnia with central apnea is 30% without a cpap and 50% with a cpap. That is what the rating states.

Not sure if you are digesting or appreciating the procedural issue- under IDES, you cannot raise or challenge the VA ratings via a VARR for conditions that are not unfitting.

I think you are focusing on the what should be the final result or findings of the VA. Sounds to me like you have a solid case for a successful appeal to the VA findings. All I have pointed out and written is the FACT that PROCEDURALLY there is no mechanism withing the IDES PROCESS to raise this issues now. If you were found unfit for the sleep apnea, then you could. But, from what you have stated, they did not find this condition unfitting and you agree with that.

So, if the above is correct, you have to wait until you are retired (and get your finalized VA ratings) to take the next step to address this issue- file a NOD.

My follow up is on Oct 24th for the CPAP discussion which I will press for. The VA should of rated me the 30% for apnea with hypersomia, but instead they wrote it off as not service connected and put my hypersomnia under anxiety???? My results are completely fubar and need to be redone by the VA.

Yes, assuming- as I do- that all you say is correct, PROCEDURALLY, you cannot do more with this until you are "out"/retired.

I could just tell you something made up or what you want to hear. But, the reality is what I have stated previously.

The above may be bad news. The good news is that I think you have a good case once you are at the right place in time PROCEDURALLY.

Unless you have other facts, that is the situation. Feel free to ignore my input.

No matter, I hope things go well for you and you get all you are due. Best of luck!!

Jason
 
Chris_USMC_E6,

Read below. I understand that you are frustrated. Just, my read, from what you have written, leaves you no recourse under IDES to address the non-unfitting conditions with the VA. Under IDES rules, if you have a beef with the VA for conditions that are not unfitting, you have to raise it with the VA- once you are out (retired).



Not sure if you are digesting or appreciating the procedural issue- under IDES, you cannot raise or challenge the VA ratings via a VARR for conditions that are not unfitting.

I think you are focusing on the what should be the final result or findings of the VA. Sounds to me like you have a solid case for a successful appeal to the VA findings. All I have pointed out and written is the FACT that PROCEDURALLY there is no mechanism withing the IDES PROCESS to raise this issues now. If you were found unfit for the sleep apnea, then you could. But, from what you have stated, they did not find this condition unfitting and you agree with that.

So, if the above is correct, you have to wait until you are retired (and get your finalized VA ratings) to take the next step to address this issue- file a NOD.



Yes, assuming- as I do- that all you say is correct, PROCEDURALLY, you cannot do more with this until you are "out"/retired.

I could just tell you something made up or what you want to hear. But, the reality is what I have stated previously.

The above may be bad news. The good news is that I think you have a good case once you are at the right place in time PROCEDURALLY.

Unless you have other facts, that is the situation. Feel free to ignore my input.

No matter, I hope things go well for you and you get all you are due. Best of luck!!

Jason
Jason trust me you have been a huge help. If I didn't have a tentative offer for a government job I would have gone to a formal board to add the central sleep apnea as unfitting. With the time ticking down for my ratings to be presented by the PEBLO I need to be out by mid Nov. to secure the position, which is about where I'm at currently. My earlier frustration was me pointing to the facts, and that is I do have copies written in black and white about these prognosis's. I requested a representative from the American Legion, are they any help once out or is a civilian lawyer more beneficial?
 
I requested a representative from the American Legion, are they any help once out or is a civilian lawyer more beneficial?

Technically, for "original VA claims" lawyers are not supposed to be able to charge a fee....so, by default, a lawyer is not the way to go with your original claims. (There are ways around this, but, for a lot of reasons, basically, most good lawyers also won't touch the early "pure" VA claims). Long way of saying, most likely VSO/American Legion is a fine choice. Now, a slight caveat- not all VSOs are equally good. Some are studs, some are duds. I would suggest talking to your rep, seeing if you have a warm fuzzy and think it is a good fit and proceeding from there. If you have a bad feeling, feel free to "fire" the rep, seek another from the same organization or from a different organization. From what you have stated, your issues/case is not very complicated so I would suspect that you can/would get decent assistance.

Hope all goes well for you. Best of luck!!

Jason
 
Technically, for "original VA claims" lawyers are not supposed to be able to charge a fee....so, by default, a lawyer is not the way to go with your original claims. (There are ways around this, but, for a lot of reasons, basically, most good lawyers also won't touch the early "pure" VA claims). Long way of saying, most likely VSO/American Legion is a fine choice. Now, a slight caveat- not all VSOs are equally good. Some are studs, some are duds. I would suggest talking to your rep, seeing if you have a warm fuzzy and think it is a good fit and proceeding from there. If you have a bad feeling, feel free to "fire" the rep, seek another from the same organization or from a different organization. From what you have stated, your issues/case is not very complicated so I would suspect that you can/would get decent assistance.

Hope all goes well for you. Best of luck!!

Jason
Thanks Jason I'll report back when my DoD ratings return, and what the over all final rating looks like. I'm praying for the best but expecting the worst so I'm prepare for the damage either way.
 
You guys are not hearing me. I have not one, but three studies on paper that confirm central sleep apnea, hypersomnia, sleep paralysis, and insufficient sleep syndrome. I have those three write ups from the Pulmonologist uploaded to ebenefits. Hypersomnia with central apnea is 30% without a cpap and 50% with a cpap. That is what the rating states. My follow up is on Oct 24th for the CPAP discussion which I will press for. The VA should of rated me the 30% for apnea with hypersomia, but instead they wrote it off as not service connected and put my hypersomnia under anxiety???? My results are completely fubar and need to be redone by the VA.

Were the studies already loaded to ebenefits prior to VA ratings (doubted)?

Were the same studies triggered by C&P or IDES?
 
Were the studies already loaded to ebenefits prior to VA ratings (doubted)?

Were the same studies triggered by C&P or IDES?
The studies were submitted with my medical records to the VA. I contested the C&P to the DoVA rep and he even admitted that he couldn't deny that inside my records since 2015 has been diagnosis for central sleep apnea. He stated the medical record goes to the VA along with any other evidence. I don't know how they missed this and determined it not service related. So I uploaded nearly two years worth of evidence from my PCM and Pulmonologist to Ebenefits just in case they seem to forget that it was submitted the first time around.
 
If the studies and the apneas were diagnosed and conducted in 2015, why would you not push for a CPAP right thereafter in 2015?

Did you claim the apneas as disability to VA?
 
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