Diagnosed with Sleep Apnea AFTER C&P Exams and dealing with the VA via IDES

[SanDiego2009]

Happy New Year,
I wanted to see what was the process of filing a new VA claim while undergoing IDES. I finished all my exams with the VA and my case is at the PEB level.

Can I file a new claim for a recently diagnosed medical condition(sleep apnea) while still being in PEB? This diagnosis occurred after all my exams were finished via doctor at Portsmouth.

 

[assmilk]

I reached out to my MSC regarding this - You will need to fill out a new VA form 526EZ, You will also need to provide the medical evidence with the VA form. My issue with this is that I have gone to CAS regarding my new medical condition and they have yet to populate the medical document on MHS genesis. I went Dec 5th and they still have not populated it, I went in person regarding this and essentially they gave me the treatment for it - a referral to physical therapy as well as medication / but there is still no document that I am able to submit to be able to add the condition. I am worried about this because i will most likely get my final results back before medical is able to upload the documentation (its funny that this has never been an issue before but now I am encountering it when I specifically need a medical document in a certain timeline). In the case that I get my final results back before I am able to provide documentation - does anyone know how I can go about adding the diagnosis?? Please let me know

 

[Provis]

Happy New Year,
I wanted to see what was the process of filing a new VA claim while undergoing IDES. I finished all my exams with the VA and my case is at the PEB level.

Can I file a new claim for a recently diagnosed medical condition(sleep apnea) while still being in PEB? This diagnosis occurred after all my exams were finished via doctor at Portsmouth.

You can also file after you get out and as long as its within a year of getting out it will be backdated to the same date as your IDES VA claims.

 

[assmilk]

You can also file after you get out and as long as its within a year of getting out it will be backdated to the same date as your IDES VA claims.

When you do this do you have to re-do the entire C and P head to toe?

 

[JoelPettit]

I'll try to shed a bit of light on this, from a functional standpoint. Simply put, there is ZERO requirement to have a VA disability rating for a condition when seeking to add it/having it considered during the IDES/PEB process. In fact, unless the diagnosis in and of itself causes a Service member to be unfit (yes, there are a few diagnoses that do), the PEB won't bat an eye unless you can show the condition causes funtional loss. Nevertheless, if the unrated condition causes you to be unfit and the PEB determines it so, the PEB will request the VA rate the unfitting condition before it renders its final decision. To be clear, I have not commented on the evidentiary weight of VA ratings during an IPEB, FPEB hearing, or PFR (USN/USMC), as that would require much more discussion and analysis of case-specific facts that would be inappropriate on a public forum.

Therefore, if you stay silent and don't request an FPEB or PFR on the basis of not having a VA rating, you will likely not have standing to appeal to BCNR later, as you didn't exhaust your administrative remedies.

The above discussion notwithstanding, if the goal is to avoid post-IDES VA complications/have accurate ratings upon exiting the military, filing a new VA claim during the IDES makes complete sense, in theory. Of course, in reality, there is always risk that the initial ratings will be reviewed and changed. Although I cannot comment on the magnitude of this risk, the decision to shoulder this risk must be made with extreme care and close attention to the facts of your individual case.

I hope this helps.

 

[assmilk]

I'll try to shed a bit of light on this, from a functional standpoint. Simply put, there is ZERO requirement to have a VA disability rating for a condition when seeking to add it/having it considered during the IDES/PEB process. In fact, unless the diagnosis in and of itself causes a Service member to be unfit (yes, there are a few diagnoses that do), the PEB won't bat an eye unless you can show the condition causes funtional loss. Nevertheless, if the unrated condition causes you to be unfit and the PEB determines it so, the PEB will request the VA rate the unfitting condition before it renders its final decision. To be clear, I have not commented on the evidentiary weight of VA ratings during an IPEB, FPEB hearing, or PFR (USN/USMC), as that would require much more discussion and analysis of case-specific facts that would be inappropriate on a public forum.

Therefore, if you stay silent and don't request an FPEB or PFR on the basis of not having a VA rating, you will likely not have standing to appeal to BCNR later, as you didn't exhaust your administrative remedies.

The above discussion notwithstanding, if the goal is to avoid post-IDES VA complications/have accurate ratings upon exiting the military, filing a new VA claim during the IDES makes complete sense, in theory. Of course, in reality, there is always risk that the initial ratings will be reviewed and changed. Although I cannot comment on the magnitude of this risk, the decision to shoulder this risk must be made with extreme care and close attention to the facts of your individual case.

I hope this helps.

In the case where someone is already in the PEB phase and only wants to add a condition that they know will not affect the military percentage outcome and only wants to add it to correctly have their VA disability percentage be more accurate, when adding a new condition that you have medical evidence for that occurred after someone began the PEB phase, would they have to risk their entire disability percentage being re-evaluated / re doing the head to toe exam or would it just be an exam for that new condition?

 

[chaplaincharlie]

I recommend you prepare a fully developed claim. This can be done online, without an exam.

On you first day out of the military. Go to E-benefits and claim OSA. Then upload to the claim your sleep study and Rx for CPAP.

 

[Provis]

When you do this do you have to re-do the entire C and P head to toe?

Nope. In fact most times there is no C&P exam needed. Just upload your sleep study and prescription for CPAP. My wife claimed sleep apnea and was in your exact situation where she was diagnosed after having all of her IDES C&P exams. She filed and got it for 50% without needing to go to an exam.

 

[JoelPettit]

In the case where someone is already in the PEB phase and only wants to add a condition that they know will not affect the military percentage outcome and only wants to add it to correctly have their VA disability percentage be more accurate, when adding a new condition that you have medical evidence for that occurred after someone began the PEB phase, would they have to risk their entire disability percentage being re-evaluated / re doing the head to toe exam or would it just be an exam for that new condition?

To be blunt, to my knowledge there is no publicly available regulation, directive or law stating VA examiners are prohibited from correcting errors in a Service member's file upon the member submitting a supplemental claim to his or her MSC. That's functionally what would be needed for there to be ZERO risk. In my experience, the risk is quite low; however, this does not mean there is no risk. Some may say my view is overly cautious. I'd argue that it all comes down to a risk-reward analysis for your unique circumstances. You are the one who must live with the consequences, so it must be you who weighs the benefits against the potential costs.