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VA Claims: Disabled Veterans Community|Hadit.com

How to apply for disability for Hypothyroidism

I’m currently at 70%, pending an appeal for PTSD. Over the last couple years, VA has been watching my thyroid (multiple nodules), ended up having a total thyroidectomy this past December, so I am on the Synthroid roller coaster, trying to get my levels under control, dealing with depression, sensitivity to light, sensitivity to cold, nausea, dry skin, headaches, fatigue, etc. – this condition has severely impacted/changed my way of life. I’ve always had struggles with my weight, being borderline for the weigh-ins, was put on the PT program because I was over the body fat %, I was diagnosed with sleep apnea (non-service connected; they never tested me while I was active duty). How do I approach applying for service connection for the hypothyroidism with secondary sleep apnea (OSA) and depression? People are telling me that there’s a clear nexus there to prove service connection.

Tips for Sleep Apnea Secondary to PTSD/Mental Disorder Claims

Moderator, you might want to Pin this somewhere, as this seems to be a recurring trend.
I have given out this information to others, but I will post it here so that others can find it rather than searching through the forum.
First and foremost, claiming and getting sleep apnea secondary to PTSD or Mental disorder is not easy. I have personally seen more lost than won, however, it can be obtained and I myself have personally received it.
If you had sleep apnea diagnosed while in active duty, it is usually a slam dunk……..for the rest of those trying to get it, it could require a lot of work. I suggest trying to get it both direct and secondary service connected.
It is easier to get sleep apnea as a direct service connection obviously, however, most Veterans do not get it diagnosed while in service. Best way to get that resolved is through buddy statements. I suggest getting 3-4 (I personally had 7-8) or more. Do not have them only say that they saw you snoring…….that is great and all, but that is not a symptom of sleep apnea…….it is incidental. They would need to say that they saw you gasping for air, choking, etc. Preferably roommates. If you were deployed, it would be easy to have many people saying that they saw/heard this as you would have more than likely been in an open bay setting at some point in time. You can also have your spouse write up a statement. This all needs to be during active duty periods of times and dates need to be included. M21-1 reference III.iii.2.E.2.b “Types of Evidence VA May Use To Supplement or as a Substitute for STRs” allows for buddy statements to act as STRs for medical evidence………if they are certified “buddy” statements or affidavits………….having them written on VA Form 21-4138 solves this issue as it has the appropriate verbiage written near the bottom. Under M21-1 reference III.iii.1.B.7.a and 38 CFR 3.200, it meets the certification criteria……….problem solved. From my experience, getting all of the buddy statements needed can take longer than you originally anticipate….plan ahead.
Now, for secondary criteria.
Have you ever been diagnosed with alcohol abuse (it is frequently written as “ETOH”)? If so, has it been attributed to your mental disorder or did it exist prior to that and is it considered willful? If you have been diagnosed with alcohol abuse, and it is attributable to your mental disorder, guess what, alcohol consumption is attributable to sleep apnea.
would suggest that you start doing your own academic research. You might be able to locate peer-reviewed academic journal articles (those are the types of articles that you want to submit) through https://www.researchgate.net/. If not, another alternative is using a college database to search academic journals through. Ah, but you need to be a college student to use the database to search academic journals through. One might make an argument that you could register for classes at a local community college (you can even register online nowadays without even stepping foot on campus) and even register for “late start” classes, and have access to the aforementioned database immediately (hint hint, look in the academic journal Chest); one could easily find within a 60 minute search at least 5 appropriate and recent journal articles clearly establishing a link between specific mental disorders and sleep apnea; there is a clear link between PTSD, anxiety disorders, depression, and especially schizophrenia. One might make an argument that you could simply then disenroll from the classes that you enrolled in by the date specified in order to get a full refund, thereby being charged nothing. Save the academic journal articles as pdf files, and create a work cited page (bibliography) for them in APA format (google is your friend.)
You now have a choice………..
Submit your claim with the buddy statements, mental health notes from a private provider, and evidence that you have and go with either a VA exam or vendor exam (whichever is given) or you can get an IME and IMO from private providers. If go the latter route, I would schedule one with a sleep specialist, why, because sleep apnea is their specialty. Pulmonologists also fall within this scope as well, though I suspect that you will have better luck finding a sleep specialist believing there to be a link between mental disorders and sleep apnea. You will get a Sleep Apnea DBQ and an IMO. Make sure that you have your C – File first as an examiner is required to have access to it and state that they have seen it on the DBQ for it to acceptable proof to the VA.
I would also get one from your psychologists/psychiatrist (Make sure that they are a psychiatrist or a psychologist…..if a psychologist, they need to be PsyD or Ph.D., or under the observation of a Ph.D.).
Make sure before you solicit those medical opinions, that you acquire “buddy statements” from 3-4 (or even more) people with whom you served. Roommates would be best, or people who slept in close proximity to you………again, this is only if you believe that sleep apnea developed while you were in Active Duty service. Make sure that they are written on VA Form 21-4138. Make sure they say that they witnessed clear symptoms of sleep apnea i.e. gasping for air, choking sounds, moments where they visibly or auditorily could determine that you ceased breathing etc.
Remember, you will want the sleep specialist and the psych professional to have your academic journal articles and buddy statements.
Once you have all of them, solicit your medical opinions from the two aforementioned providers.
Ideally, you would love for the IMOs to say that they believe that you could be both direct service connected for sleep apnea or secondary due to mental disorder, possibly even say that the mental disorder and sleep apnea aggravate one another (which there is medical evidence to support.)
If you opt to go the route of getting the private IMO and IME, you will obviously submit those with your claim, and all medical records from private providers pertinent to sleep apnea and your mental health treatment, buddy statements, academic journal articles, and a nicely written statement written by yourself on a VA Form 21-4138 talking about the issue at hand and summarizing everything concisely. Mention everything that you are providing that you wont to be considered for the claim, and when the issue first manifested.

Tips for Exams from a VSR

First and foremost, it would always behoove you to write out support of claim statement for each and every contention that you are filing a claim for. Make sure to bring a copy of this with you to your exam. It would be highly intelligent to have any paperwork that would be critical for your examiner to have pertaining to your claim on hand with you when at your exam. Case in point, when I went for my sleep apnea exam, my examiner stated that they couldn’t find the sleep study. I knew that it was in VBMS (the system that stores all documents and the system that VSRs and RVSRs aka raters use to process claims) as the VA not only sent me out for the sleep study to a third party, but I also submitted the results as part of my evidence that I was building and submitting for my sleep apnea claim. However, there was no issue because I simply handed her a copy of my sleep study because I had it on hand. I literally had a thumb drive with all x rays, MRI images, radiology reports, C File, buddy statements, support of claims etc, and paper copies of any relevant information that could potentially be asked for.
For hearing loss and tinnitus exams, know what can and won’t give your statement more probative value. Yes, your MOS/Rate will be taken into account. So will combat. If you can prove via DD 214 i.e. Combat Action Bage, Combat Infantry Badge, Combat Medic Badge, Purple Heart……….you get the idea, they are awards that can concede combat exposure. This gives more probative value to any of your statements made concerning hearing loss. However, keep in mind, with regards to hearing loss, they primarily look at audiograms………….entrance and exit audiograms, and any audiograms that you provide up to 12 months after service……….much beyond that, one can’t likely connect that to service. If one shoots guns recreationally, rides a motorcycle to work, uses power tools regularly etc, this also throws other factors into the equation that could affect hearing loss.
For tinnitus…………if you are claiming tinnitus, I honestly don’t know why one would show up to the exam and say that their ears aren’t ringing, but it happens all of the time. Another common phenomenon is that people didn’t complain about it in service or go to get treated for it (there is no treatment really for it other than trying lipoflavinoids or newer hearing aids that can block it out via white noise.) However, there is one little-known thing about tinnitus……it is essentially the only illness that a Veteran can actually diagnose themselves.
Here is the most important manual reference for tinnitus claims………….it clearly says that you do not need a diagnosis of tinnitus in service so long as you provide a competent lay statement indicating that you had it while in service AND you get it diagnosed later on (hint hint……..get an exam done privately.)
III.iv.4.D.3.b. Requesting Medical Opinions for Tinnitus
A medical opinion is not required to establish direct SC for claimed tinnitus if
STRs document the original complaints and/or diagnosis of tinnitus
there is current medical evidence of a diagnosis of tinnitus or the Veteran competently and credibly reports current tinnitus, and
the Veteran claims continuity of tinnitus since service or there are records or other competent and credible evidence of continuity of tinnitus diagnosis or symptomatology.
Exception: An opinion may be necessary in the fact pattern above if evidence suggests a superseding post-service cause of current tinnitus.
A tinnitus examination may also be necessary if the STRs do not document tinnitus but
there is evidence establishing noise exposure or another in-service event, injury, or disease (for example ear infections, use of ototoxic medication, head injury, barotrauma, or other tympanic trauma) that is medically accepted as a potential cause of tinnitus, and
there is a competent diagnosis or competent report of current tinnitus.
Notes:
Under Jandreau v. Nicholson, 492 F.3d. 1372 (Fed. Cir. 2007), a layperson may provide a competent diagnosis of a condition when a layperson is competent to identify a medical condition. Tinnitus is a medical condition that a layperson is competent to identify in himself/herself because the condition is defined by what the person experiences or perceives – namely subjective perception of sounds in his/her own ear(s) or head. Therefore, a layperson may establish the diagnosis of tinnitus at any point in time from service to present. However, consider credibility and weight of the evidence in deciding whether to accept lay testimony as proving tinnitus in service or presently.
The Hearing Loss and Tinnitus Disability Benefits Questionnaire tinnitus-only examination includes a number of options for examiner opinions on etiology. The examination may be conducted by an audiologist or non-audiologist clinician.
Only ask the audiologist to offer an opinion about the association to hearing loss if hearing loss is concurrently claimed or already SC.
Know the Disability Ratings before you go into the exam. You will want to check out this website: https://www.law.cornell.edu/cfr/text/38/part-4/subpart-B 38 CFR Subpart B
For instance, if you have any issues with bones/joints etc, you will want to check out this: https://www.law.cornell.edu/cfr/text/38/4.71 and https://www.law.cornell.edu/cfr/text/38/4.71a
Know the politics………………
There are some good posts on here about PTSD exams, and I agree with most of what has been said. I must add on to some of it, and some of it is very very crucial. We are Veterans…..that is why we are here. Generally speaking, most of us are going to be politically conservative. Guess what, most psychiatrists and psychologists do not tend to be. Statistically speaking, of all of the MDs (yes, a psychiatrist is an MD), psychiatrists are the most politically liberal (left) of all MD fields whereas surgeons are the polar opposite. Guess what might not be a good idea to do in exams? You guessed it………bring up politics. In fact, I would suggest that going in there acting like a hard ass would not bode well for you. If you walk in there wearing a MAGA hat, you might want to consider writing up your appeal later that evening. If it is a female examiner (and you’re a male), I would suggest not grimacing at them during your mental health/PTSD exam.
I would suggest not trying to play the examiners; sure, you can roll the dice and try some of the advice about talking about walking to kill people all of the time and acting super hypervigilant in the room etc, but I suspect that most of these examiners see 5-8 people a day and have become very astute on picking up on the bull shit artists and won’t think twice about drawing a line through your name rather than under it. I would suggest being truthful…….that doesn’t mean that you can’t elaborate on your worst experiences pertaining to the questions that are asked, but I wouldn’t recommend lying or exaggerating. I certainly wouldn’t recommend lying about anything pertaining to your military record either, as while the examiner might be none the wiser, the raters reviewing it are more likely than not Veterans are thoroughly adept at combing through military records.

Tips to help out with C&P Exams from a Veteran Service Representative

First and foremost, it would always behoove you to write out support of claim statements for each and every contention that you are filing a claim. Make sure to bring a copy of this with you to your exam. It would be highly intelligent to have any paperwork that would be critical for your examiner to have pertaining to your claim on hand with you when at your exam. Case in point, when I went for my sleep apnea exam, my examiner stated that they couldn’t find the sleep study. I knew that it was in VBMS (the system that stores all documents and the system that VSRs and RVSRs aka raters use to process claims) as the VA not only sent me out for the sleep study to a third party, but I also submitted the results as part of my evidence that I was building and submitting for my sleep apnea claim. However, there was no issue because I simply handed her a copy of my sleep study because I had it on hand. I literally had a thumb drive with all x rays, MRI images, radiology reports, C File, buddy statements, support of claims etc, and paper copies of any relevant information that could potentially be asked for.
For hearing loss and tinnitus exams, know what can and won’t give your statement more probative value. Yes, your MOS/Rate will be taken into account. So will combat. If you can prove via DD 214 i.e. Combat Action Bage, Combat Infantry Badge, Combat Medic Badge, Purple Heart……….you get the idea, they are awards that can concede combat exposure. This gives more probative value to any of your statements made concerning hearing loss. However, keep in mind, with regards to hearing loss, they primarily look at audiograms………….entrance and exit audiograms, and any audiograms that you provide up to 12 months after service……….much beyond that, one can’t likely connect that to service. If one shoots guns recreationally, rides a motorcycle to work, uses power tools regularly etc, this also throws other factors into the equation that could affect hearing loss.
For tinnitus…………if you are claiming tinnitus, I honestly don’t know why one would show up to the exam and say that their ears aren’t ringing, but it happens all of the time. Another common phenomenon is that people didn’t complain about it in service or go to get treated for it (there is no treatment really for it other than trying lipoflavinoids or newer hearing aids that can block it out via white noise.) However, there is one little-known thing about tinnitus……it is essentially the only illness that a Veteran can actually diagnose themselves.
Here is the most important manual reference for tinnitus claims………….it clearly says that you do not need a diagnosis of tinnitus in service so long as you provide a competent lay statement indicating that you had it while in service AND you get it diagnosed later on (hint hint……..get an exam done privately.)
III.iv.4.D.3.b. Requesting Medical Opinions for Tinnitus
A medical opinion is not required to establish direct SC for claimed tinnitus if
STRs document the original complaints and/or diagnosis of tinnitus
there is current medical evidence of a diagnosis of tinnitus or the Veteran competently and credibly reports current tinnitus, and
the Veteran claims continuity of tinnitus since service or there are records or other competent and credible evidence of continuity of tinnitus diagnosis or symptomatology.
Exception: An opinion may be necessary in the fact pattern above if evidence suggests a superseding post-service cause of current tinnitus.
A tinnitus examination may also be necessary if the STRs do not document tinnitus but
there is evidence establishing noise exposure or another in-service event, injury, or disease (for example ear infections, use of ototoxic medication, head injury, barotrauma, or other tympanic trauma) that is medically accepted as a potential cause of tinnitus, and
there is a competent diagnosis or competent report of current tinnitus.
Notes:
Under Jandreau v. Nicholson, 492 F.3d. 1372 (Fed. Cir. 2007), a layperson may provide a competent diagnosis of a condition when a layperson is competent to identify a medical condition. Tinnitus is a medical condition that a layperson is competent to identify in himself/herself because the condition is defined by what the person experiences or perceives – namely subjective perception of sounds in his/her own ear(s) or head. Therefore, a layperson may establish the diagnosis of tinnitus at any point in time from service to present. However, consider credibility and weight of the evidence in deciding whether to accept lay testimony as proving tinnitus in service or presently.
The Hearing Loss and Tinnitus Disability Benefits Questionnaire tinnitus-only examination includes a number of options for examiner opinions on etiology. The examination may be conducted by an audiologist or non-audiologist clinician.
Only ask the audiologist to offer an opinion about the association to hearing loss if hearing loss is concurrently claimed or already SC.
Know the Disability Ratings before you go into the exam. You will want to check out this website: https://www.law.cornell.edu/cfr/text/38/part-4/subpart-B 38 CFR Subpart B
For instance, if you have any issues with bones/joints etc, you will want to check out this: https://www.law.cornell.edu/cfr/text/38/4.71 and https://www.law.cornell.edu/cfr/text/38/4.71a
Know the politics………………
There are some good posts on here about PTSD exams, and I agree with most of what has been said. I must add on to some of it, and some of it is very very crucial. We are Veterans…..that is why we are here. Generally speaking, most of us are going to be politically conservative. Guess what, most psychiatrists and psychologists do not tend to be. Statistically speaking, of all of the MDs (yes, a psychiatrist is an MD), psychiatrists are the most politically liberal (left) of all MD fields whereas surgeons are the polar opposite. Guess what might not be a good idea to do in exams? You guessed it………bring up politics. In fact, I would suggest that going in there acting like a hard ass would not bode well for you. If you walk in there wearing a MAGA hat, you might want to consider writing up your appeal later that evening. If it is a female examiner (and you’re a male), I would suggest not grimacing at them during your mental health/PTSD exam.
I would suggest not trying to play the examiners; sure, you can roll the dice and try some of the advice about talking about wanting to kill people all of the time and acting super hypervigilant in the room and making sure to sit where you can clearly monitor all exits etc, but I suspect that most of these examiners see 5-8 people a day and have become very astute on picking up on the bull shit artists and won’t think twice about drawing a line through your name rather than under it. I would suggest being truthful…….that doesn’t mean that you can’t elaborate on your worst experiences pertaining to the questions that are asked, but I wouldn’t recommend lying or exaggerating. I certainly wouldn’t recommend lying about anything pertaining to your military record either, as while the examiner might be none the wiser, the raters reviewing it are more likely than not Veterans are thoroughly adept at combing through military records i.e. don’t tell the examiner that you were an Army Ranger when you were a chaplain assistant.

VA.gov appeal status page

Hi,
I am having a hardtime with the new va.gov web page and wanted to know what the status below meant. Call the 1800 and the customer service rep did not know either. Thanks for your help.
Status / Issues
Closed
Granted
service connection, sleep apnea