Why does the VA need a 3rd or 4th opinion?

CPO Private RallyPoint Member — Tue, 10 Apr 2018 10:57:03 -0400

VA Claims question...why would the VA order additional examinations (3rd and 4th opinion) from doctors after military and VA contracted Doctors already diagnosed a condition? Seems as if they are searching for a diagnosis they want rather than what's been diagnosed. For example, I have nearly severe sleep apnea (28 apneas per hour) and my CPAP which I use every night for an average of 5.5 hours, 4 hours or more, more than 80% of the time. I still average roughly 8 to 10 apnea events with the CPAP. I'm claiming an inability to concentrate (concentration issues), probably because, as one Dr. put it, I have had a proper nights sleep for over 10 years. Second example, why would the VA order X-Rays to rule out one herniated and several bulging discs that MRIs less than a year old have already concluded exist. I'm no a Dr but I'm pretty sure these injuries don't heal themselves nor does an X-Ray rule out what an MRI shows...thought it was the other way around. Does the VA intentionally set out to discredit the diagnosis of other doctors?

Response by CAPT Kevin B. made Apr 10 at 2018 11:15 AM

CAPT Kevin B. — Tue, 10 Apr 2018 11:15:10 -0400

On the apnea thing, if the first doc or two are not Pulmonologists who specialize in sleep medicine, then the diagnosis can be in doubt. Don't know what's going on in the second case. With the apnea and disc thing combining for well over 50% disability, the VA is like any insurance company in that they're doing cheap things to try and limit their monetary exposure. One other thing about the apnea. From what you describe, whatever is going on is outside therapeutic parameters for which a specialist needs to take a deeper dive on. If you're getting 10, that's well above the target of 5 or less. Many times it's a matter of dialing you in or choosing the right type of equipment or configuring the equipment correctly. I get 0-1 events just with a fixed setting. My wife does much better with a variable response that tends to sense an event coming and pumps her up a bit to prevent most of them. It's and art and a science.

Response by CSM Darieus ZaGara made Apr 10 at 2018 12:51 PM

CSM Darieus ZaGara — Tue, 10 Apr 2018 12:51:34 -0400

Regarding claims; Apnea, when you change physicians or first enter the VA they have to verify conditions because you may or will have a percentage of disability associated with it. Many sleep clinics fudge numbers. As for bulges and hyrniations, they can sometimes improve. Either way they need to assess your current status in support of your disability rating. Even when they treat, updates after a year for comparison if nothing else. As long as they are not impeding your care, I would say be patient. If they are then ask for immediate assessment. Thank you for your service.

Response by CPL Angelika Guilbe made Dec 26 at 2019 1:20 AM

CPL Angelika Guilbe — Thu, 26 Dec 2019 01:20:23 -0500

Yes they do discredit, to avoid paying out out what is promised. Similar situation

Response by CPL Angelika Guilbe made Dec 26 at 2019 1:22 AM

CPL Angelika Guilbe — Thu, 26 Dec 2019 01:22:44 -0500

My honest opinion keep complaining and having it documented, and annoy the crap out of them until they see the truth. My experienece is they let it sit until you you call 1x a week asking or complaining before they do anything

Response by SPC Gary C. made Jul 20 at 2022 9:58 AM

SPC Gary C. — Wed, 20 Jul 2022 09:58:29 -0400

It might be your VA that does that, the one I go to never asked/told me to have additional examinations. Now I did have to do two sleep studies because the first one where you go in and they hook up so many wires you could talk to the ISS, I couldn't fall into a deep enough for them. The second one was a home test that they gave me a small machine to check my apnea, I was more comfortable and was able to get more sleep. Have you tried to get them to increases the air pressure ? I had to go back 3-4 times to have them up the pressure.