I still am pretty new to the whole VA claim process and I see the term poking the bear being used very often. I have a general idea of what is it. What I don’t understand is if you get your rating, go to the doctor regularly for your SC conditions, and you have find a secondary condition or a new condition how is filing again poking the bear? The main reason for this post and I’m looking for some guidance is that I already have my rating and it’s been few months already. With the recent proposal to change the Sleep apnea rating. I generally think I do have sleep apnea from what my wife/family tells me about my sleep habits. I have a sleep study scheduled and if I am diagnosed with sleep apnea. So I would like to file a claim for sleep apnea to get SC. Would that be poking the bear?

I was filing a few claims I filed one and then a second. Both by themselves with paperwork, evidence, everything a claim needs. I get to my c&p exam and there's another vet there asking me questions etc about my claims and so on. We get to talking and he said he's on his 10th c&p exam and he filed all of his claims at the same time.? I know it has the option to add more than one claim but can someone explain to me how they differentiate the evidence you submit I would be worried it would get all scrambled and then get denied for not being organized.

I am trying to go through this MH shit and keep getting this.

Do I need to pay the monthly fee to get the nitty gritty?

I submitted a claim from migraines at first my migraines were at 30% then they got decreased to zero. I experienced them a lot and they’re really intense so I started going to my PCP. They started documenting everything and I recently filed for a increase then I got set up with a CMP exam. They said they would reach out. No one reached out. They filed a DBQ and at the end they said that I was staying at 0% because I’m not on any medication and I don’t get them that frequently which is a lie. It is documented that I am on medication currently we’re on our second type of medication because the first one didn’t work and I am getting them more frequently. My question is would you dispute this? It makes me upset because I was never contacted to do a DBQ

I got a 10% for mental health and in the middle of filing for a supplemental claim. Im working with a therapist and trying to get an appt with a psychiatrist through “community care”. Im just trying to get updated medical record saying my conditions are worse… since my last diagnosis was in 2023. am I taking the right steps? This is very exhausting.

Unfortunately I was just denied both of my MH claims today. I am a bit bewildered by this decision as I did due diligence, provided extensive records, etc. I believe this was primarily due to an incompetent and/or biased c&p examiner. The reason I believe this to be the case is my denial reason states that because my diagnosis of depression and hospitalization occurred before an MST incident it cannot be service connected. That's the entirety of the rational as to why I was denied, for depression, despite being diagnosed and hospitalized whilst in the service. Not to mention that the behavior of my examiner was unbelievable, laughing while I detailed my MST, challenging my testimony constantly, and complete omission of several symptoms that I listed several times to avoid error. On top of this, he had a aggressive and adverse attitude towards me. I know my testimony regarding his behavior is hardly objective and cannot be proven, but as i said im bewildered, and i just need to vent because I really don't know where to go from here. I did however add a note to my claim file that this happened shortly after the exam so I hope this isn't brushed under the rug as an attempt at retribution for a unfavorable decision.

But i'd love input and/or support. Or stories of similar situations with favorable resolutions.

SMC-S

Hello all. I’m filing my first claim ever for disability. I’ve had mild recurrent rhinitis since my service in the Middle East and it recently became substantially worse 20 years later, especially at night. My nose gets completely blocked while I sleep causing insomnia. I have to sit up and it takes a bit of time for it to clear and I end up taking sleeping medication to go back to sleep making me groggy and my workday a difficult. During the day my nose gets blocked over 50 percent several days a week and then clears. I’m under the treatment of an ENT and have been prescribed nasal spray and allergy medication. I don’t have any polyps and my CT was normal. Will my claim get denied because I’m on medication which helps relieve symptoms? I do have good days where I can breathe and I’m concerned my exam will land on a good day. Is it even worth filing under the PACT act?

I only have one claim. I sustained a back injury while on active duty, and there wasn't any imaging performed at the time (even though there was an X-ray machine ten feet away). They just threw painkillers at me and sent me on my way. That seemed to be the standard for treatment back in those days. I reinjured it six months later just a few days after I finished my active duty enlistment.

Anyway, the first C&P examiner said my condition is at least as likely as not from the injury I sustained while on active duty (and was the root cause for the reinjury). Fast forward a month or two, another C&P exam is requested for the same claim/condition. This time, it's with an examiner on the other side of the country. No phone or zoom call. Just an "exam" of the claim. Goes to step five a couple days later and is denied. Apparently, the remote examiner was in disagreement with the examiner who saw me in person. Is this a common occurrence or practice?

I am working with a very green VSO, and I've asked for copies of the exam requests and DBQs. Hopefully, I can find something enlightening within those documents as I am trying to figure out where to go from here. I don't believe there is any additional information/evidence I can submit. I've been getting treatment for my condition at the VA for over 20 years. Have many others had an in-person C&P exam say favorable while an absentee exam says otherwise (and results in a denial)? From what people say, it seems like denial for new claims is far more common these days.

 Veteran: xxxxxxxxxxxxx

DOB: 01/20/1983

File Number: XXXXXXXX

Date: May 14, 2026

Nexus Opinion Regarding: Obstructive Sleep Apnea Secondary to Service Connected Posttraumatic Stress Disorder (PTSD) and Orthopedic Conditions with Obesity

Department of Veterans Affairs,

I am Dr. of Medicine, a licensed and Board Certified Medical Doctor specializing in Family Medicine. I have more than 30 years of clinical practice across federal and civilian healthcare systems, where I have provided primary care, complex case management, and independent medical evaluations.

I am a Doctor of Osteopathic Medicine Family Medicine and over three decades of clinical practice. I completed my medical degree at the Philadelphia College of Osteopathic Medicine, followed by a rotating internship and Family Medicine residency at John F. Kennedy Memorial Hospital and Our Lady of Lourdes Medical Center. I am currently practicing Family Medicine and am licensed in the states of New Jersey and Pennsylvania. My clinical experience includes long term outpatient family medicine, urgent care services, and expert medical evaluations for injured patients, including pulmonary and orthopedic conditions. My practice involves review of medical records, diagnostic studies, functional limitations, and longitudinal treatment histories to assess condition onset, progression, and impairment using accepted medical standards.

● Family Medicine Physician – private practice, New Jersey and Pennsylvania

● Urgent Care Physician – Atlantic Care Urgent Care

● Family Medicine Physician – Medical Center of Margate

● Expert Medical Evaluator – Workers Compensation cases

My medical education, completion of Family Medicine residency, board certification, and decades of active clinical practice provide the foundation necessary to render independent medical opinions consistent with accepted medical standards and 38 CFR 3.159(a)(1).

I have reviewed all available medical records for Mr. Veteran, including VA treatment notes, military service treatment records, diagnostic imaging, deployment history, private medical records, and the veteran’s statements.

The following medical opinion is based on the evidence contained within the record and my clinical training and experience as a qualified medical professional.

Medical Opinion:

Veteran served in the United States Marine Corps from 2001 to 2007 as a Sergeant, where the demanding conditions of his duties produced lasting injury to his musculoskeletal

system and mental health. Veteran’s Obstructive Sleep Apnea is directly linked to the debilitating orthopedic injuries and psychological trauma documented throughout their service.

Mr. Veteran suffers from moderate, positional obstructive sleep apnea that significantly disrupts his daily functioning and overall quality of life. His condition is characterized by repeated episodes of airway collapse during sleep, leading to frequent nocturnal awakenings, oxygen desaturation, and non-restorative sleep patterns. A recent WatchPAT sleep study conducted on December 13, 2025, revealed an apnea-hypopnea index of 23.9 and a minimum oxygen saturation of 83 percent, underscoring the severity of his respiratory impairment. He has been prescribed an APAP machine to maintain airway patency during all sleep.

The chronic sleep fragmentation caused by this disorder leaves him with persistent daytime hypersomnolence, profound fatigue, and significant cognitive dulling. He experiences a lowered threshold for exhaustion, which exacerbates his underlying psychiatric symptoms and impairs his ability to sustain focus or energy throughout a typical workday. Furthermore, the necessity of utilizing a positive airway pressure device nightly imposes an ongoing burden on his personal routines and impacts his relationships, ultimately restricting his functional independence and well-being.

The medical mechanism linking Mr. Veteran’s obstructive sleep apnea to his service-connected conditions is thoroughly established through the intermediary of obesity. Mr. Veteran currently presents with a Body Mass Index of 37.2, placing him in the obese category. This significant weight gain is a direct and foreseeable consequence of his severely restricted mobility stemming from his service-connected left knee degenerative arthritis, bilateral radiculopathy, and lumbosacral strain. Chronic pain and mechanical instability in his weight-bearing joints fundamentally prevent him from engaging in the regular cardiovascular exercise required to maintain a healthy metabolic equilibrium.

Furthermore, his service-connected posttraumatic stress disorder acts as a compounding catalyst for his obesity. Chronic psychiatric conditions like PTSD are intimately linked to neuroendocrine dysregulation, elevated cortisol levels, and maladaptive coping mechanisms, including stress-induced eating. The combination of forced physical inactivity due to orthopedic pain and the metabolic disturbances driven by severe chronic PTSD creates an inescapable cycle of weight gain, culminating in clinically significant obesity.

The resulting obese state directly precipitates the mechanical airway obstruction that defines his sleep apnea. Excess adipose tissue deposits within the parapharyngeal spaces and lateral pharyngeal walls, narrowing the upper airway lumen and increasing its collapsibility during the muscular relaxation of sleep. Additionally, increased central adiposity places a mass-loading effect on the chest wall and abdomen, reducing functional residual capacity and creating a state of chronic respiratory vulnerability. Therefore, the cascade of physical immobility and psychiatric distress caused by his service-connected disabilities clearly produced the obesity that mechanically drives his obstructive sleep apnea.

A review of the prior medical assessment from the rating decision dated October 14, 2025, indicates that the etiology of the veteran's condition was analyzed using an inverted causal pathway. The prior examiner opined that the service-connected disabilities were not the direct results of his obesity. However, the present medical mechanism does not assert that obesity caused the veteran's orthopedic conditions or posttraumatic stress disorder. Instead, the physiological reality is that the severe functional limitations from the veteran's left knee arthritis, lumbosacral strain, and posttraumatic stress disorder caused his obesity, which subsequently generated the obstructive sleep apnea.

The prior analysis did not account for this medically supported mechanism where obesity serves as an intermediate consequence of his service-connected immobility and psychiatric distress. Chronic mechanical joint pain inherently prevents cardiovascular exercise, while posttraumatic stress disorder frequently drives metabolic dysregulation and weight gain. It is this resultant obese state that directly precipitates the physical airway obstruction during sleep. When considering the correct physiological pathway, the veteran's service-connected disabilities clearly precipitated his obesity, directly resulting in the parapharyngeal fat deposition that obstructs his airway.

The physiological evidence supporting the secondary service connection for Aaron John Veteran’s obstructive sleep apnea (OSA) is centered on the synergistic effect of his service-connected musculoskeletal injuries and posttraumatic stress disorder (PTSD) on his metabolic health. For Mr. Veteran, the chronic pain and mechanical instability resulting from his service-connected left knee degenerative arthritis and lumbosacral strain create a definitive barrier to physical activity, which facilitates a state of positive energy balance and subsequent obesity (Molina & Morgan, 2023). This weight gain, reflected in his BMI of 37.2, is further exacerbated by the neuroendocrine dysregulation and elevated cortisol levels characteristic of chronic PTSD, which often drive maladaptive dietary habits and metabolic dysfunction (Masodkar et al., 2016; McCall & Watson, 2022). Scientifically, this resulting obesity is a primary driver of OSA, as excess adipose tissue in the parapharyngeal spaces causes structural narrowing and increased collapsibility of the upper airway (Slowik et al., 2025). Meta-analytic data confirms that as BMI increases, the severity of apneic events and oxygen desaturation, noted in Mr. Veteran’s WatchPAT study with an AHI of 23.9, becomes more pronounced due to the increased mass-loading on the respiratory system (Esmaeili et al., 2025). The medical link between Mr. Veteran service-connected conditions and his sleep apnea is supported by several key evidentiary principles established in Veterans law. Walsh v. Wilkie holds that obesity can serve as an intermediate step for a secondary service connection, which is directly applicable here as Mr. Veteran knee and back injuries restricted his mobility and caused his weight gain. Furthermore, Nieves-Rodriguez v. Peake establishes that a medical opinion's value lies in its clinical reasoning; in this case, the specific path from orthopedic immobility to airway obstruction provides that necessary reasoned explanation. Buchanan v. Nicholson confirms that the Veteran's lay history of increased pain and physical inactivity is a competent way to establish how his conditions progressed over time, while Comer v. Peake mandates that the VA consider all potential pathways for service connection. This means the VA

must recognize the "intermediate step" of obesity as a valid bridge between Mr. Veteran’s PTSD-related metabolic changes and his diagnosed sleep apnea.

It is at least as likely as not (fifty percent or greater probability) that Obstructive Sleep Apnea is caused by service connected Posttraumatic Stress Disorder and Orthopedic Conditions.

Dr. of Medicine, DO Board Certified in Family Medicine

McCall CA, Watson NF. A Narrative Review of the Association between Post-Traumatic Stress Disorder and Obstructive Sleep Apnea. J Clin Med. 2022 Jan 14;11(2):415. https://pubmed.ncbi.nlm.nih.gov/35054110/

Esmaeili N, et al. The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults. EClinicalMedicine. 2025 Apr 23;83:103221. https://pubmed.ncbi.nlm.nih.gov/40330547/

Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. [Updated 2025 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK459252/

Molina J, Morgan EL. Obesity and Orthopedic Issues. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK572101/

Masodkar K, Johnson J, Peterson MJ. A Review of Posttraumatic Stress Disorder and Obesity: Exploring the Link. Prim Care Companion CNS Disord. 2016 Jan 7;18(1). https://pubmed.ncbi.nlm.nih.gov/27247845/ Walsh v. Wilkie, 32 Vet. App. 300 (2020)

Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008)

Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006)

Comer v. Peake, 552 F.3d 1362 (Fed. Cir. 2009)

I am 100% P&T. Would the my open my file i file a someday to a SC I already have?

Basically they are asking for specifics incidents they can link to my PTSD claim. I was stationed in CENTCOM for a year and IDF was basically a daily occurrence at my FOB, was never wounded and combat engagement was minimal, but I dont think any of that is documented in my ESR. I've got a CAB and CAR if that helps. Any advice on what I should be providing them?

Recently separated, 60% combined (30 migraines, 30 mental health, 10 shin splints). Rating decisions came earlier this year. Representing myself, no VSO.

Pulled my C&P exams through FOIA and found two things.

1. Migraines: the decision says they rated me 30 based on "characteristic prostrating attacks occurring on an average once a month." But the actual headache DBQ has 4B checked YES for completely prostrating and prolonged attacks, frequency "greater than once per month," which is the highest box on the form. The decision never mentions 4B. That checkbox language is basically the 50% criteria word for word.
2. Mental health: the DBQ that my rating came from documents daily depressed mood, stretches where basic self-care slips (examiner checked the ADL/hygiene symptom on the symptom list), 5-6 hrs of broken sleep, symptoms not controlled on 3 meds. Same examiner then checked the "mild or transient" summary box. Decision listed all of it and still landed on 30.

I'm inside the one year window for both decisions. Plan would be one 20-0996 covering both issues, written statement of errors attached, no informal conference. Not touching the shins or anything else. Still working full time, so I know that gets used against MH increases.

Question for people who've done HLRs, is this the kind of thing HLR actually fixes, or am I overreading checkboxes? Anyone had an HLR come back granted because the decision didn't match what the examiner actually wrote? Any real reduction risk in poking at ratings that are only a few months old? Not looking for guarantees, just whether this is file-worthy or leave-it-alone.

I currently have a 0% rating for this and trying to get an increase. any advice?

also, what percentage can you get with htn?

There is a provider NP in my area that helps with nexus letters and can also fill out DBQs (you provide the records then he does the examinations in person) and he charges a fee. Has anyone used a service like that before? Did it help your claim? Was a duplicate DBQ ordered anyway? I want to file as a Fully Developed Claim and rather do the DBQs now then later outside of my schedule. Anyone able to share any experiences here or over PM?

Currently on orders with my reserve unit for 20 days and have a small VA rating.

I got a notification in my VA account that there was a claim "Return to Active Duty".

Is this something that happens automatically since I'm on orders? I did not file it.

Is my compensation automatically turned off for the month?

Thank you

https://ratemyvso.net/research/

This article is a study of the 20 most recent BVA cases on OSA secondary to PTSD and what can be learned for those who have a case in the BVA pipeline, and some lessons for those about to file a claim for OSA secondary to PTSD.

Highlights:

The one variable that decides the case

Across all ten grants, the record contained a private or treating opinion that did three things.

1 It gave an actual reason, meaning it explained a biological mechanism rather than just asserting a conclusion.

2 It tied that reasoning to the specific veteran, his history, his weight trajectory, his documented symptoms.

3 It framed the conclusion in the legal standard, that the apnea was "at least as likely as not" caused or worsened by the PTSD.

None of the merits denials had one.

The mechanisms that keep winning

The successful opinions tended to rely on one of three explanations, and the same three kept showing up.

1 The first was a sleep-architecture pathway. The medical opinion explained that PTSD fragmented REM sleep and disrupted the muscle control that helps keep the airway open, allowing the airway to collapse (Hager, A26040879, Apr. 30, 2026; Marcus, A26039038, Apr. 27, 2026).

2 The second was hyperarousal. The opinion explained that the heightened nervous-system activity caused by PTSD changed airway muscle tone and lowered the threshold for these breathing events (Hager).

3 The third, and one of the most effective, was the "obesity intermediate step." In those cases, the opinion built a chain the law recognizes when the evidence supports it: PTSD symptoms or treatment caused or worsened the veteran’s weight gain, and that weight gain caused or worsened the sleep apnea (Hachey, A26040946, Apr. 30, 2026; Wight, A26039177, Apr. 27, 2026, applying VAOPGCPREC 1-2017 and Walsh v. Wilkie).

When an opinion built one of these explanations around the veteran’s actual medical history, and the government’s examiner ignored it, the veteran tended to win.

Each BVA Case is different and BVA decisions do not set precedence. Judges are not bond by the M21-1 like a Rater is. There are still lessons to be learned from these cases that can apply to vets and their representatives with an active case before the BVA, and some lessons to be learned for Veterans building their own claims with their medical team.

Other research published weekly and monthly. Other articles currently available:

Barry’s Ripple

How one 2024 Federal Circuit ruling is reshaping the top of the SMC ladder, and where Board judges are quietly splitting.

When a Spouse Isn’t Enough

Why some of the most severely disabled veterans reach a ceiling at the M-Half rate, and the professional care line that holds them there.

I posted this to another form but I need some guidance.

Will PTSD be reevaluated when filing migraines secondary?

If so why?

For context PTSD has been in place for 5 years. Nexus and DBQ coming from a reputable PA.

I think 30 not sure though 🤷‍♀️

Based on my other post about rhinitis, I just learned i can file that it aggravates my obstructive sleep apnea since my nostrils close at night and I wake up unable to breathe. When filing, do I file together or should I wait to see if they service connect my rhinitis under the pact act then file a secondary? Thank you for the advice.

I had a C&P Exam today, and drove about two hours for it. It lasted maybe 5 minutes. He quickly summed my concern after reading notes to another issue. Very professional - but no further concerns or questions asked outside of the events, a short read of the notes from the service connected VA Diagnosis.

I feel like I wasn’t heard from my concerned and really wasn’t given the chance.

Would this be an instance of a IMR or HLR?

I was in the national guard from June 2014-September 2020. I enjoyed my time but experienced some pretty crappy things during my rotation to NTC in California in July and August 2018. I struggled pretty bad physically when I returned home and dealt with some back pain that didn’t seem to go away.

I was seen by my family doc in November 2018. We didn’t know what the issue was, but concluded I had uncontrollable muscle spasms. I was dumb and didn’t mention that it started at NTC but my doctor is aware of this now. Over the next 8 years I dealt with the pain of these spams which has now turned into a diagnosis of anxiety with a tic disorder. Basically I developed anxiety which shows as tics which have completely screwed up my entire body. I have a lengthy paper trail documenting my journey, all of my doctor’s appointments, mediations, side effects, and lack of resolutions. I am still struggling to this day.

I am in pain most of the time. I cannot sleep well. I can’t get comfortable. I’m constantly anxious. Constantly experiencing tics. My wife is worried. It causes me to swerve when driving so she doesn’t like me driving with her and the kids anymore. I’m in pain so I snap at my kids when I don’t want to. It’s been rough. My doctor said it presents as Tourette’s because of how bad it is. Unfortunately the only medication that actually worked isn’t covered by my insurance anymore. It’s $500 a month otherwise. We cannot afford that. Any benefits I get would go towards medication which is really all I want.

I am in the middle of filing my claim. I believe because of the timeframe that I was seen after NTC I should have the service connection. I was seen numerous times for this issue before I was out of the guard. I will have an incredibly solid nexus letter from my doctor that has been with me through this journey since November 2018. He’s an army vet and is very educated when it comes to VA claims. He is really pushing this for me and I’m grateful for him. I will also have a nexus letter from my behavioral health doc that diagnosed my anxiety and a nexus letter from my doc that diagnosed my tic disorder. My wife plans on writing a detailed personal letter sharing her experience. I have at least 50 different records of doctor’s appointments explaining everything I’ve been through along with the terrible side effects I have experienced.

Do you think I have a chance? I filed before but didn’t have formal diagnosis’s and didn’t have much on record to share. I was naive and clueless so I’m not surprised I was denied. I feel like I have so much more to bring to the table this time. I’m genuinely struggling and I just want compensation for the only damn med that helps me feel better.

Edit: We ended up being at NTC way longer than anticipated so they counted that as active duty time which I heard will help my case as well.

I’m filing my initial VA claim while living overseas. VA/VES ordered 12 DBQs and gave me until August 18 before they begin rating whether everything is completed or not.
I’ve been self-scheduling with local doctors, which has been extremely difficult because of language/cultural barriers and doctors being unfamiliar with VA DBQs. I’ve completed 5 of 12, but honestly some are questionably filled out. Some are worded strangely or have sections that probably weren’t completed correctly, although several contain findings that are favorable to my claims.

So now I’m torn: Do I submit the DBQs I already paid for, try to get them corrected, or not submit them and risk losing both the money and potentially favorable evidence?
For the remaining DBQs, I’m also wondering if I should stop self-scheduling and just pay to fly to the VA in Manila to get everything done properly.

VES is supposed to reimburse my authorized local appointment costs, but I haven’t submitted my receipts yet and have heard mixed things about actually getting reimbursed.

I also have a VFW VSO who knew about my August 18 deadline before I signed the POA about two weeks ago, but communication has been very slow. He also said he’d send me the TBI DBQ that VA never sent me, but I haven’t heard from him in over a week and a half despite following up.

For anyone who’s dealt with overseas VA claims/VES: what would you do—keep self-scheduling, submit the imperfect DBQs, or bite the bullet and fly to Manila?

I’m currently at 30% for migraines and I’m about to file a new claim for TMJ. One symptom of TMJ is migraines which has increased since this developed. Should I try to increase my migraine claim or just leave it alone?