Sorry, while admittedly I was trying to make a joke and not imply that sunshine and exercise is a "solution," the early stages of therapy include the fancy term "behavioral activation" which frankly includes getting active. So, while it isn't a complete solution, if we were to offer a false choice between getting outside and exercising versus KZfaq I'd put it up against many of the videos on KZfaq any day ;)

@@user-nb7tp6fb6v hey, truth in advertising I suppose- what you see is what you get ;)

@@centuriesvintage yes, everything I do you know the total cost in advance (and the cost is posted publicly on my website). You can learn more at nexusletters.com

@@lightning9279 sure, it is still medically necessary despite your trouble

Keeping in mind that I'm not an accredited rep/attorney or VA official-- it may depend on the sleep disorder. For example, sleep apnea would likely be rated separately from anxiety/panic, but if you're already rated for anxiety/panic and say the insomnia is due to that, the insomnia would likely be lumped in with the existing mental disorder as a symptom of the anxiety/panic. It can be something that is pretty case specific, so it never hurts to talk with someone if you have questions.

Thank you for responding to my question. There are alot of is veterans that are suffering in silence, so any information of value is appreciated

@@mkultravibes7763 yes, they can. The diagnosis itself isn't necessarily the most important thing.

Thanks for this. There isn't much fairness in the sense that two Veterans with very similar cases can have dramatically different outcomes just based on the interpretation of the science from the C&P examiner and rater. The stats I've seen for BVA reflect that despite the fact that the case has been denied multiple times by that point, there is a double-digit approval rating (they find in favor of the Veteran). It would likely be cheaper and overall more ideal for everyone if a "correct" favorable finding was found earlier in the process, but sometimes it takes sticking with it. Sorry you're dealing with that.

I will do the nexus opinion via a records review but not a migraine-related exam or migraine DBQ

@@nexusletters ok thank you

@@jingham2654 yup, plenty of people have done it. There is also a psychologist in NY who is on the referral list on my website as well if you want a referral to a NY psychologist

If you haven't already feel free to fill out the referral form at nexusletters.com; that is the type of thing I'd do a telehealth exam and complete a DBQ for. You can also sign up for a free 15-minute phone call with me to discuss your case first if you're interested.

thanks, let me know if you have any questions or need anything

This is a great question, and I will do something related to this whenever I get a chance to record my next video, thanks. Some people hear that being obese will hurt your claim, while other people hear that you can only get sleep apnea secondary to a psych condition if that psych condition made you obese. I don't agree with either extreme truthfully. What I have seen related to that that can hurt your claim is a C&P examiner that essentially just copies and pastes a laundry list of risk factors that may or may not be related to your own medical evidence (with obesity topping that list of risk factors). The examiner never addresses the fact that psych conditions by definition can impact eating behaviors/emotional eating and reduce activity levels/exercise which can lead to obesity. The examiner then uses an inappropriate burden of proof that reads like requiring definitive 100% causitive /proof of causation between the two, rather than the actual burden of proof of getting to a coin flip of at least as likely as not. So really what hurts claims the most (assuming the person has the diagnosis) is probably a C&P examiner who has a mind that is closed to the evidence. It is funny that I have now seen countless C&P rationales where the examiner essentially said sleep apnea is "caused" by the "risk factor" of obesity, yet applied a higher burden of proof on the evidence to something like PTSD. That isn't even the punchline though: In those countless C&P's where the examiner said it was due to obesity the Veteran had a normal BMI at their sleep study. Then the rating decision actually gave weight to the C&P opinion because they did a "thorough" review of the evidence. You can't make this stuff up. Thanks for the question.

Thank you for answering my question, Dr. Finnerty. It was most detailed and informative.​@@nexusletters

Sorry, that story about the contractors is far too common unfortunately.

Thanks, I should probably keep making more videos that just say this (as simple as it may sound) ;)

Thanks old chap, I will add your comment to my safety manual for future videos

@@mcneilfajardo1820 check out nexusletters.com and toddfinnerty.com/schedule.html

I think anyone worth their salt will understand. Just be sure they're aware of that history when you see them.

I'm applying for disability for ptsd, depression and anxiety. My case is a little interesting because I went in the Air Force and documented that I had added a diagnosis and was medicated 6th grade, but hadn't taken medication since then and didn't really have any issues with it. I had a 3.3 GPA in high school, was able to hold a job while going to high school for 2 years, and I went into the military at 18. The shop that I was at had horrible leadership treat me like s*** everybody treated me like s***, Long story short they want to do aggravation for adhd, as well as the mdd, and anxiety and PTSD that I have now but I absolutely did not have issues with when I was younger. It's an interesting case, I did go to inpatient care for depression while I was in.

@@titanpolus5088 Thank you for your comment, it is certainly possible to aggravate ADHD from a baseline of it not impacting a person at all (but for that person to also have new and different mental health issues like you noted as well). Lots of people have ADHD symptoms which essentially resolve or more likely do not have a significant functional impact on them by the time they reach adulthood even without medication. Then there can be a new diagnosis from the military (ex: depression, anxiety, PTSD) due to other factors with different symptoms or even similar overlapping symptoms such as concentration issues- but a diagnosis that isn't ADHD (these new problems could also make the ADHD worse, for example if the old strategies of dealing with it may have been impacted, etc. but these problems are also different from the ADHD). It is perfectly reasonable to expect C&P examiners to get a good history and not simply write Veterans symptoms off because someone said they had ADHD when they were in elementary school.

Thanks for letting me know. You can send me the decision and any new info such as a C&P opinion and I will write a response for free. I am not an attorney or an accredited rep and am not an expert on the best way to appeal, etc., but from the data I have seen the higher up people go in the appeals process the more likely they are to be favorable to the Veteran.

@@nexusletters Thank you. I will do that.

Amen

The more the merrier; the VA likes to see that I've reviewed as much as possible.

quite a while ago SSA proposed updates to their mental listings prior to the DSM-5 being finalized, then held off on their proposals and ended up not finalizing their rules until after the DSM-5 was published essentially. We'll see what happens with the VA's proposals- they were informed by DM-5 but admittedly the DSM-5 itself/alone is pretty terrible when it comes to actually assessing impairment in relation to disability claims

I think the VA is great for a lot of things. Sometimes Veterans in the early stages of looking for help may be unsure of the best path though. One of the most common questions I get is essentially "do I need a diagnosis?" (to apply for disability, whether it be something like sleep apnea or depression). Very often, with a few asterisks, if the Veteran reaches out for help via the applying for VA disability path they wait around a while then get a denial letter with no exam, no help, etc.

Admittedly my expertise is centered on the impact of psychological conditions on it, you could try a medical person such as one from this list nexusletters.com/list-of-doctors-who-write-nexus-letters/

Sorry, I missed the bottom part of the comment. I am out of town with limited Internet. Assault definitely can cause PTSD

I am not an accredited rep/attorney but from my experience it makes sense to get the diagnosis first (ex: by getting a sleep study).

I got denied sleep apnea secondary to ptsd because no formal diagnosis thru sleep study but doctor stated I had all symptoms of osa. I even had a c&p exam which the examiner agreed that my osa is secondary to ptsd. Now that I have a sleep study and prescribed a auto sleep apnea device, would I need a Nexus IMO?

@@sweetd4872 someone will need to offer an opinion that they are connected. If the C&P examiner does you are doing great, if not or if you want some extra insurance you can get a nexus.

@@nexusletters thank you

I am accepting new people for one-time disability exams or opinions/ nexus letters based on records reviews, but I am not currently doing any ongoing treatment. You can learn more at my website nexusletters.com thanks

@@nexusletters i sent a few emails and haven't heard back. is there another way to follow up?

@@KelvinExU sorry, my inbox has become a bit of a mess. I just replied.

Some C&P examiner struck again, sorry. It does seem a bit wacky since a diagnosable insomnia is essentially chronic sleep impairment and chronic sleep impairment alone falls at the 30% level on the VA's current mental disorders rating schedule view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.benefits.va.gov%2Fwarms%2Fdocs%2Fregs%2F38CFR%2FBOOKC%2FPART4%2FS4_130.doc&wdOrigin=BROWSELINK

Because you did it wrong!

@@YHWHWILLBEDONE I’m going through the process. Have filed had my hearing exam. Filled for tinnitus and insomnia. Have taken sleeping pills for years. What tips you have for the filing?

@@larryviars6199 Insomnia is classified as mental health symptom now. What is insomnia causing? I would use Insomnia as an intermediate step!

I have done exams where people were still in bed. It should be okay.

@@nexusletters Thank you Dr. Todd. I will let her know. I found the vid to be good information.