Question Nexus Letter For Claim

[oldman273]

To whom it may Concern,

Ive been treating (veteran) for Several Years. I have reviewed his latest MRI scan which shows 3 Level Degenerative Disc and Herniated Disc in his back. It is my opinion he will not be able to seek gainful employment due to his service connected back condition. It is also my opinion that he undego surgery. this would be a 3 level lumbar fushion with Decompression. If you have any questions feel free to contact me.

Dr. XXX

With this letter I submited it along with all of the surgery notes from the surgery I have had on my back. I wondering is there anything I should have mentioned to him prior to submiting this. I put in for IU but was denied I hope this will put the IU claim to bed. Any Ideas or thoughts please advise. Have a good day...

[*Bergie*]

To whom it may Concern,

Ive been treating (veteran) for Several Years. I have reviewed his latest MRI scan which shows 3 Level Degenerative Disc and Herniated Disc in his back. It is my opinion he will not be able to seek gainful employment due to his service connected back condition. It is also my opinion that he undego surgery. this would be a 3 level lumbar fushion with Decompression. If you have any questions feel free to contact me.

Dr. XXX

With this letter I submited it along with all of the surgery notes from the surgery I have had on my back. I wondering is there anything I should have mentioned to him prior to submiting this. I put in for IU but was denied I hope this will put the IU claim to bed. Any Ideas or thoughts please advise. Have a good day...

The doctor must state that they have reviewed ALL your treatment records before they can opine. Also, what are his credentials? What about after the surgery, will you be able to work then, or is the surgery an attempt to improve existing conditions that are not mentioned in this letter. It is in my opinion weak. It leaves the RO to much leeway to deny. It is always good to have others opine on letters such as this. Sorry, I'm not trying to burst your bubble, but It leaves more questions than it answers.

JMO,

Bergie

[oldman273]

The doctor must state that they have reviewed ALL your treatment records before they can opine. Also, what are his credentials? What about after the surgery, will you be able to work then, or is the surgery an attempt to improve existing conditions that are not mentioned in this letter. It is in my opinion weak. It leaves the RO to much leeway to deny. It is always good to have others opine on letters such as this. Sorry, I'm not trying to burst your bubble, but It leaves more questions than it answers.

JMO,

Bergie

Thanks not a problem I posted to get some advice. I may have to get him to include it in another letter when I hear from the VA. The surgery itself was a result of my SC DDD to my lumbar spine from an injury in service. I brought him the SMR, Private Docs Records and about everything I could get for his review. I know he is one of the top Nuerosurgeon in our Area. Any ideas or thoughts of a better letter. I also think like you that anyway the VA can snake out of it by using regs one way or another is my guess. Have a good weekend thanks...

[*Bergie*]

Thanks not a problem I posted to get some advice. I may have to get him to include it in another letter when I hear from the VA. The surgery itself was a result of my SC DDD to my lumbar spine from an injury in service. I brought him the SMR, Private Docs Records and about everything I could get for his review. I know he is one of the top Nuerosurgeon in our Area. Any ideas or thoughts of a better letter. I also think like you that anyway the VA can snake out of it by using regs one way or another is my guess. Have a good weekend thanks...

Alot of people here feel the letter should say things like "at least as likely as not," but I won my cervical DDD/radiculopathy claim and my nexus did not contain that statement. The easiest way to tell you how to write the nexus is like this (no specific order); You want the doctor to give his title/credentials, you want him to state the facts ie: Your diagnosis, long term prognosis (will the condition get better/why the condition won't get better). What affects it has/will have on your activities of daily living (ADL's). You want his statement that he has based his decision following review of ALL of your medical records. As I said I won my claim by my doctor stating and confirming the facts of my injury. There was really nothing they could say or do other than lowball the rating, which is what they did.

I hope this helps,

Bergie

[Berta]

Yes Bergie is correct.

I went over my IMO post here and realized those key words were not in it- but others have posted those phrases here too many times.

"More than likely" is the strongest phrase but "at least as likely as not" stated by an independent doctor is good enough in most claims to put the evidence into Relative Equipoise.

Here is my original post on IMos which I developed from reading over how Dr. Craig C. Bash had prepared my IMOs. He was a former VA doctor and fully aware of the VA lingo that helps to resolve a claim. It mght seem odd that contacted him a NeuroRadiologist, for a claim on diabetes.

However he made a dynamic statement as to my husband's brian trauma due to ischemia of brain resulting from atherosclerosis due to AO DMII.

He was able to state that he had experience in reading thousand of MRIs of diabetics and cerebral ischemic damage and correlated that experience with the clinical record.

The right IMO doc -since these IMOs are usually very costly- makes the difference as VA cannot match -in most cases- this type of expertise.

This is my older post on IMOs.

"Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim.

Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability can be very costly.

However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO.

A Valid IMO must contain the following:

The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs.

Also the doc needs to have all prior SOC decisions from VA particularly those referencing any VA medical opinions or a copy of the actual C & P results.

The doctor should define their medical expertise as to how their background makes their opinion valid.

In other words a psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.

The doctor must have some valid medical expertise that makes his/her IMO valid.

The doctor should state their opinion in terms of “as least as likely as not”, or “More than likely” as to the present disability and the nexus to the veteran’s service medical records or other SC disabilities, if the medical evidence warrants them to agree with the claim.

They should then refer to specific medical evidence to support their conclusion.

They should rule out any other potential etiology if they can-but for service as causing the disability.

They should briefly quote from and cite any established medical principles or treatises that support their opinion.

They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record.

They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion.

They should attach a full Curriculum Vitae if possible or list their expertise within the opinion and tell VA of any special medical background they have that also makes their opinion valid. (For example, how long they have treated patients with the same disability, any articles they have written, or symposiums attended etc,)

It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion.

A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records.

Send the VA and your vet rep copies of the signed IMO.

And make sure your rep sends them a 21-4138 in support of it.

[Berta]

Oh I did cover the terms- duh-

this is important:

"They should rule out any other potential etiology if they can-but for service as causing the disability."

In the late 1990s the VA denied a claim I had by making up an etiology.

That is -they didn't give the C & P doc all of the probative evidence so he speculated and the VA accepting his speculative statement and denied.

His statement was parsed in the SOC and in those days I didnt know I could obtain the actual C & P.I won the claim anyhow when VA Central read all of my evidence (this was 1151 and I used the FTCA award to win the 1151 claim)

When I reopned my AO death claim that is when I called this doctor at the Buffalo VA and he sent me his actual C & P report from years ago. He even agreed with my new claim.

These C & P reports as well as past SOCs can often help an IMO doctor.

Dr. Bash also in my second IMO from him directly refered to statements in a SSOC I received for the AO death claim.And to many specific medical records.

It pays to do a LOT of leg work before hiring an IMO doctor.

I tabbed all of the med recs that were specific to my claim, and then listed what the tabs records referred to.

Medical records can contain a lot of data that is extemporaneous to a claimed disability- hospital nurses notes, treatment for other SCs, even the PTSD inhouse program adds many records to the stack.

The IMO doc needs them all but it pays to tab the specifics.

Dr. Bash even referred to the Strategic Health Team review these records went to in DC and named the above C & P doctor by name as a way of supporting the fact that my husband had been misdiagnosed to such an extent that the initial FTCA claim didn't cover all of the malpractice.I couldnt FTCA them again.I had to re-open on a different basis-Agent Orange caused his death due to their misdiagnosis of DMII.

He made the same conclusion I had given them bt they ignored me and the VARO even ignored him.The BVA didnt.