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Nexus Letter

Question

Hi folks,

I asked my Dr for a nexus letter. He complied. So I thought. He made a note in my chart, that I have forwarded to my VSO.

In the section of my notes under "History of Present Illness" the Dr noted...

"Patient reports that OSA symptoms began while he was in active military service, while serving in the Army. He believes that his symptoms were present, but were at the time attributed to PTSD and depression. I HAVE REVIEWED SEVERAL SERVICE MEDICAL RECORDS THAT ALLUDE TO SLEEPINESS AND UNREFRESHING SLEEP AT THAT TIME."

Then in the assessment portion of my chart he wrote.

"I beleive it is as likely as not the pt had sleep apnea while he was in the Army."

My question is... Is this strong enough to link my Sleep Apnea to service for disability rating?

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The magic wording the VA likes to see is below, along with the percentages:

Is due to (100%)

More likely than not (greater than 50%)

At least as likely as not (equal to or greater than 50%)

Not at least as likely as not (less than 50%)

Is not due to (0%)

The "as likely as not" statement should equate to "at least as likely as not". It might be worth a shot.

I have seen BVA appeals where this alone was sufficient. Typically, you would want your nexus letter to equate to crushing evidence and spell out the etiology in great detail, indicate the service or VA medical records were reviewed, etc...

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Its probably not strong enough. The Doc really needs to say its their opinion and not what you reported to them'

'

I would ask the Doc to shore it up if they can see fit to doing it.

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Its probably not strong enough. The Doc really needs to say its their opinion and not what you reported to them'

'

I would ask the Doc to shore it up if they can see fit to doing it.

Then in the assessment portion of my chart he wrote.

"I beleive it is as likely as not the pt had sleep apnea while he was in the Army."

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The doc did reference the SMRs-and that is good-

but I wonder- can you support this with a buddy statement too?

If you were a loud snorer in service, it would be great to find a buddy in your unit who slept near you and who could verify that.

Did you have any SMR documentation as to being late for duty due to oversleeping due to poor rest at night?

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I went back to my Dr today and this is the letter I was able to get him to write. Is this good enough?

Dear Sir/Ms.

I am writing this letter on behalf of my patient, Mr. Pog, who is under my care for obstructive and possibly complex sleep apnea syndrome. I am a board certified sleep medicine physician.

I have reviewed Mr Pog's service medical records from May 2007 to November 2007. I have also reviewed a developmental counseling from 01, October 2007. Based on my review of his service medical records, I believe his sleep apnea today is more likely than not related to military service, as it was likely present and undiagnosed at that time.

Mr. Pog provides a history that suggests symptoms consistent with sleep apnea during his time of military service in 2007. At that time, he was under medical care for both depression and post traumatic stress disorder, both of which could have contributed to these symptoms, as could have the patients medications at the time.

However, I believe that it is more likely than not that Mr. (first name) did suffer from obstructive and possibly complex sleep apnea at the time of his military service, and that his symptoms, consistent with this disorder, were not recognized, due to his other medical problems.

Please feel to contact me for additional information if necessary.

Sincerely,

Dr SoandSo

Edited by Pete53
Edit per request

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