ptsd Nexus Letter

[pog]

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?

[pog]

pog,

No matter what - a claimant needs those 3 things.

BOD is a whole different issue.

Read those 3 cases again that I posted.

carlie

Thanks Black bird! I think I'll lay down the cash for Dr Bash :o And get an air tight IMO. I just got a packet from the VA. They said they will schedule VA claim soon, and outlined what they need and will do to resolve my claim.

Carlie, I went back and looked over the cases you linked to. As near as I can tell the BOD is for application when "...there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter.

That's what I ineffectually tried to communicate when I said. "And at least 50 percent likely hood of a nexus to military service".

Do you think a nexus letter written by Dr Bash to satisfy the VA needs is a good idea at this point?

[carlie]

Carlie, I went back and looked over the cases you linked to. As near as I can tell the BOD is for application when "...there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter.

pog,

In the case that BVA granted due to BOD -

notice the second paragraph

http://www4.va.gov/vetapp09/files1/0905894.txt

However, under the "benefit-of-the-

doubt" rule, where there exists "an approximate balance of

positive and negative evidence regarding the merits of an

issue material to the determination of the matter," the

veteran shall prevail upon the issue. Ashley v. Brown, 6 Vet.

App. 52, 59 (1993); see also Massey v. Brown, 7 Vet. App.

204, 206-207 (1994).

The mandate to accord the benefit of the doubt is triggered

when the evidence has reached such a stage of balance. In

this matter, the Board is of the opinion that this point has

been attained. Because a state of relative equipoise has

been reached in this case, the benefit of the doubt rule will

therefore be applied. See Alemany v. Brown, 9 Vet. App. 518,

519 (1996); Brown v. Brown, 5 Vet. App. 413, 421 (1993).

That's what I ineffectually tried to communicate when I said. "And at least 50 percent likely hood of a nexus to military service".

pog,

The term "at least as likely as not", to me, does not trigger the BOD.

Do you think a nexus letter written by Dr Bash to satisfy the VA needs is a good idea at this point?

pog,

It depends on if your medical evidence is strong enough

for Bash to support it with full medical rationale.

jmho,

carlie

[pog]

The VA just called to schedule my C&P Exam for this coming Tuesday at 0900. As you can see below this is for my reconsideration of sleep disorder as Sleep Apnea. I'm not sure what to expect since I got the sleep study already done and they are not making me take another sleep study. Any tips for a sleep apnea c&p exam would be very welcomed.

Thank you all so much for your feedback.

[pog]

Hey Guy's,

I had my CandP exam this morning. The examiner (I'm not sure she was an MD or not...) commented on my evidence by saying it was "good" what ever that meant. I think was just trying pacify me.

But when I gave her my nexus letter from my doctor she asked "Who wrote this?" then She asked if my doctor was a VA doctor. Then she commented that the language in the letter was exactly how medical opinions are given by the VA. Then she read the sentence..."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." I took that as a good sign.

Other than that... We'll see soon.

[Cm Burns]

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...

WOULD IS THE RESULT OF BE THE SAME AS ((IS DUE TO))

[pog]

I received a copy of my C and P examiners impression today. She wrote...

"It is at least as likely as not that the veterans current condition of obstructive sleep apnea existed during military service as evidenced by multiple buddy statements to support the presence of snoring, apnea and sleep disturbances during active duty, symptoms which are consistent with sleep apnea."

So what do you guys think?