Advocate’s Example Medical Nexus Opinion Letter SAMPLE Dear Dr. Jones: I represent Ms. Smith in her claim for veteran disability benefits. I am writing this letter to request a medical nexus opinion regarding her back condition. While serving in the Navy, Ms. Smith fell down a flight of stairs during a sexual assault. She was treated for back problems following the attack. Her service medical records found details of the fall and treatment during the service. Since her 1988 discharge, Ms. Smith’s back problems have been treated by a rheumatologist at the VA Medical Center. Treating doctors at the VA facility have diagnosed Ms. Smith with the following conditions: Cervicalgia with radiculopathy across both shoulders; Lumbago with radiculopathy down both lower extremities; Bilateral SI joint arthralgia: Myalgia, middle fibers of both trapezius muscles. Ms. Smith indicated that you would be willing to review her records and provide an opinion regarding the cause of her back conditions for her VA disability claim.  I believe that Ms. Smith’s fall down the flight of stairs during her attack caused her current back condition. If a medical expert determines that it is “as likely as not” that Ms. Smith’s current back condition is linked to her in-service fall. Then, her current back disability will be considered service-connected, and her claim for benefits will be compensable.  After reviewing the veteran’s medical records, please answer the following questions:  Is it “as likely as not” that her current back condition is linked to her fall down the flight of stairs during her attack in service? What are the reasons and basis for your opinion? The reasoning for your opinion is as important as your opinion. Therefore, please indicate the documents you reviewed to reach your opinion and the facts you base your findings on. I have attached a copy of Ms. Smith’s disability claims file (C-File), which includes her service and post-service medical records. It is essential to note in your opinion that you reviewed Ms. Smith’s claims file. The veterans’ disability benefits system is unlike other legal proceedings in which medical opinions are requested. Please note that relevant portions of the claims file have been highlighted for convenience. If you choose to assist Ms. Smith, you will not be called to testify in court proceedings or depositions. Your opinion cannot be directly challenged, and you cannot be cross-examined. If you believe additional information may be helpful to this claim or have questions regarding this request, please get in touch with me at your convenience. Thank you for assisting Ms. Smith in pursuing the veterans’ benefits she earned. Very truly yours, Linda Agent, VA Accredited Claims Agent ID# Enclosures M21-1 Part V Subpart ii Chapter 1 Section A.1.i. Standards of Evidentiary Proof (M21-1 V.ii.1.A.1.i.) Every substantive or procedural factual matter must have a standard of proof whether stated explicitly or not.  Standard of proof specifies the degree of persuasion or confidence in the evidence with regard to the subject of the proof that is required in order to find a fact proven.   Note:  The application of standard of proof is qualitative, not quantitative.  The question is weight or persuasiveness of the evidence and not the number of items of evidence.  Evidence is not necessarily in relative equipoise when the number of acceptable items of evidence tending to support a fact is equal to the number of items tending to not support a fact.     The table below describes the different standards of evidentiary proof.    Standard Description relative equipoise Evidence must persuade the decision maker that the fact is as likely as not. preponderance of the evidence The greater weight of evidence is that the fact exists. The fact is more likely than not. affirmative evidence to the contrary The fact is unlikely; the evidence against the matter is of greater weight. This standard is the opposite of the preponderance standard. clear and convincing The fact finder has reasonable certainty of the truth of a fact. This is a higher standard of proof than having to find a fact is more likely than not. clear and unmistakable The evidence must establish the fact without question. advocates-sample-letter.pdf

I have never received an email from the BVA.  (And, I had appeals there at least 4 times that I recall, probably more).  But, things do change.  It would be a nice change.   I have to admit "IM SHOCKED" to hear BVA would send an email notification of a decision for more than one reason: 1.  Email is not secure, and is often hacked.  This alone, often means companies wont communicate a lot of stuff by email.  My doctor will only do it "via secure mail" where you must login to myhealthevet.   2.  BVA "just doesnt" summarize the decision like that.  At least not that IM aware of.  They send you "the whole enchilada" decision or none.  No summaries.  But maybe they turned over a new leaf.  

I dont see how its possible "to only be housebound" for one day.  Specifically, housebound defination (per VA) is that you are "substantially confined to the premises".   Further, VA has added that "substantially confined to the premises" means the Vetean cant leave the house except for doctors appointments.   Using the definition of "housebound" VA uses, I dont see how one could only meet the criteria "for one day".  What day WAS that anyway?  Chrismas?  Most of us stay at home for CHRISTMAS!  

It’s been a long while since I posted…but, the good news is that hubby's claim was approved at 100%! It has been a long, stressful road but so happy that it has finally been decided. The journey was hard but victory is sweet. I learned so much along the way from other veterans all fighting the same fight and I cannot express enough gratitude for all the support and advice!    To those still waiting, never lose hope! There are blessings waiting for you. Stay strong and know there are people praying for you.   Thanks again!    Blessings,  EJ 

Thank you for this. I’d just put in an inquiry to her and this my first time doing this. Hopefully I’ll have better luck as I always heard rumors that our congressman/woman don’t really move the needle dealing with the VA.