Navy4life

Example of a Nexus Letter
DATE ____________

Reference: (Veteran's name) ____________

SS# ____________________         VA File #____________________

To Whom It May Concern,

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim.

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service)

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition).

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.)

Mr.____________ has no other known risk factors that may have precipitated his current condition.

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________'s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur - "at least as likely as not", "more than likely", or "highly likely")

In my personal experience and in the medical literature it is known (Give a rationale).

Signed,

Dr. ____________
(List credentials and contact information)

Please understand that the VA often uses credentials to assign probative value to the nexus letter.
While the nexus letter must be brief as possible it should be as detailed and complete as the circumstances dictate.


 

Denials for claims are based on evidence of record (EOR)-i.e. the evidence against is more prolific than the evidence for. If some of the evidence was never made available to the original rater, it is imperative that you "re-present" it to the DRO. Think of it like baking cookies. You prepare the claim history in a nice, short summary and timeline. Make one for the DR Officer too. Make copies of the STRS from service documenting the injury.  Show him what evidence supports your contentions. Tell him that it is apparent that the rater could not have considered the evidence in question and still come to that conclusion. Look over the denial in the EVIDENCE CONSIDERED section. Is that important document listed? If it is and it isn't a salient part of what they looked at, this may be the winner. Just like cookies, you need all the ingredients present. Do not make the mistake of thinking he won't notice if you substitute baking soda for baking powder. He will. Don't try to impress yourself with your own evidence. You have to convince him, not yourself. If the the nexus doctor said it "probably" was from falling out of a perfectly good airplane with a silk balloon to support you too many times, you'll lose. Probably also connotes probably not. It has to be unequivocal as in "more likely than less likely". I can't count the number of Vets who arrive for help and say "Don't worry. I have the nexus covered." If it says might, could have, possibly, or it's just like what happened to my Uncle Clyde, you are not going to win. Sadly, our new DBQs do not have a box for the nexus. Coincidence?
Conversely, if Waco is dead set against granting it, you'll get the bum's rush regardless. We see that a lot in Hep C claims with a jetgun as the risk factor. Regional Offices simply are not allowed to adjudicate these. Every one goes up to the BVA. If you have a red hot nexus with proof your gastrodoc saw the c-files and the contemporary STRs, you win. It just won't happen at the local puzzle palace, unfortunately.
This phenomenon is beginning to dissipate but the backlog forced VA into their new "develop to deny" game and the practice of shoveling the backlog up to the BVA to reach the magic 125-day/98% accuracy. They missed the deadline of Dec. 31,2015 with 80,000 still on the books and the same abysmal 45% accuracy they are renowned for. 

okie dokie   LoL  
Sounds good to me.
I wish you the best   and its best to call them too around Tuesday or Wed.   That you need these records ASAP.
To prepare for your Hearing on the 27th Feb

http://www.archives.gov/veterans/military-service-records/standard-form-180.html
you need to fill out the 180 form send it to these people  but also call them and let them know what you want   the 180 is in the mail (get  certified return receipt.) give it 3 days to get there then call.
 
.......Buck

The Hospital that  put your ankle in a cast should have your smr's  at Ft Belvoir call them.&fax you the records...you need a nexus letter connecting the right ankle spring  but  you need a Qualified Dr to state its likely as not this occurred during military service...without it or any medical records to connect it  you will probably be denied   that's what there bases their decision on is no evidence of record

PTSD isn't always related to "war" - I suffered PTSD due to a personal assault which was very difficult for me.  I think PTSD comes in all shapes/sizes/etc...
I too live in Dallas BroncoVet!

Asknod;
Thank you for your response and suggestion.  The more I think about it, the more I firmly believe the DAV rep is of no use to me.  Like I said in one of my posts, this DAV WACO office knows NOTHING about my case and is just going to be in the way.  I will take your advice and ask for the hearing to go on the record.  I will look at the denial letter again and dissect it as well as go through all the evidence already submitted.  The issue I have is the FACT that the denials for my claims were not valid based on the evidence presented.  The rater clearly did not see all my evidence I presented in my original claim.  Are you saying I should not regurgitate that information?  
Secondly, the irony of this, is that right now I have an FDC in for an increase on my L ankle, 100% Total Disability for my R foot (not S/C but linked directly to my L ankle per my doctor) and my PTSD.  I know you should not discuss anything that is not related to the NOD but it's interesting that I am fighting the denials for my L foot/toe & R foot/ankle since 2013 and now I have even more issues to contend with..UGH
As a paralegal, I know that revoking a POA is not that difficult and most POA's do not have "time limits" on them.  I plan to simply submit a revocation letter to the DAV Office, submit it to the VA as well.

Type up a request for a transcription of the hearing to be sent to you and take it in with you. You need an unbriefed VSO rep. there like you need a cancerous tumor. If you have any paralegal education you're already light years ahead of a service rep. To be truthful, the only thing a service rep. can do is suggest questions (ahead of time), or file things for you. They are generally unknowledgeable about your case in advance which makes them like a fifth wheel getting in the way. If the fellow has not had any prior involvement in developing the claim, he's going to impede your progress in trying to present the contentions. You sound like you have a modicum of intelligence. A DRO review is meant to be a hands-on, intensive study of all facets of the claim and any info you feel was ignored or overlooked. Bringing new and material evidence in or a new nexus /IMO are most often the reasons why you will prevail. Merely reiterating your old arguments will be a waste of time. Possession of your c-file ahead of time is paramount. You cannot fight them if you don't have the file. 
Read your denial and break it up into parts. Why did they deny? What were you lacking or what was it they failed to take into account? Was it merely a lack of the injury in your c-file? Was it the lack of an independent nexus by your own doctor(s) entirely? Did you rely on VA to provide you with a nexus and it turned out to be "not as least as likely as not"? If you do not rebut the denial facts with exculpatory evidence, this is going to be a milk run. Far too many go in and try to convince a DRO that their version is correct without any supporting facts using nothing more than lay testimony. Always remember, if you provide unsupported facts, it is called "history". That means it's your recollection of events-not necessarily what transpired. 
Don't waste your time trying to extricate yourself from the DAV gomer. Let it ride, They sure won't show up unannounced. If they do, tell them to sit in the back of the room and remain silent. Furthermore, I would request it to be on the record if you have any qualms about this ending up on appeal later. If it is not recorded, there is no evidence of it occurring in your c-file. This can be very damaging to the claim on appeal. 
You are not permitted to add any evidence to the file after a BVA decision. Your appeal to the CAVC, if necessary, will hinge entirely on the Record Before the Agency (RBA) established at the VARO or the BVA-period. One thing few realize is that if you go on the record with the DRO review, it will all be in there, including any errors by the DR Officer in the decision.That may be paramount to winning later- e.g. "forgetting" to extend you the combat presumption under 38 USC 1154(b). I see that quite frequently. VA raters , from DROs all the way down to FNG VSRs rely entirely on their M 21 bible. If They are using the wrong metric, the whole process is an exercise in futility. Considering they do this 65% of the time, it behooves you to get it all down in the record against any appeal you may have to pursue. 
A VA form 21-22 is used by VSOs. A VA form 21-22a is used by VA agents and attorneys. A 21-4138 is permissible to use as a vehicle for rescinding your POA with a representative or attorney. One must be mailed to both parties (VA and the rep.). I can't say it does any good though. I got the MOPH stuck to my shoe for 6 years. IRIS is all well and fine but the VA also requires a blue line paper recission for the c-file. 
Best of luck.

I am going to call their office (DAV) on Monday in WACO and tell them I do not need them.  I will go ahead and remove them if I have to for sure!  I don't need someone there that knows nothing about me or my claims!
Thanks Buck!

Buck;
I have my hearing next month on the 26th which is my DRO Review Hearing and I have two C&P Exams next week BUT those C&P Exams are not related to the NOD.
I just don't need the representation of a DAV rep.  I can handle my claim with the DRO Review Hearing Officer myself.  I just don't want to have a DAV rep show up and expect to "defend" me.  Like you said I know my case better than anyone and at this point I know it better than a DAV rep who has NEVER talked to me nor seen my file.  I would say differently and feel differently about wanting a DAV rep with me if that DAV rep had been actively involved in my claim/NOD/etc from the start.
I know the saying about "representing yourself, you are your own worse client" but I am a Paralegal by trade and I do have some experience with hearings but again, this is not at the BVA level....
HMMMMM

Buck
good advice. My hearing is less than a month so I'll step it up for sure!

I cannot phantom an attorney that would not go after this.  If I were I would gladly take the case. I would like the fight.  But I am neither an attorney nor an entity knowledgeable,versed, and functional enough to pursue a claim such as this.  You have the elements for a good defense, my only suggestion is, don't go for CUE unless you absolutely have to.  You will have a daisy of a time trying to win that way.  Keep plugging away the way you are. Contact an attorney and get  a professional medical opinion to line up your case and win that claim. Follow and heed to their advice.  JMO
Good luck, Fight till your last breath!

Navy4life,
I guess I am confused a bit here
  The 21-4138 is a ''statement in support of claim'' form
and the form 21-22 is he selection of POA  its now changed to 21-22 (a)
I think you can just write in a plain letter   to revoke them  as your POA...As long as they know you want to revoke their service from POA that's all you need  and date it and sign it
Mail it with certified return receipt 
This is what I am going to do  and wait a few days and call make sure they received it   even if I get my return receipt back   because they tend to lose things and forget about things the veterans sends in to them.
and I'll wait about 30 days and call the 1-800  and ask them to send me a confirmation on the POA.
As some veterans has tried to revolk their DAV -POA and found out months to years later they were still on as their POA 
This is why its good to ask for a confirmation letter after the fact.
jmo
.........................Buck

First congrats on the award!  I too am 30% for IBS. it's a very difficult rating to obtain in my opinion. 
i would consider a CUE based on the 2015 CnP stating that the error was clear that you should have been s/c back in 2004. 
Just my two cents!

First congrats on the award!  I too am 30% for IBS. it's a very difficult rating to obtain in my opinion. 
i would consider a CUE based on the 2015 CnP stating that the error was clear that you should have been s/c back in 2004. 
Just my two cents!

I received my decision an award of 30 percent. I am posting a picture that includes the exact wording of the 2004 denial the 2015 c and p opinion and the 2016 decision. In the evidence for the current decision they did not list anything for the 2003 c and p exam. Getting m ibs backdated to 2003 when I first submitted the claim would bring about 60k in retro as I had a 50 rating from 2004 to 2013 and now after current award went from 60 to 70 . Any and all help is greatly appreciated. I'm considering hiring an attorney  to fight for an earlier eed.

Corpsman8404
Thank you for this information, maybe you should start a new post on this subject for other veterans to read!
 
..................Buck

I was just at the VA this morning...Have to be back there on Friday :)

PTSD isn't always related to "war" - I suffered PTSD due to a personal assault which was very difficult for me.  I think PTSD comes in all shapes/sizes/etc...
I too live in Dallas BroncoVet!

Sweet information, I will put it to use.  Thank you for posting the intel.

Buck;
I have my hearing next month on the 26th which is my DRO Review Hearing and I have two C&P Exams next week BUT those C&P Exams are not related to the NOD.
I just don't need the representation of a DAV rep.  I can handle my claim with the DRO Review Hearing Officer myself.  I just don't want to have a DAV rep show up and expect to "defend" me.  Like you said I know my case better than anyone and at this point I know it better than a DAV rep who has NEVER talked to me nor seen my file.  I would say differently and feel differently about wanting a DAV rep with me if that DAV rep had been actively involved in my claim/NOD/etc from the start.
I know the saying about "representing yourself, you are your own worse client" but I am a Paralegal by trade and I do have some experience with hearings but again, this is not at the BVA level....
HMMMMM

Okay so I received this letter DAV letter_Redacted.pdf and I am questioning myself as to whether or not to use them?  I hired a DAV rep in 2013 when I lived in DC but I haven't spoken to any DAV rep in over 1-1/2 years.  The WACO DAV knows NOTHING about my NOD.  We were just talking about this in another thread about releasing your POA.
Is it wise to go without a DAV rep?  I think I am my own best advocate and I am a bit worried he/she will not know anything about my NOD.
Thoughts?

Its not eazy to dismiss or revoke your POA You need to do that in writing  theres a ''form'' for it  but even when you do that  it does not mean they revoke your DAV POA There was a thread on this last summer about firing your POA (I'll see if I can find it and the form to dismiss your POA)
 ...you may continue to receive letters from them (DAV)...just Ignore them   and if you ever have to go past the RO and into the BVA Courts  you can hire a Private Attorney   ...Remember the DAV can't go with you past RO Level anyway.
 
....Buck

Okay  you can do it just  have all your information /evidence ready for your Hearing.
I bet you can do it by yourself  o with your hubby/or best friend.
If the DAV person is there to represent you  just tell them ( with all due respect)you would like to go it alone and represent yourself
I believe you have that right to do that..if not  just ask the DAV Rep to keep his mouth shut and don't say anything during your hearing   because you simply don't know me or my case.
Its my opinion here only but just because you have a DAV Rep don't mean you have to use them.
I bet you will do Fine.
 
........Buck

I had a DRO Hearing years back  in Waco Tx and it was pretty simple, the DRO TOOK my IMO over a VA Dr...That had proposed to take away my 50% and reduce me to 0% and take away my Service Connection.
I went got an IMO recommended by hadit members and walla I walk out of that hearing with a 40%increase to 90%combined rating and was awarded TDIU P&T with no future exams and my disabilities was chronic in nature  meaning my disability will not get any better in my life time
this award is effective immediately as the DRO expedited everything.
 
I did ask for Help from the DAV because they had an office in the RO...But the DAV SO just sit there through my Hearing and never was really any help  so I guess them being there may help but I don't think so  because me and DRO went back and forth..and he liked my answers and he liked me 
This was at the Waco Tx RO...On Clay street there in Waco
Maybe I did draw a good DRO   he was nice and gave me a thumbs up after the Hearing was over...tlk about a happy man  on the way home I sang my heart out...LoL
It was not as bad as I had expected  if I had to do it all over again  Yes Mam  I sure would.
Maybe your familiar with DRO Hearings  and you know there not that Bad.
 
.........Buck