jonnyohio

Well LHI just contacted me and now I'm waiting for my appointment. I guess it'll be awhile lol

Still waiting for a C&P exam to be scheduled. I've heard nothing yet. No changes to the status of my appeal in va.gov, no appointments scheduled in myhealthevet that I wasn't notified about. I'm waiting until end of next month and then I'm going to start inquiring about the status. I know they are behind, but this is quite a wait to be schedule for an exam. UPDATE: Just got contacted by LHI and they are working on scheduling my exam. Now the next wait begins.

Still waiting to hear about mine being scheduled to receive my rating which was granted by BVA in February. I keep seeing people posting about getting their C&P exam done and getting scheduled, but nothing but crickets for me. It'd be comical if I hadn't just spent a full week in bed last month and off work. I guess there's no rush to provide a rating, it's more important to schedule C&P exams for people with P&T status.

Yeah, when I saw the notice that I'll be getting a notice, I just rolled my eyes. But at least I know someone is working on my rating.

Just got notified I'll be getting contacted to setup an appointment for one. Glad to see I can get mine done and get my rating.

I had tried to contact him last year about doing an IMO but got no response, which is not surprising because a lot of the popular ones are busy. I ended up hiring a lawyer in my state because I don't care about the 20% of my back pay and feel it's worth it for someone experienced and knows the law; my local VSO was not all that helpful or great and said I'd need an IMO to help win my case but she couldn't help me with that. My attorney then ended up getting in touch with him and I paid him to do an IMO, and it was spectacular. It pretty much guaranteed a win at the BVA with what was in my service records, and since the VA never bothered to do a C&P to help me develop my claim, the evidence in my favor was so overwhelming, I didn't need a hearing and got my SC granted just 4 months after it arrived at the BVA. Getting an IMO is probably one of the most difficult parts of a claim in my experience, because it takes a lot of research and time to do. If your claim relies heavily on getting one, you'd probably be better off just hiring an attorney (do your research first, and if you aren't 100% you may as well not bother with the ones you find online in google search, because they are so busy they will not bother unless you are 100% disabled-- tip: if the lawyer you contact doesn't contact you back directly, move on and find someone else because it means they won't take a personal interest in your claim).

HLR is mostly only good for disagreeing with a ratings decisions, and not SC. In most cases, the HLR will just agree with the other person who denied your claim. I didn't use HLR in my appeal, because it was just stupid that they were denying service connection, and the SOC had blatant lies as if they didn't even bother to look at my file or even consider my service records, which contained a diagnosis for what I was asking for. I went straight to BVA with a Nexus (because I wanted a doctor to provide them with an opinion and overview of everything for an easy decision) and a complete file ready to be decided, no need for a hearing, just decide my claim I said. 3 months at the BVA it was granted and a couple secondaries remanded because I didn't have the evidence in my va medical records yet when it went there, and the BVA ordered specific things to be done, so the xxxxxxx that blatantly denied my claim just ended up creating more work for themselves and I'll be getting my benefits soon and the secondaries will eventually be awarded since my VA doctors have added the connection to them from my primary in my records. So avoid the HLR for service connection, go ahead and try it for increases to get a better rating. But to answer the question: vets.gov will have status of your HLR and any appeal you file.

I have been looking at different posts about this, because I had a grant for SC in Feb, and so far they have not implemented it. I was told by my attorney who checked on the status that it's at the Rating Board so it should be any time now. Based on recent posts the implementation can take anywhere from 3 months to a full year, and no one knows why some take longer than others. I have figured out though that it is rarely done before the 120 days are up, because the RO apparently has to allow you the opportunity to file an appeal of a BVA decision before implementing a grant or starting a remand, which is 120 days from when the decision letter was sent to you. Why anyone would appeal a BVA grant, I don't know, but it seems that there must be some kind of internal rule, especially if you had a grant and some issues remanded by the BVA. Mine hits the 120 day mark as of next Wednesday, so I'm hoping to see it finalized since I may have to get surgery soon and could be off work for months. Also, apparently the Appeals Management Office may not actually transfer jurisdiction of your claim immediately to the VARO and that can cause a bit of a delay. If you don't hear anything after 4 months you should start inquiring about the status to see if it's being worked on. I know there's a fast letter addressing delays of 120 days, but based on many forum posts I've read, they don't follow it or their own rules. I saw a post not long ago from someone who worked as a claim processor and said that records get locked for 120 days and it's a PTA to work on them during that time frame so most employees don't want to even touch them until the 120 days have passed. Also, there's a saying floating around that since there are so many claims to work on, and they are all special, nothing is special. In a nut shell: expect 3-6 months to get your % and retro.

Unfortunately your employer still has you on the books, which means technically they disagree and feel you can still work (the VA is trying to use a legal loophole here). What you should obtain is a competent medical opinion stating that you are unable to work and why and how long you have been unable to work. Then appeal the decision and submit that to BVA along with arguments. Your employers opinion on your ability to work is meaningless, because their opinion does not constitute competent medical advice. Simply because your employer has failed to take action to either remove you or approve your disability claim, does not mean you are employable.

I know this is old, but I keep seeing this misunderstanding, and the definition applied incorrectly to 5002. "Did the doctor order bed rest?" Under 5002, bed rest would be contraindicated for inflammatory arthritis such as PSA and RA, as activity is the usual recommendation to prevent a joint from locking up. Bed rest would only make it worse. For the purposes of 5002, there is no set definition but it usually means that the patient isn't able to do what he/she normally can do as a result of the inflammatory arthritis or required time off work to see doctors. I get to work all the time with joint pain and stiffness because if I give in and stay home and lay around it only makes it worse. Being unable to get up and clean the house or unable to do social activities because one is in so much pain and has fatigue is a good example of a totally incapacitating episode. Having to take time off work to go to the doctor for followups and blood tests because one is on multiple drugs to try to slow or halt the disease process would be a totally incapacitating episode, because the person is unable to earn income like a normal person does because they have to take off work to go to the VA doc.

I'm probably going to end up with 100% because of the problems I'm having, but yes definitely going to go for it asap. With so much happening I never thought was possible with this, I'm going to need to try to get some enjoyment out of my life before it ends (which may be sooner than I thought).

As of 2 days ago, the BVA granted me service connection for Rheumatoid Arthritis! Several other secondaries were remanded for further development with a lot of specific requirements from the BVA as to what the regional office needs to do. My lawyer said I should get 60% but she is planning to argue for 100% and also filing a CUE to get an earlier effective date. I'm so relieved right now it's not even funny. I missed two days of work this week, and laid around my house in agonizing pain Wednesday. I'm about to go on Humira, which is a drug that comes with a lot of risks, but the alternative is me being totally incapacitated in the very near future if I don't take it. I feel so lucky, I thanked my lawyer profusely today, because if it wasn't for her help I don't think I'd have gotten this far so fast! I'm also so thankful for the care team I have at the VA hospital, because they have been absolutely amazing helping me deal with this crap disease and keeping me working while I wait for the safety net of benefits. I'm also thankful for the few people on this forum that pointed me in the right direction! And to think, it was just two years ago I was sitting here at my keyboard feeling so depressed and alone, and scared that I was going to lose everything I worked so hard for.

Ended up hiring a lawyer in my state who was able to contact Dr. Anaise who did a very awesome IMO for me after hearing what was in my service record and my history with the VA. My claim is now sitting at the BVA waiting to be sent to a veterans law judge with a very good chance of getting granted. My lawyer submitted her arguments which were better than I could have ever written for myself. My fingers are crossed.

Since there wasn't a lot of people posting their experiences, I went ahead and just paid the $150 to see what it was like, since I can afford it and a lot of other vets can't. So this just shows anyone on the fence that this place is a complete waste of time and is a rip off. I am working on a couple better ways to get the nexus letter I need. I still have plenty of time to file my NOD yet and I'm in no rush. I just wanted to see how their service worked and give them a chance to see if they really were worth it. They are not worth it at all.

So here is my recent experience: I have an inflammatory arthritis and since the military it was speculated that it was this. In fact, my military records show that they recommended an RA panel, but none was actually given. So my plan was to order a basic record review for $150 and see a rheumatologist and use them as a guide for writing the letter (since, after all, she is just a nurse practitioner, and a va doc could easily discredit her). On January 20th I ordered the record review, and I had already consulted with Dr Bash (who wanted to charge too much for me to afford, but felt it was an easy win). A symptom commonly associated with GERD and complaints of joint pain while in service are documented well in my service record. On 3/9/2019, I emailed them asking about the status of my record review with concerns because I had not heard anything. I got a response like this: "The RPR, an inflammatory marker seen in lab work, was negative while you were in military service. November 2007 medical documents report negative x-rays, negative lab work, and a normal physical examination associated with complaint of multiple joint pain. The clinical indicators for an inflammatory arthritis condition is not evident during your military service." The problem with this response is that I had no labs done while in service. My diagnosis is based on a physical exam by a rheumatologist in Detroit in 2018, initial onset of symptoms was in 1997, and this is rather common for this type of illness, and one only has to perform a simple google search to know this. So it is evident that my condition is either out of her league or she is not interested in doing basic research to help you with your claim. Honestly I didn't expect much for $150, but I did expect at least a little bit of support and knowledge when it came to my condition. For GERD there is no YES or NO result (it appears she just didn't care enough to say YES or NO), just this: "Military treatment records are vague. Current symptoms most likely associated with a hiatal hernia found on EGD in March 2017." So I don't care much about GERD, but this should have been quite easy, since tightness in the throat area is a common GERD symptom (and I'm not even a doctor). I was just looking to service connect inflammatory arthritis for the most part; so apparently my complaints of joint pain and the fact that the doctor was recommending an RA panel mean nothing. A simple google search on the condition I'm claiming will tell you that the disease is not the same for everyone, that often times it goes into remission sometimes for years, and that blood tests are not definitive; plus it is very common that a diagnosis is not given immediately. So I'd recommend looking elsewhere, since she is obviously not very well educated when it comes to things like this; plus it appears that she has a lot of submissions and doesn't have time to research yours. Unless of course you have something that is very clear and very well described in your service records, I'd look elsewhere, but that would probably be a waste of money since you'd probably win anyway. I'd recommend that you save your money for an expert or an actual physician; I spent my money so you don't have to; I'd not recommend this service. TLDR; It's a waste of $150, and just a waste of your time and effort. You will have better luck with a specialist in the field you are looking to claim. It's not worth the money, and I suspect that they only respond if you email them or if your records contain something that would probably be a quick win for you anyway, so don't bother. I only received a response upon inquiring about the status of my records review, and the response was half arsed. Spend your money elsewhere.

Unfortunately, I see no record of the blood tests in my SMRs, and I don't recall if they actually did order the blood work. However, I was very happy to see documentation in there of every one of the same complaints I still have today, including Apthous Ulcers that have also gradually gotten worse since the military, and a complete lack of any evidence of the same symptoms on my entrance physical exam. So it shouldn't be too difficult to link the diagnosis from last July to my time in service. The only one that I've ever gotten a positive on is ESR, and the only record they seem to have is from a test they did last year (also recently had a slightly elevated white blood cell count). I was going through my VA history from 2007-2008 and it appears that some of the data is missing. I'm guessing that someone deleted some things or the records were lost, because I remember having more tests done than what's in there. Also there's no documentation of the last appointment I had where they told me I didn't need to be seen until it got worse (maybe they were worried of me filing a complaint, I don't know). Nevertheless, it looks like there are still plenty of notes about what symptoms I was having to establish a continuation from the service to present. Thank your for your advise, Berta. I really do appreciate you taking the time to help me. I'm going to focus on getting the IMOs I need before I go into the appeals process and not worry about a CUE for now.

Just got quoted 10k from Bash a couple days ago. He will do DBQs and a detailed nexus. He said it was a flat fee so it included everything. If I had 10k just lying around I'd probably do it. He felt as though I could file a CUE; I had my doubts about that, posted a question about it and, just as I figured, will be a difficult thing to win. He seemed confident that he could get me 100%. Probably should be able to get it, but 10K is a lot to risk, especially since it would basically clean me out if I had to pull that kind of money together. I'm exploring other options and going to give Valor4vets a try and hopefully get at least one other Nexus. There is a Rheumatologist 2 hours from me that does IMOs/IMEs I'm going to look into.

Ha, that's what I initially thought too when I first read it, but then I saw "RA Panel" under it, a term I've become all to familiar with. It's a set of blood tests that I've had several times. And then I looked at it closer and realized it was R/o Arthritis.

I reached out to Dr. Anias but he never responded. I've been hunting for a Rheumatologist both online and locally and I've found one locally that seems like a good bet, because she gets a lot of good reviews from people that mention she takes her time with them. She probably has zero experience with the VA and nexus letters though. I've also wrote a lawyer in my state that meets all the qualifications, and I'm waiting to see if they contact me. She lists on her website what cases she handles with VA claims and lists "musculoskeletal" as one so maybe she knows a doctor she can refer me to. I was considering Valor4vets, but I'm not sure if I'd get a strong opinion letter from them that would hold up, so I was going to use them as a last resort. My VSO recommends I file the NOD By August.

Yes Berta, it's the 2nd image from my SMRs...next to "A" which stands for "Assessment" and above "R" which stands for "Recommend". I assume R/O is an abbreviation for "Rule Out", but it could very likely be her abbreviation for "Rheumatoid/Osteo" since the next word is "arthritis", because she did point something out to me on my shoulder x-ray and said it was the early signs of it. The VA has made notes of osteophytes in my knee on a recent x-ray, and that's probably what she was pointing out. It was 22 years ago, so I don't remember everything she said. But yes, I posted the image of what is in my SMRs. Here they are again: This next image is where it says: Xray A R/o Arthritis R Ra Panel DR MGNT As for X-rays, she makes a note in the SMRs about a X-ray on my shoulder, but I can't read it. Her writing is bad. Another doctor did one on my ankle. However, the actual x-rays are not in the files. On the doctors making a note that they did it from what I can tell. From my research, they apparently do not keep x-rays from SMRs past a certain time period. But it's good to know that I don't need to do the CUE right away. So basically I just need a strong medical opinion/nexus letter. I know I can make arguments that "hey this is in my SMRs and here is my diagnosis" but I really want to get a nexus letter to improve the chances I'll win in appeals. Thanks for the advise. I guess I'm going to have to keep looking for a doctor since Dr. Bash wants me to pay so much. I wish he had quoted a bit lower, but I guess he is in high demand so he can ask quite a bit more than others.

And that's what I was thinking. The problem that my original filing posed was they would not give me a diagnosis at the VA, they would only speculate what it was. Last year they finally confirmed it was indeed inflammatory. So I asked to reopen based on the diagnosis and the fact I had the diagnosis in service. I understand that a nexus letter at this point is a must, and based on similar claims I read if I have that I can appeal it and I will most likely get a rating for RA. However, Dr. Bash is the one saying I could file a CUE. I'm afraid of doing that because I don't feel like I have enough to win that. I was hoping for just a strong medical opinion based on my records and current diagnosis and just appealing it. But he wants 10K, which was just soul crushing to me because without a Nexus I'm most likely going to lose. They'll just deny reopening it to avoid having to make a decision. Keep in mind RA is rated differently. If you have RA, it's an automatic 10% even if you have no problems with it or it doesn't affect you much at all. So it does make me angry though that they had my SMRs and it should have been approved back then; even if just at 10%. What more evidence did they need? They had my service records that clearly show I had it in the service. But I feel you are right that the problem is, had I understood it, I should have responded like you said. But I was dumb, and my VSO failed to advise me properly. He had told me I needed medical evidence after the service, which I did not have because I never saw anyone for it other than the military doctor and the VA doctors. Plus I have gaps in treatment, which is very common with this disease. I appreciate your opinion broncovet, and thank you for the advise.

That's just it, he didn't have them. However, he talked to me for 40 minutes and asked me about them. I had them in front of me and he had me read things off that are in them. We focused on the one entry with the most evidence. I explained to him that the doctors writing is hard to read, but what I could make out, and that it states I was seen for "Shoulder pain, Knee Pain, Ankle Pain, stiff fingers". Prior to this, I was seen for tightness in my throat (no pain), another one I had tightness in my throat with pain and it was diagnosed as strep throat. The one with no pain was diagnosed as just stress related. But he focused on the visit where I complained about joint pain, and I told him I could make out what looks like "RA Panel". Top Part of my record (note: I cropped the images so my SSN and other personal info aren't shown) - BERTA, this is what's in my SMRs: 2nd Page Bottom Part: As you can see her writing is horrendous, but it's obvious she was thinking it was an inflammatory arthritis. It looks like under RA Panel she wrote "Dr Mgmt", and that coincides with what she told me "If it gets any worse, see a doctor at your next command." (I was close to either separating or reenlisting) I had extended out for 6 months and was considering reenlisting and this contributed to my decision to separate. I separated in November that year. " If we can see here those denials (I assume Dr Bash has seen them?) we can better advise on CUE- and everything you need to know on CUE is here as well in the CUE forum. " He did not see them directly, no. I explained what happened that I filed in 2007 with the help of a VSO and they denied it. He asked what I filed for, I said among other things I filed mainly for RA. He said that was smart and asked how I knew to do that. I told him I based it on what the doctor told me in service and the fact my dad was diagnosed with it years ago. He said that was good. Here is the relevant part of the denial in 2007: When I first filed I ordered my service records, but I didn't get my outpatient records and I assumed that either they were lost or that doctors just failed to document my visits. After all, the VA lists my SMRs as evidence. It wasn't until early last year I discovered that all my outpatient records were sent to some other place. So I did a FOIA directly to that facility and they sent it all to me within a few months. It appears they were wanting a medical opinion back then, but I didn't know what I know now so I didn't fight it, but they seem to indicate there is no evidence in my service record anyway, and since I had no other evidence I didn't know what to do. I explained to Dr. Bash, since the doctor in the service told me there was nothing they could do about it, and I was familiar with my Dads diagnosis, I didn't seek treatment immediately after service. It wasn't until 10 years after service I enrolled in the VA health care system (which I didn't know about until then) and tried to get help. I was seen for a year and they told me the same thing as the military doctor said, that there wasn't anything they could do for me at that stage. They directed me to take ibuprofen and exercise and when it got worse to come back. So another 10 years went by and that's what I did. I went back because now it's even worse and they set me up on a long term plan of care for it. So, after discovering the entry in my service record that seems to clearly indicate the doctor suspected RA, I asked to reopen it and was promptly denied within 60 days after filing. This time I submitted my SMRs and all my VA treatment records just to be sure they understood I had everything they claimed they had that they based their decision on in 2007-2008. Here's the relevant part of their decision: Here is their explanation for continuing to deny my claim: So my VSO told me it's obvious they want a Nexus Letter. No problem, except I can't find anyone willing to help me except Dr. Bash. Unfortunately, he wants 10K because he said that I should be owed back pay plus I could easily get at or close to 100% since I'm on medication that pretty much makes 60% automatic for RA, and my medical record from service can establish I've had GERD since then too. He told me that's going to be at least 30%. He said by the time he adds in all the little stuff I'll be getting very close to it if not 100%. I'm just nervous about doing a CUE, because I have no clue when it comes to that. I was just fine with getting a strong Nexus letter and proving service connection, and having them back pay me to Oct last year when I filed to reopen. Then filing for an increase at a later date. I haven't done a lot of research yet, but I thought I had to do the CUE when I filed the NOD. I can do that at a later date? Bash seemed to think my plan wasn't good because he said it would take years for me to get everything he felt I was owed and that I should just do the CUE immediately because he felt the error was an obvious mistake, and they should have automatically approved a rating for RA in 2007. I know Dr Bash knows what he's talking about but before I even think about trying to come up with 10k, I need your opinion on this. It just feels too risky. If I had the 10k to spare, I'd just do it and get it over with. If he had said 5k, I'd be able to handle that no problem. But 10K is just too much for me right now to risk.

Hello everyone, I really need some advice. I am about to embark on a long fight, and I hope I have the energy to do it and I hope I'm on the right path. So I'm hoping at least one person on here can advise me if I'm going down the right path or not. Here is my story: In 1997 while in the service I started to have joint pain out of no where. I went to the doctor because suddenly my ankle started to hurt when I tried to go for a run after work. They did an x-ray, doctor said it appeared I had arthritis in my foot and asked me if anything else was going on? I told him, yes, as I had been having pain in my shoulders. He told me I should see a doctor and have it checked out. I did, and the doctor did x-rays on my shoulders. She told me it appeared I had early stage of an inflammatory arthritis. I asked what I could do about it? She said there was nothing they could do, just take ibuprofen and exercise, and see a doctor at my next command. Well, I had extended out 6 months because I was having my first child and thinking of doing another 4 years of service. After that diagnosis, I decided to separate as I worried about not being able to meet PT standards (In hindsight, I should have stayed in and made them medically discharge me). My dad had been diagnosed with RA when I was younger, but at the time I was ignorant of it and just thought it was no big deal. After service I went 10 years of having symptoms on and off again. At 32, it got bad enough that I decided to try seeing someone about it. I found out that I could go to the VA for healthcare, which was great because at the time I had no insurance. So I ended up seeing a Rheumatologist at the VA and a VSO helped me file a claim, and I ordered my service records. When I got my service records there was next to nothing in it, just my entrance physical and exit exam. I did not know that my outpatient records had been transferred to another facility. After a year of going to the VA (2007-2008), the VA Doctor didn't give me a definitive diagnosis, but told me that he was pretty sure it was either seronegative RA or early psoriatic arthritis. He offered me no treatments other than the same thing the military doctor told me: NSAIDs and exercise. Then told me I didn't need to be seen until my symptoms progressed. So another 10 years went by and slowly it got worse; starting in 2016 I began having more severe flare-ups. So in (2017) I enrolled once again in the VA healthcare system and started going back. I got pretty bad, and my GP gave me a steroid burst, started me on diclofenac, and put me in for referrals (also got some imaging scans ordered to check the progress to see if I had any damage). During this time I started getting noticeable swelling in my finger joints. So I finally I got a diagnosis for inflammatory arthritis from the VA just this past July and they immediately started me on Plaquenil. Then a few months later, started me on Sulfalazaline, and will start me on Methotraxate within the next month or so. I have a new local VSO (old one retired) and she's pretty good. She said I'd have to file to reopen my previous claim but warned me that it will most likely get denied and I'd have a long fight ahead of me, considering the circumstances. Prior to meeting with her I tracked down my OP service records and low and behold my appointments are in there. First, there is an appointment I forgot about that was the first symptom I had related to what they are saying is GERD, and then shortly after is the appointment for my ankle and then right after that is the appointment where it says I was seen for should pain, knee pain, ankle pain, and stiffness in my fingers. It's hard to read the doctors writing, but near the bottom I can make out this: "A R/O Arthritis" and under that it clearly says "R RA Panel DR MGNT" and then two other things I can not for the life of me read. From what I understand "A" stands for Assessment and R/O means "Rule Out" The R stands for recommend, and she was recommending an RA Panel which is a blood test to test for Inflammatory Arthritis. This all supports my statements I've made in my claim and a statement I said to the VA doctor 10 years ago that is documented in my VA medical records (which I have). For my ankle pain, it appears that doctor just treated it like it was a sprain. But makes notes that I told him I heard and felt a "pop". My original claim was for RA and they rejected stating in their letter than there was no evidence of me being treated for a chronic condition during or after the service. A couple months ago I got denied for trying to reopen. I sent them all my VA records and military records, showing that I was seen in the service for the same thing I'm being seen for now, and the VA records now have my diagnosis. Got denied saying the evidence wasn't new and material, of course. So this morning I spoke with Dr. Bash, who says he's willing to write a Nexus letter for me and do DBQs (Yes, he is expensive, but he's the best fit for me from what I can see). He recommended I file a CUE, because he says that I should have been approved in 2007 since my military records show I was seen for it while in the service and it's obvious they thought it was inflammatory and he tells that is an error. He also told me he is confident I will end up with 100% or close to it, since being on the meds they have me on is an automatic high percentage. My VSO said that I could take the route of filing a NOD and going through RAMP. However, she recommended I get a NEXUS letter and possibly a lawyer because she said I might need better help than she can provide, but that if I at least got a NEXUS letter it would greatly improve my chances since that was obviously what the VA is looking for in their response to me. So my question is, is a CUE the way to go? It looks complex and risky. Would you advise I get a lawyer to help me with this? 10 years of back pay is a pretty good amount. I'm really considering forking over the money to Dr. Bash to get a good medical opinion but it's really intimidating going through this, and I feel like I'm alone.

Yes, if you don't go to annual appointments at minimum you are "kicked out" of the system, but you can just enroll again. You have to go through orientation again though. it happened to me. I had to enroll again last year as I had not seen my GP for 10 years since they didn't bother to schedule me for an appointment. I have a different one now. Now it seems they make an effort to schedule appointments a year in a advance so you don't get kicked out of the system automatically.

I am in need of an IMO from a Rheumatologist, prefer Ohio, Michigan, or Indiana but since it's just an Opinion/Nexus letter I guess it can be anywhere in the U.S.