broncovet

Thanks, Mark, for your great, informed opinion. Navy Vet. Bergman and Moore focuses on issues which have the highest likelihood of winning Veteran's benefits (aka, retro). And, this is not always consistent with our own ideas. This is usually a judgement call by the law firm, based on their years of experience. Of course, we mostly lack their legal experience, and that is why we hired them. Like yourself, I was suprised that the 3 law firms I hired did not always persue the issues that I mentioned to them, and, instead, focused on issues they felt were most likely to result in additional retro for me and them. And, yes, I was disappointed, and, further, I did not like being "wrong" about those issues. But, in the end I discovered that all 3 firms..which I have named in the past, wound up winning additional benefits for me, and, they further did so at little or no cost to me (after eaja fees). However, like you, I was upset at least a portion of the time, like yourself, when they did not persue particular issues I felt were valid. Looking back, Im glad I trusted their judgement, and expertise..which I paid them for. I also learned that Veterans law firms are pretty much "not" in the education business, teaching us by explaining all the "why they do this". They have to justify their law fees to the CAVC or the VA, per hour, and "educating Veterans" is not billable, so they generally dont do it. There are around 25 million Veterans, but only about 1000 or so attorneys to represent them, so most of the good ones are very very busy. If you go in a busy resteraunt, the cook probably does not want to take time to explain how/why he cooks your meal, either. My advice is to judge your law firm "by his results", not by how quick he returns your calls, by what you think he should have filed or how long he took explaining it all to you. We do that at a resteraunt too. We judge "how good the food was", not how good they are at explaining how they cooked it. Many law firms are so busy it may take weeks to return non emergency calls.

Im gonna give you my best answer, but be forewarned: My best is not always the right answer. To be sure, you should check with a competent law firm such as CCK law firm. So, here is my 2 cents:

Once service connected, disabilities are rated on symptoms. We dont know your symptoms. And, specifically, symptoms which are related to "how well" you are able to perform a job, that is to earn a living. VA compensation is designed to compensate Veterans for the loss in earning capacity due to their disabilities. For example are you able to lift things? How many pounds? Some jobs require lifting. Does it affect walking? Do you have pain? All these symptoms, and more, have to be documented by a doctor to guess at a possible rating. It could be as little as 0 percent if you have no symptoms, and could be as much as 100 percent if you were unable to maintain substantial gainful employement because of your back disability. Back problems can cause other problems such as nerve issues, and other stuff a doctor would have to document and figure out, if it causes (provide a nexus) to other disabilities. As already stated, we would need more to venture a guess. Reminds me of a GSW. (gun shot wound) A gsw can be fatal, can be a "nick", barely even noticable, or anywhere in between. My father had a gsw. While he did have a scar, the wound hit no bones and caused no symptoms, with the exception of the scar. Scars, from surgery or the woulds can be compensable, again, depending on symptoms. Some scars cause pain, while others do not.

This is an age old problem. While I have not read your medical opinion, or lack therof, in regard to the eitiology of your ED, you will need a medical statement from a qualified medical person that opines your ED is at least as likely due to either an event in service, or related to an existing service connected condition. I see it that you have some choices: 1. Get another doctor in the VA and ask him or her for a nexus. He or she may or may not do it either. However, people are not the same, and doctors are not either. The next doc may be willing to write a nexus, I can not speak for them. 2. Hire your own physician for his/ her medical opinion. (nexus statement). 3. Forget about sc for ED, because it probably wont happen without a valid nexus either from a VA doc or from a private doc. You can certainly try item 1, before shelling out the money to pay for your own doc. You can try going to a nearby VAMC, or you can try another provider (doc). Remember, the VA is signing the doc's paycchecks. And, so their loyalty goes to the one that signs their checks, not to us Vets. We dont have to like it. Its the Golden rule: The guy with the gold makes the rules. In this case that is the VA.

Ok, lets focus on helping this Veteran, please. Sometimes that last 10 or 20 percent is difficult. Lets begin at the beginning. You have at least 3 options, and you dont have to choose, you can choose them all! 1. Apply for an increase percent to your existing rating. This generally means either you were lowballed or your symptoms got worse over time. 2. Apply for new disability conditions, either that are from military service or may be secondary to your existing service connected condtion. 3. If you are not working, due to Service connected conditions, apply for TDIU. My advice, if you are not working, is to apply for all 3, especially if you may have new conditions that may or may not be related to your service connected condition. We would need to know more to suggest what you should apply for. Incidently, yes, I agree 4.16B (extra schedular TDIU is rare) and I got it! But it was a fight!

Welcome to hadit. My answer is in 3 parts: 1. You might as well get used to VA "wanting to know everything and I mean everything about you". Here is the deal. You give them all the information they request or its easy for them to deny you. We do not get to pick and chose what is relevant. In order to get VA benefits, you have to lay your life bare. Remember, when you went into the miltiary, they made you strip down and cough for a physical. So they checked inside and out. Expect no less with the VA. While you are not required to release information, they also are not required to provide benefits if you dont provide the requisite information and they get to decide what that requisit information is. While I agree with dustoff, they send that form out all the time, you could get benefits right away or you could get a quck denial "if va thinks" they dont have all the information 2. Now, the good news. The "fear of the reduction wolf" mostly turns out to be a puppy. There are numerous regulations in place which protect your rating from the big bad wolf and they do a great job, but only when you know how to scare the wolf off, and know how to find and use those regulations to protect you from the big bad wolf. In sum, if you have been rated over 5 years, or are P and T, its very tough for the VA to reduce you. THe protections for 10 years, is still better, and the 20 year protection is like Fort Knox, because VA cant reduce you after you have been rated for 20 years without proving fraud. My short paraphrase of the protections (over 5 years or P and t) mean that "not only" does the VA have to prove you "actually improved under ordinary conditions of life (not with prolonged rest)", but your improvement is sustained (ongoing) and not just a one exam improvement. Further, the exam to reduce you has to be "at least as thorough" as the one where you were rated. Finally, remember, when the VA issues you a decision, and does not address past disabilities, then the presumption is "there was no improvement in previous disabilities since that time", so they have to show that improvement occurred since your most recent VARO decision. However, dont take my word for it, then go pet your new puppy: Read the regulations your self: The threats to reduce are often overblown BUT you must act if you get a proposed reduction letter or else its assumed you dont protest the reduction. If you get a Proposed reduction letter, start a new topic on hadit and get help. https://www.law.cornell.edu/cfr/text/38/3.344 3. My last part is concerning to me. You posted: "Clear nexus letter" is relative. Clear to who? You? probably? VA, maybe not so much if it was worded like that. Rating specialists search for terms like "at least as likely as not" related to an event in military service. It may work, but VA seems to love "at least as likely as not caused my heart disease", and not so much the little less clear (to some rating specialists, who may be doing a search for a nexus using search terms like I suggested). The BVA is full of cases where the nexus was less than clear. Most of those wind up getting remanded for clarification of the nexus. This means another c and p exam. My advice is to read over the nexus letter again. Now, "if" your prime care is a va doc, he likely knows how to write a nexus letter. However, if he does not work for the VA and you get your care outside of VA, he may be unfamiliar with exactly how to do a va nexus to satisfy them. Especially critial parts of a nexus letter: A. The doctor provides his CV detailing his competence as an expert witness. (The VA c and p examiner gets a presumptive, your doc does not!). He needs to demonstrate medical training and experience diagnosing and treating your types of maladies, aka blood pressure/heart disease. B. The doctor needs to state he reviewed your records. This seems obvious, but VA often loves to do the "gotchas". This is one. C. The doctor needs to provide a medical rationale as to "why" he presented the opinion your high blood pressure was related to heart disease, such as citing a Harvard medical study that showed this link. D. He needs to sign it, and provide his medical license number along with address and stuff. "Anon" or "ghost" docs cant provide a nexus because their competence can not be verified. The VA can check with the medical license number to see if this doctors license in under suspension for any reason. E. Of course, the VA needs to be able to read his writing. Im not trying to be a naysayer here about your nexus. It may be fine. However, it is best to review it. It may well save you years of delays and denials, as "there may" be time for your doctor to slightly amend that nexus letter to include all of the above, "if" any one or more of the above is missing, incomplete, or inaccurate. Instead, Im trying to save you heartache which has resulted in delays and denials for many Veterans. EVen tho, I had a "dead on" nexus, the VA still found a way to deny, and that delay meant I lost my home to foreclosure. They made up a way to deny. Even tho, the Caluza elements of diagnosis, event in service, and nexus should suffice, they made up a new one. They said it had been "too long since military service" a bogus denail. I overcame their denial..but lost my home in the process. Im trying to prevent that from happening to you.

The original post was from almost 8 years ago, Lemeul. While it would be awesome if the OP responded, it is not exactly likely. Im not sure how/why this is happening.

The obvious advice is to appeal all the ratings. You can allege an inadequate exam, alleging they could not have done a thorough job in 45 minutes. However, be sure to address the reasons and bases for denial. Dont make it an attack on the examiner, make it an appeal, on the bases that the "reasons for denial" were inapplicable/incorrect. Example: (Dont use my example) "While the Nov.4, 2023 VARO decision (cite the decison) denied tinnitus stating that "no evidence of tinnitus could be found", in an exam by Audiologist Cooper, on Jan, 2019, it was noted the exam could not be completed correctly because of ringing in the ears (tinnitus)." This Jan. 2019 exam directly refutes the VARO decision claim that no evidence can be found.

Its the same reason VA (loans) can charge Veteran interest on the loan, but not PAY interest to the Veteran when they delay his claim 5, 10, 20, or even 30 years: The VA gets to interpret their own regulations because of Chevron Deference aka Auer Defence. Many times, cases boil down to "how VA interprets" their regulations. The VA is free to interpret their own regulations in a manner they see fit, and to modify, scrap, or change those regulations, at will, for their own purposes, when it serves their best interests. Further, it seems to be that for Veteran "Joe" the Va can interpret its regulations in xyz manner, but for Veteran "Bob", the VA can decide this is a different situtation and they are to be interpreted in abc manner. And, unfortunately, VA has apparently interpreted the regulations requiring those above it to be 100 percent plus a combined 60 percent, seperate and distinct, not an "added" 60 percent. In the ground breaking case of Chevron, the Supreme Court ruled that (a government agency) was in a postition to interpret its own regulations, and "the bar for us to get that overturned" is very very high. The good news is that Chevron deference is being reconsidered by SCOTUS, and it could be changed, or eliminated: https://www.duanemorris.com/alerts/us_supreme_court_signals_it_may_jettison_chevron_doctrine_0124.html#:~:text=The conservative majority of the,federal agencies less interpretive discretion. I suggest you watch this Scotus decision, I will try also, and let you know if the results when I find them.

Good point Jamescripps. I did not know that. Great advice. I heard that you were the first to get sc for AO in Conus, is that right? That is quite an accomplishment.

Its not that unusual to have more than one exam. The C and P exam has to have pretty much everything right to be ready for rating. As an example, as you pointed out, if there is a nexus, are the symptoms documented? Further, Va sometimes requires a medical reasons as to why the doc makes said opinion, "especially when/if" that opinion is somewhat controversial. Lets say a doctor opines that your high blood pressure caused your prostate issue. Since that may be rather rare, the VA may ask the doc to explain his medical rationale as to how high blood pressure can cause a swollen prostate. So, you may have to go back. There are many reasons why you may have to go back, this is just a couple. I have posted things c and p exams need to be valid, but wont do that again here.

Excellent question. I would refer you to the regs on reductions, found below: https://www.law.cornell.edu/cfr/text/38/3.344#:~:text=Rating agencies will handle cases,governing disability compensation and pension. The answer to your question depends on many factors, such as "how long have you been rated?" and are you P and T? It will also depend on your symptoms and residuals. https://www.law.cornell.edu/cfr/text/38/4.115b

Something a bit weird is going on. Your question appparently is from 2022, but no answers until 2024. I generally at a minimum answer way, way, way before that. However, my advice, if you feel like you deserve "loss of use" , the go ahead and apply. If awarded, you should get an effective date "the facts found" regardless of when you apply, because this involves SMC. SMC is inferred and the effective date is not limited by the date of claim, but rather only by the date the doc said you had "loss of use".

Make sure you understand: You do not need a TBI DIAGNOSIS in service. NO. You need an "event" in service. There is a difference. If you jumped out of airplanes, its entirely possible, or even likely you hit your head at least once. Instead, you need the Caluza elements of: 1. Current diagnosis. A doctor needs to diagnose you have TBI now. And 2. You need documentation of one or more events in service. Jumping out of an airplane is an event. So is combat. If you have a buddy from the service who was there and saw you hit your head, then he could write a letter about same. This letter, may suffice for Caluza element 2: "event in service" 3. Nexus, or doc statment that "its at least as likely as not that your current diagnosis of tbi is from head trauma you received from combat, jumping out of airplanes etc while in military service". Use your actual example, not my sample. Get the Caluza elements: Get service connected. Miss one or more Caluza Elements: Get denied. NOTE: SECONDARY TBI does not really make sense to me, UNLESS PTSD caused you to hit your head. (maybe, IDK). In any case secondary SC is mostly like the above except: 1. Current diagnosis 2. Nexus that your Secondary condtion (TBI?) was at least as likely as not due to PTSD. This seems a little far fetched to me, but IDK, so it may well be possible to bang your head with PTSD. IDK. My opinion does not matter anyway, it takes a doctors opinion regardless.

My attorney explained it. The law firm can collect the "greater" of (the percentage agreed upon) or eaja fees, but not both. In my case, I had agreed to 20 percent which would have been 5000. But, since eaja already paid her 4000 from the cavc, She got 1000 from me and 4000 from eaja. And, she only got the 1000 because I agreed to pay her for representation at the BVA. In my other appeal, Chris attig does not represent claimants at the board. He won a remand at cavc, collected his eaja fees, I paid nothing. He advised me to go pro se, I went with a vso and hired a IMO per his recommendation, with a name he provided. The IMO cost 500, and I won a six figure retro where my only cost was a 500 IMO. I hope this explains it. IN short: EAJA pays fees at the CAVC YOU pay the fees at the BVA

Caluza elements require a CURRENT diagnosis...not a diagnosis in service. This is a big difference. You need an "in service EVENT". For example, did you work in close proximity to weapons being fired? Those can be very loud, damaging ears. Did you work near aircraft? Jet engine noise is, frankly deafening. Sometimes the VA uses your MOS. Now, the Navy does not use "MOS", but I also know just because you may have a MOS of a personelman, (human resources, the kind usually not in battle, but in offices to take care of other troops questions about insurance benefits, leave, etc. etc), does not mean you were necessarily working in that field. You may have been a personelman, but your CO (commanding officer) may well have placed you else where, such as a cook or something else, wherever he thought you were needed. So, to demonstrate (aka document) noise exposure in service, there are several ways, "if" indeed, your audiologist report says your vertigo is from loud noise exposure. There are at least 2 types of loud noise exposure: 1. A single blast of extremene noise, such as an IED going off in close proximity. A single blast of extreme noise can cause varying degrees of hearing loss/tinnitus depending on degree of the noise and your proximity to the blast. 2. Prolonged exposure of noise over time. This often happens to military people who, for example, work on flight decks, and were not offered ear protection way back when. Jet engine noise, or other loud noises repeatedly can cause hearing loss over time. So can repeated gunfire with defective or missing hearing protection. You can sometimes document military noise exposure with a "buddy letter". Let's use an example (dont use my example, its hypothetical only). You were assigned duty as a cook. However, after arriving on duty, it was discovered they had far too many cooks and not enough flight deck hands. So, your CO decided you would work on the flight deck, but he did not want to change your rating, you were still a cook. In this instance, you had a friend who worked with you and he trained you. He had no idea why they trained a cook to do this, he thought you should have had some aircraft training, but they sent you instead, so he had no choice but to train you. He was pleased, however, how well you picked it up, and you 2 became friends because you live in the same state, and keep in touch. In this case, your buddy could write a letter testifying he say you regularly working 40 hours a week or more on the flight deck exposed to jet engine noise. This may suffice as a buddy letter to establish noise exposure. Your buddy probably can not diagnose hearing loss, but he can relate that the sound of the jet engines was deafening and you could not hear for 2 hours after a plane landed or took off because your ears rang. This is an example of how a buddy letter may help document noise exposure. In my case, my barracks were at the end of the runway. Yep, planes landing had to gun it to clear my building I slept in. I found my exact barracks online in google maps, demonstrating it was only about a couple hundred yards from the end of the runway,. I specifically recalled training there, where the supervisor, when a plane flew overhead, we had to take a 15 minute break because we could not hear for 15 minutes while he was teaching classes. It was frustrating for him and us. I seem to recall maybe a half dozen planes taking off per day. (Landing was not quite as noisey.). No hearing protection was provided, and, we now know that is a huge mistake for anyone working near jet engines. Employees at airports wear mandantory hearing protection near jet engines.

Good read, in the link provided, dustoff. This answers many questions. It explains their are at least two types of attorney client fee agreements related to Veterans law: 1. Agreements where the attorney agrees to accept EAJA fees exclusively before the CAVC. 2. Agreements where the client agrees to a percentage of the recovered retro, such as 20 percent. For more precise information, read the link above, absent my hillbilly paraphrase which may not be that useful.

Welcome to hadit, lodidoddi. This is a 2021 post, and I can not say. However, my advice is two fold: 1. Start a new post, and you will get more and better answers. 2. Since you are new, I will address your concern this time. Next time, please start a new post with your question. Vertigo, as well as other conditions should be service connected with the Caluza elements. To find out if you have those documented, check your medical and service records for the following (Caluza elements...required for service connection, with some exceptions such as presumptives): 1. Current diagnosis. 2. In service event(s) you allege caused your conditions. 3. Nexus, or medical professionals opinion (such as an audiologist) that your (vertigo) is at least as likely as not due to an event in service such as loud noises, gunfire, trauma, etc. etc.

Carpenter is the cream of the crop. He is extremely busy. According to this report, in the link below, 80% of CAVC claims end in remand: https://www.gao.gov/assets/d24106156high.pdf That leaves just 20% total for "win" and lose for the Veteran. With a remand, your attorney could/should ask for eaja to pay the fees to date. That leaves what do do with representation "at the BVA" upon remand. This should be brought up with your attorney, preferably, sooner rather than later. I had 2 remands: 1. Glover luck represented me also at the board. She applied for at got CAVC eaja fees, which were deducted from the 20 percent I had agreed to. I may have mentioned earlier, the 20 percent amounted to $5000, of which $4000 was paid by eaja fees, so I paid $1000. Not bad. 2. Chris Attig also won a remand, and applied for eaja fees. He informed me "he does not represent (at that time) Veterans before the board, probably for reasons like you mentioned. He advised me an IMO before the board should win it, gave me the name of a skilled IMO writer. He suggested I could represent myself before the Board. Instead, I went with a VSO, won, got the IMO, paid $500 for the IMO, and no attorney fees. Both of these were a win for me, and a big win. Im not sure if it was dumb luck or due diligence, but, either way, it worked out well. Its unrealistic to expect the attorney to: 1. Do the claim "just like you do." If that were the case you dont need an attorney. 2. Hold your hand or call you each time he files a document. A win or remand is good enough. He does not need to prove to me he is working.

My advice is to hire a professional. Why? https://www.vetadvocates.org/cpages/why-professional-advocacy This does not mean a VSO can not do a good job for you, especially in the early stages. Most Veterans dont hire a professional until/unless they are unable to or frustrated by the long delays with a VSO. At the CAVC level, generally, lawyers will receive their compensation from EAJA fees. To make this happen, you need to appeal a BVA decsion within 120 days and no more. Dont wait the full 120 days, it does take time to enlist the services of a NOVA advocate professional. At least some Veterans hired "unaccredited agents" and did not get a good result. In all fairness, not every Veteran is happy with his or her attorney either. The 2 biggest complaints I hear from Veterans about their attorneys are: 1. They often dont return phone calls promptly. This is an upgrade from VSO's who often dont return them at all. 2. The attorney "does not persue the claim" in the manner suggested by the Veteran. Or, "the Attorney did not do anything". Generally, the attorney does not call the Veteran and say, "Gee, I read 400 pages of your file today and filed an amendment to your appeal, adding a point of law the Veteran overloooked". And, he does not send the Veteran a copy of this either. Best and safest is to stay with an accredited agent or better yet, lawyer experienced in representing Vets on this page: https://www.vetadvocates.org/cpages/sustaining-members-directory At least one Veteran reported he did not get a good result when he hired an "unaccredited agent": https://www.texastribune.org/2023/07/05/veterans-disability-benefits-brian-reese-va-claims-insider/

I agree, and dont use HLR. I have had, on at least one occassion, the VA deny claims when I was 100 percent because it was "moot". I appealed to the BVA, arguing it was not moot because it could involve in additional benefits such as: 1. SMC S 2 Earlier effective date (for tdiu, which I had sought). The board agreed with me and stated that "it was not moot" and ordered the VA to consider my tdiu to include extra scheduler tdiu. There is a common misconception among VSO's, Veteran advocates, and VA employees that "100 % is the maximum benefit". Its not. According to VA's SMC compensation rate tables, a Single Veteran rated R2 can get 10,697.23 per month which is more than double the single Veterans 100 percent rate of $3737.85 The myth of "100 percent is the best you can do" is just another way the VA gets you to settle for less than you deserve/. Dont let them do it. Appeal.

Ben Krause is a disabled Vet himself, also an attorney, who is a Veteran's activist. This is what he has to say about this recent scandal and coverup involving at least 2 "high ups" of VA who are non Veterans. I would ask why non Veterans are being promoted to the highest levels of VA, when Veterans there are around 30 million Veterans available? https://www.disabledveterans.org/integrityfirst-veteran-privacy-breach/?inf_contact_key=71ee763de3db9cb7e92c7579b6b15d6e680f8914173f9191b1c0223e68310bb1 It may be time to write to your senator and ask this non Veteran employee NOT be confirmed by congreess to this high level va position, especially in light of this scandal.

When VA awards a disability rating, it comes with an effective date. The 5,10, and 20 year periods begin on that effective date. This effective date "does not change" until/unless you get a new decision which actually changes your rating or effective date, whether its a reduction or an increase. A c and p exam does not change your effective date "unless/until" a rating specialist, or applicable judge, such as a bva judge, renders a decision changing it. If you do not have your effective dates/ you can usually find them in ebenefits/va.gov. That should clarify your protection levels. Remember 5 years and P and T are the same. 10 years is for severance, 20 years is for reduction. More here: https://www.law.cornell.edu/cfr/text/38/3.344

Welcome to hadit: I agree with Marine.Cpl. However, since VA LOOOOOOOOOOVVVVVVVVVES to delay, if you see that when you request your cfile, file the nod anyway, in any case before your year after the decision is up. They could take over a year to get your cfile! Shortcut: You could/should be able to get your cfile as soon as "now" by going to a VSO "who has VBMS access" in real time. Ask them before granting your POA. Then, compare your records, to make certain the following 3 things are in place. Unless your VSO is clueless he should be able to help. If he does not know what "Caluza elements are", well, he needs more training. This is VSO 101 training. 1. Current diagnosis 2. In service "event" (if applying for ptsd this is referred to as a stressor event) which you allege caused your condition you applied for. 3. Nexus, or doc statement that your current diagnosis is "at least as likely as not" due to your in service event. The 3 above are called the Caluza elements: Get them and get service connected, miss one or more and get repeatedly denied. Sometimes, to get your nexus, the va doc wont provide it. This means you need to go to a private doc that you pay for to provide the nexus, called an IMO, or IME. The va wont call for a c and p exam if: a. You have no inservice event or stressor. b. You have "bad paper", that is, such as a dishonorable discharge. Or you dont meet "qualifying military service" serving the applicable time period. c. A c and p exam "wont change the outcome" such as if your military records are missing. A review of your records is necessary to find out if: a. You were missing one or more caluza elements. OR' b. Its a bogus denial, you had all the caluza elements and va denied you anyway. (This is what va did to me, and others, too). "IF" your military service records were missing, but then VA and/or you find them, then you can/should resubmit this claim under 38 cfr 3.156 C, and you should get benefits back dated to when you first applied.

The reasons and bases for decision which you posted suggested either a missing nexus, or defective nexus. "Nexus killer". Many well meaning doctors put in words which are nexus killers. They are words like, "could be", "may be", "might be" "is possible". Instead, you need the classic, "at least as likely as not", because the previous words in quotes I posted are considered speculative. My advice is to check your medical records, specifically your medical exam, and see if it contains "nexus killer" statments. If it does, you are gonna need another medical exam to win benefits with "at least as likely as not related to (SC diabetes, depression, etc)". ALSO: Dont forget to have the doctor give a date the symptoms began. Why? Because that can be your effective date: aka retro. Something like this: (Dont use my example, but it could be somewhat similar, your doctor will need to write it in his words) "In my professional opinion, the Veteran's ED is at least as likely as not due to (list sc condition(s), and or medications for those conditions). The records show the Veteran has complained of ED since Sept, 2003, when he first started medications for diabetes." This is a sample nexus, do not use my sample. Signed, Ima Doctor atVAorprivatedoc, Board certified to treat diabetetes ED, etc. The doctor in question signing this needs to demonstrate comepetence to make said opinion.