Approval Of Nexus Letters (gerd Gastritis)

[mags1023]

I posted yesterday that I had won my claim. I got my envelope today and thought it might help some folks out to post how my letter reads and what the VA said about my NEXUS letters, so here it is:

For Hiatal Hernia/GERD and mild erosive gastritis as secondary connection for long term use of NSAIDs:

Your Dr. opined that the long term use of NSAIDs used to treat your arthritis and carpal tunnel "more likely than not" adversely contributed to your Hiatal Hernia/GERD and mild erosive gastritis.

In another letter dated...your family Dr. opined that your medications prescribed may have contributed to your condition. Your Dr. further stated these conditions are "at least as likely as not" related to your military service or the treatment of your service connected conditions.

The VA examiner opined that your Hiatal Hernia/GERD and mild erosive gastritis was not caused by NSAIDs (surprise, surprise ;) ).

Decision: Since the medical opinions of your private Dr's and the VA examiner are at "equipoise", reasonable doubt has been resolved in your favor and we have granted service connection on secondary basis. The opinions of the private physicians have been assigned more weight, as a rationale was provided with each opinion. The VA examiner did not provide a rationale.

So there you have it. All the experts on Hadit advised me to get these nexus letters from my Dr.s and they obviously were the key. I wrote the letters myself and had the Docs sign them when I was in their exam room. I can't imagine ever submitting anything without a NEXUS letter again. The wording could be a little stronger like use "caused" instead of adversely contributed. Hopefully, the doc will sign off on it.

I hope this helps some of you out there searching for the right words to say.

[Vync]

1 hour ago, flores97 said:

Mags1023, I know this is an old thread but thank you for posting this, I have gerd/hiatal hernia and IBS caused/aggravated by long term use of nsaids and this post gives me hope.

I completely agree with the advice from everyone on this post.

Any doctor who says long-term NSAID use does not contribute to GERD, gastritis, or IBS is an idiot.

My nexus came from a VA C&P doctor who was an internal medicine specialist. I made sure all of the records were present and procedure results were in my favor and recent so there would be no doubt. I did not want to just leave it up to the VA to do their own tests. Keep in mind that I was SC as secondary, but it still required a nexus.

Quote

S: Patient reports having GERD due to long term use of NSAID medication taken for service-connected TMJ pain. The condition began in the service post-op removal of all third molars in 1994 resulting in service-connected TMJ pain and has become progressively worse. Reported symptoms include acid reflux, heartburn, scratchy throat, burning pain and nausea daily, and awakening during the middle of the night with sub-sternal chest pain.

O: Service and VA treatment records show consistent use of prescribed NSAIDS for more than 17 years which include aspirin, ibuprofen, naproxen, and vioxx. Medical history indicates frequent medical treatment visits for GERD, left-sided colitis, and gastritis averaging six times a year. Current treatment medications include omeprazole, mylanta/benadryl/xylocaine GI coctail, immodium, and miralax. Upper GI series procedure showed contrast found esophageal reflux. UGI scope confirmed lower esophageal irritation and mild gastritis. Heliobacter pylori test was negative.

A: NSAIDs can cause dyspeptic symptoms (epigastric discomfort, upper/lower abdnominal pain, nausea, fullness, bloating, and dysphagia). It is as least as likely as not that his use of NSAIDS to treat his service connected TMJ are responsible for GERD.

 

 

[flores97]

Thank you Vync, that is a great Nexxus letter. I am obtaining an IMO from Valor Compensation Consulting, i am also obtaining an IME from Dr Ellis in April for the Gerd/hiatal hernia (i have hernia as well), ibs, and urinary incontinence. I have been on a high daily dosage of NSAIDS for the past six years, I had almost no gastro problems before, they developed in the past two years and have gotten to the point they are almist as bad as the lupus. I also take azathioprine, plaquinil, prednisone, gabapentin, venlaxafine and pantoprazole. I am hoping with both the IMO as well as the IME the FDC for the secondaries will be, if not speedy, at least steady, lol. Thank you for posting that, it is a huge help and I appreciate it!

[Vync]

Flores,
Glad to help! I saw that you and mrmark1999 would probably benefit from it, so it was the least I could do.

[mrmark1999]

 

On 3/5/2016 at 9:29 AM, pete992 said:

First, I really do not like responding to old post but this particular post is very important. The highlighted part is what I have been saying for years. Veterans have to build a good rapport with their medical doctors. It doesn't matter what the condition is, when a veteran is feeling the symptoms of his/her illness s/he must go and see their doctor.  The doctor need to see the veteran while the symptoms are going on making the doctor a witness of the fact that he/she (the Doctor) not only treats the veteran but has actually witnessed the symptoms and can be a very powerful ally in fighting VA red tape. Especially if the treating doctor is a VA doctor or a specialist working in his/her specific profession.

I can also agree my podiatrist was awesome he had been treating me for a while he wrote a small IMO for me and the VA denied it he was personally offended with their rational on why so he spent 2 1/2 hrs on a regular appt and went page by page dot by dot connecting all the dots in my service records on my NOD I was approved without question because of the expertise of my physicians treating them well and they will do the same. Listen to what they have to say follow their advise

Edited March 19, 2016 by mrmark1999

[ArielNavy]

Very helpful. I have a disability on appeal

Edited July 28, 2019 by ArielNavy

[Angry Vet]

On 3/7/2016 at 12:45 PM, flores97 said:

Thank you Vync, that is a great Nexxus letter. I am obtaining an IMO from Valor Compensation Consulting, i am also obtaining an IME from Dr Ellis in April for the Gerd/hiatal hernia (i have hernia as well), ibs, and urinary incontinence. I have been on a high daily dosage of NSAIDS for the past six years, I had almost no gastro problems before, they developed in the past two years and have gotten to the point they are almist as bad as the lupus. I also take azathioprine, plaquinil, prednisone, gabapentin, venlaxafine and pantoprazole. I am hoping with both the IMO as well as the IME the FDC for the secondaries will be, if not speedy, at least steady, lol. Thank you for posting that, it is a huge help and I appreciate it!

Can you share a redacted copy of the NEXUS letter linking reflux to NSAID use?