Nexus Letter?

[smilen66]

Hello to all,

My private Podiatrist is willing to write a nexus statement/letter for my ankle. I've searched hadit and I am unable to locate a sample letter. I used the sample provided here for an IMO for another condition but I need the sample nexus letter for Tuesday's appointment. The Dr. that wrote the IMO appreciated the sample and of course she put her own spin to it. If anyone can help me with a draft, outline, or sample nexus letter I would greatly appreciate it.

Thanks

[darkhorse]

It's best to be original with the nexus letter and just let your doc type it up their own way. Just remember that there are important incerpts such as "I have reviewed the veterans medical records" and "it is my opinion that his/her condition if more likely than not related to _____." You may want to consult with your VSO and see what they would recommend.

I have letters but the wording in them wouldn't do you any good since there are many ways these letters can be constructed. This would also be considered coaching and coaching isn't allowed here.

dh

Hello to all,

My private Podiatrist is willing to write a nexus statement/letter for my ankle. I've searched hadit and I am unable to locate a sample letter. I used the sample provided here for an IMO for another condition but I need the sample nexus letter for Tuesday's appointment. The Dr. that wrote the IMO appreciated the sample and of course she put her own spin to it. If anyone can help me with a draft, outline, or sample nexus letter I would greatly appreciate it.

Thanks

Edited October 25, 2009 by darkhorse (see edit history)

[kw34]

Smilen,

Below is the format recommended by VA watchdog and most here on Hadit. I used this and the VA examiner commented on how well it was written. To key elements is the review of your SMR and the statement "it is at least likely as not " 50% is the burden of proof for the VA.

Good Luck

DATE

Reference: YOUR NAME

YOUR ADDRESS ETC.

To Whom It May Concern;

I am Dr. Quack. I am board certified to practice in my specialty. A CV is included.

Mr. John Doe is a patient under my care since DATE. His diagnosis is YOUR CONDITION, etc.

I have personally reviewed his medical history (NAME DOCUMENTS) and I've also reviewed his history of the (EVENT OR EVENTS YOU CLAIM ARE THE CAUSE OF YOUR CONDITION) while he served during his military service.

I am familiar with his history and have examined Mr. Doe often while he has been under my care. (SPECIFY LAB WORK, X-RAYS, ETC.)

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

In my personal experience and in the medical literature it is known, ETC.

It is my opinion that it is more likely than not that Mr. John Doe's condition ETC.

SIGNED

Dr. Quack, M.D.

[smilen66]

Smilen,

Below is the format recommended by VA watchdog and most here on Hadit. I used this and the VA examiner commented on how well it was written. To key elements is the review of your SMR and the statement "it is at least likely as not " 50% is the burden of proof for the VA.

Good Luck

DATE

Reference: YOUR NAME

YOUR ADDRESS ETC.

To Whom It May Concern;

I am Dr. Quack. I am board certified to practice in my specialty. A CV is included.

Mr. John Doe is a patient under my care since DATE. His diagnosis is YOUR CONDITION, etc.

I have personally reviewed his medical history (NAME DOCUMENTS) and I've also reviewed his history of the (EVENT OR EVENTS YOU CLAIM ARE THE CAUSE OF YOUR CONDITION) while he served during his military service.

I am familiar with his history and have examined Mr. Doe often while he has been under my care. (SPECIFY LAB WORK, X-RAYS, ETC.)

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

In my personal experience and in the medical literature it is known, ETC.

It is my opinion that it is more likely than not that Mr. John Doe's condition ETC.

SIGNED

Dr. Quack, M.D.

Thanks, KW! I've seen this letter before however, I thought it was an IMO. Is there a difference between an IMO and a nexus? Since, my stroke I get a little confused and anxious when I attempt something new. Okay,now my podiatrist has 2 examples he can follow...the one you are sharing and the IMO written by my Orthopedic doctor. I'm straight now (I think).

Again, thanks so very much!

[smilen66]

It's best to be original with the nexus letter and just let your doc type it up their own way. Just remember that there are important incerpts such as "I have reviewed the veterans medical records" and "it is my opinion that his/her condition if more likely than not related to _____." You may want to consult with your VSO and see what they would recommend.

I have letters but the wording in them wouldn't do you any good since there are many ways these letters can be constructed. This would also be considered coaching and coaching isn't allowed here.

dh

Thanks Darkhorse. I wasn't aware my request would be considered coaching. I reread forum rules but couldn't locate the rule pertaining to coaching. Thanks, again.

[darkhorse]

I thought you wanted someone to post their actual letter and then you would just fill in the blanks. That wouldn't be good. Now I understand your request.

Thanks for your service,

dh

Thanks Darkhorse. I wasn't aware my request would be considered coaching. I reread forum rules but couldn't locate the rule pertaining to coaching. Thanks, again.

[Pete53]

Darkhorse:

Please do not make jokes about serious inquiries.Consider this a warning after some of the problems we have had here we take a dim view of people who are not seriously trying to help. Your posts remind me of cryptotech for some reason.

You have no reason to quote Hadit rules everyone can read them on their own.

http://www.hadit.com/forums/index.php?act=boardrules

Pete

[Wings]

Hello to all,

My private Podiatrist is willing to write a nexus statement/letter for my ankle. I've searched hadit and I am unable to locate a sample letter. I used the sample provided here for an IMO for another condition but I need the sample nexus letter for Tuesday's appointment. The Dr. that wrote the IMO appreciated the sample and of course she put her own spin to it. If anyone can help me with a draft, outline, or sample nexus letter I would greatly appreciate it.

Thanks

Your Doctor needs to know that VA service-connected need not rise to the level of 100% medical certainty. The more strongly he asserts the link (link is nexus) from your current disability - back in timme to your medical service injury or disease, the greater the weight afforded his opinion. The term he needs to be most familiar with is that the disability is "as likely as not" related to his military injury or disease. If he can afford to opine that it is more than likely, then all the better for your claim. I'll dig around the web for more info. I'm glad you have a doctor willing to help, he sounds like a good man. ~Wings

See http://www.veteransdisabilitylawyersite.co...connection.html

Oftentimes, the key to showing direct service connection is what is often called a nexus letter from a doctor. How and under what circumstances this letter is written is extremely important because if it is not done properly the VA may simply ignore this letter. Two of the more common reasons why these letters are not given proper weight by the VA will now be discussed.

If the doctor who wrote the letter did not review the veterans file and service medical records and state that he or she reviewed the file in his/her report than the VA will often disregard the letter. It is best if the doctor actually refers to evidence in the record. Another common reason a doctor's nexus letter would be rejected by the VA would be if the doctor when describing the nexus between the current disability and the in-service injury, disease or incident does not use the "proper" language recognized by the VA. Because the VA is supposed to give the veteran the benefit of the doubt the standard of proof is that it must be at least 50% likely that the in-service injury, disease or incident caused the present medical disability. This means that if the doctor's opinion is that it is 50% likely then the doctor should use the words "as likely as not" when describing the connection. If the doctor is more than 50% sure than he or she should use the words "more likely than not". Lastly, if the doctor is less than 50% sure of the connection then the words used by the VA is "less likely than not". In other words, if the nexus letter states either that it is "as likely as not" or states that it is "more likely than not" that the veterans present disability is connected to an in-service injury, disease or incident, than the doctor's opinion is stating the condition is service-connected.

P.S. If your private medical doctor issues an opinion of less than 50% or "less likely than not", then his report will not be helpful to your VA claim!

[MikeR]

Your Doctor needs to know that VA service-connected need not rise to the level of 100% medical certainty. The more strongly he asserts the link (link is nexus) from your current disability - back in timme to your medical service injury or disease, the greater the weight afforded his opinion. The term he needs to be most familiar with is that the disability is "as likely as not" related to his military injury or disease. If he can afford to opine that it is more than likely, then all the better for your claim. I'll dig around the web for more info. I'm glad you have a doctor willing to help, he sounds like a good man. ~Wings

See http://www.veteransdisabilitylawyersite.co...connection.html

Oftentimes, the key to showing direct service connection is what is often called a nexus letter from a doctor. How and under what circumstances this letter is written is extremely important because if it is not done properly the VA may simply ignore this letter. Two of the more common reasons why these letters are not given proper weight by the VA will now be discussed.

If the doctor who wrote the letter did not review the veterans file and service medical records and state that he or she reviewed the file in his/her report than the VA will often disregard the letter. It is best if the doctor actually refers to evidence in the record. Another common reason a doctor's nexus letter would be rejected by the VA would be if the doctor when describing the nexus between the current disability and the in-service injury, disease or incident does not use the "proper" language recognized by the VA. Because the VA is supposed to give the veteran the benefit of the doubt the standard of proof is that it must be at least 50% likely that the in-service injury, disease or incident caused the present medical disability. This means that if the doctor's opinion is that it is 50% likely then the doctor should use the words "as likely as not" when describing the connection. If the doctor is more than 50% sure than he or she should use the words "more likely than not". Lastly, if the doctor is less than 50% sure of the connection then the words used by the VA is "less likely than not". In other words, if the nexus letter states either that it is "as likely as not" or states that it is "more likely than not" that the veterans present disability is connected to an in-service injury, disease or incident, than the doctor's opinion is stating the condition is service-connected.

P.S. If your private medical doctor issues an opinion of less than 50% or "less likely than not", then his report will not be helpful to your VA claim!

Totally agree, it is very important that the Doctor be able to to see the medical records and as it is related to the claim and makes the case for the nexus. The history of treatment will show the etiology and this opinion is crucial. I had 2 VA docs not opine on service connection for my foot, and it was denied. My IMO did opine, and now it's in remand and waiting for a decision. I have my fingers crossed. Good luck to you as well.

[Berta]

Good point Wings!

One of my IMos was only a two sentence email from a former VA doctor.But it was supported by 2 more detailed IMOs from a different doctor.The brief IMO was given as much weight as the other IMOs-by the BVA - because it corroborated them but could not have stood alone as the only IMO I had.

A IMO doesn't have to be a lengthy rendition but needs to cover the points we are making here.

If a doc doesn't have a prepared Curriculum Vitae-any statements as to their background in the field they opine on can help-

Or for a few bucks you can obtain a background on them at Health Grades if they are listed there.

I did this for a local vet's claim.

His IMO doc (whose first opinion the VA rejected) was livid because he thought the vet (his patient for years) had 'checked up' on him-I told the vet to explain to him that I did this on my own-not the vet-in support of the claim.

The doc is a well known diabetes expert-but the VA didnt know him from Adam.

He was also angry that he had to prepare another IMO but this time he knew what form it had to take.

We attached the Healthgrades printout with his second IMO and the VA awarded the claim.

My podiatrist has been in this field for over 30 years.He might have even written articles on podiatry or attended many seminars.

This is the length of or type of expertise that can overrule a VA doc's negative opinion.

Edited October 26, 2009 by Berta (see edit history)

[smilen66]

Thanks everyone for clearing up my confusion! All comments were greatly appreciated! Now I understand, both letters (IMO & Nexus) use basically the same language and components.

My podiatrist has viewed my service medical records and believes it is related to the supposedly sprains I had in service. He actually thinks I tore a ligament and there is a lesion...I think I'm on right track with this explanation. Anyway, he ordered a MRI last Thursday and I receive a call on Friday saying the results were in. On tomorrow he will discuss the results with me.

Berta: Can anyone request a health grade and how much does it cost? Thanks again for sharing!

Wings: Thanks for the link and additional information.

Mike: Thanks for your comments and good luck to you, also.

Pete: Thanks for your support.

[Berta]

I forget the cost- I think they had a special- 7.50 each if you get more than one healthgrade rundown so I got rundown of a C & P doc who opined on my claim and a rundown on another VA doc too. Showed the C & P docs CV was crappy and she had nothing in her background comparable to my IMO doc's CV.

But their fee could have gone up-

I think you have to see if in fact the doctor is even listed there and then they state how much the report is if you want to obtain it.

There are other sites too I think with doctor backgrounds.

Every state HHS department should have a web site and data base devoted to doctors who have been disciplined under malpractice lawsuits.

The VA is supposed to report any doctors involved in any FTCA settlements for these data bases.This is a mandated reporting requirement.

They don't do it however in every FTCA situation.They disregard this mandate- and the doctors remain scott free to continue to malpractice on vets.