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Nexus Letter Of "as Likely As Not" From Expert...



A week after an emergency appendectomy, I suffered a nearly fatal case of bilateral deep venous thrombosis (DVT, or blood clots in legs) that caused bilateral pulmonary emboli (PE, or blood clots in lungs). I spent most of a week in ICU for this. They inserted a permanent inferior vena cava filter (IVC is large vein below heart), and I'm on anticoagulant Coumadin therapy, probably for life.

After a lot of research, I am convinced that this was caused either directly or indirectly by one or both of:

a) too much inactivity after the appendectomy because my SC back disability was killing me, so I likely didn't get as much exercise as would have been ideal

B) noted side effects of at least three meds that I use (in high dosages) for my back include DVT and PEs. (The steroid shots for the spine are the likely culprit in my lay opinion, but that is neither here nor there.)

When I mentioned awhile back to my VA PCP that I thought there was a link, he looked at me like I had just told him there were screaming monkeys flying out of my derriere.

I made an appointment with a Medical Professor (who is also a practicing physician) at Univ. of Texas Health Sciences Center, one of the country's top heart & lung clinics. He has board certifications in Pulmonary and Internal Medicine.

He reviewed my records, and I think otherwise dotted i's and crossed t's in explaining his opinion, then signed off on a nexus statement of "as likely as not, 50/50 probability" that my DVT/PE problems were caused by the SC disability and meds.

Will the VA be likely to try and fight this? If he was just a plain old general practitioner like the VA PCP docs, I would be more concerned about a challenge, but will they go up against a Professor of Medicine?And, if they approve it, what kind of rating would they probably give?

Edited by Pete53 (see edit history)
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As long as he gave a full medical rationale for the" as likely as not" and made the VA aware of his credentials I think those screaming monkeys will generate an award letter.

Dont be surprised if the VA gives you a C & P anyhow- which might go against the claim.

This validates Relative Equipoise-if there is one opinion strongly for the claim and one VA opinion against the claim- Relative Equipoise kicks in and they award under Benefit of Doubt.

I have no idea how they would rate this- maybe if you search these conditions at the BVA web site-it might give you some idea of a rating.

The thrombosis--- was this appendectomy done by the VA?

Did the IMO doc suggest the VA could have been negligent?

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The surgery wasn't done at VA, it was a local private hospital and surgeon. The IMO doc did opine on the letter that the appendectomy "probably contributed to development of D.V.T.", but he did state "as likely as not" that the condition was secondary to my SC disability and the meds. The rationale is that my back pain causes me to be sedentary, which promoted the development of DVT, and that the known side effects of steroid injections and other meds I use for it include DVT.

Thanks for your comments. After reading them I feel better, especially about the 'relative equipoise' part. I guess I don't think the VA will shoot down a BIG shot specialist, but I would never attempt to outguess the VA either.


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Yes -that sounds good! Let's hope the VA weighs it carefully against anything they have that could not compare to your doc's credentials.

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