ptsd Nexus Letter

[pog]

Hi folks,

I asked my Dr for a nexus letter. He complied. So I thought. He made a note in my chart, that I have forwarded to my VSO.

In the section of my notes under "History of Present Illness" the Dr noted...

"Patient reports that OSA symptoms began while he was in active military service, while serving in the Army. He believes that his symptoms were present, but were at the time attributed to PTSD and depression. I HAVE REVIEWED SEVERAL SERVICE MEDICAL RECORDS THAT ALLUDE TO SLEEPINESS AND UNREFRESHING SLEEP AT THAT TIME."

Then in the assessment portion of my chart he wrote.

"I beleive it is as likely as not the pt had sleep apnea while he was in the Army."

My question is... Is this strong enough to link my Sleep Apnea to service for disability rating?

[carlie]

Carles right on the prompting of the C&P part. The only problam with yours that I can see is the wording. Just in case the C&P examier opines diffeently you can still get the benefit of doubt if your doctors opinoin is strong and worded corrently.

theis letter you presented here is good thourgh and should be enough. Make srue you take this letter and any medical notes you have that supprot your claim to the C&p.

sorry my typing ishn't good. I have bad arthritis

The BOD is not always for application.

Below are three BVA cases, in the first two cases

the BOD was considered - But did not apply.

In the third case the BOD did apply and the claim was awarded

due to the VBA extending the BOD to the claim.

I hope these cases will help explain to claimants the

how's when's, where's and why's

BOD is OR is not to be applied.

carlie

http://www4.va.gov/vetapp09/files4/0929970.txt

In reaching the above conclusion, the Board also considered

the doctrine of reasonable doubt. 38 U.S.C.A. § 5107(b).

However, as the preponderance of the evidence is against the

Veteran's claim, the doctrine is not for application. See

also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir.

2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

http://www4.va.gov/vetapp09/files4/0932650.txt

Accordingly, the Board concludes that the preponderance of

the evidence is against the claim for service connection for

recurrent tinnitus, and the benefit of the doubt rule does

not apply. See 38 U.S.C.A. § 5107 (West 2002).

http://www4.va.gov/vetapp09/files1/0905894.txt

The mandate to accord the benefit of the doubt is triggered

when the evidence has reached such a stage of balance. In

this matter, the Board is of the opinion that this point has

been attained. Because a state of relative equipoise has

been reached in this case, the benefit of the doubt rule will

therefore be applied. See Alemany v. Brown, 9 Vet. App. 518,

519 (1996); Brown v. Brown, 5 Vet. App. 413, 421 (1993).

[pog]

So what do I need to do to not even make it a question of a balance of doubt? I had sleep apnea that started in active duty. How do I make this clear for my C&P exam?

I'll shell out the cash for a IMO if it would make the difference.

I have a Negative counseling statement for falling asleep on the side of the road in my car on the way back to work. How can I enter that in as evidence to be considered?

You guys are such a great help. Thanks for all the help you've given so far!

[john999]

I think the only other way is to get the IMO. The doctor has to review all your SMR's and say so in his report. It is not a slam/dunk. He should do a complete medical history and justify your sleep apnea DX, and show how it started in service.

He needs to nail it.

[pog]

Carlie,

Let me see if I understand... For the benefit of doubt to be applied in a case you still need three things.

A current diagnosis of a disability as defined by the VA.

A history of cause, origin, or aggravation of said disability originating in active service.

And at least 50 percent likely hood of a nexus to military service.

[blackbird]

I went back to my Dr today and this is the letter I was able to get him to write. Is this good enough?

Dear Sir/Ms.

I am writing this letter on behalf of my patient, Mr. Pog, who is under my care for obstructive and possibly complex sleep apnea syndrome. I am a board certified sleep medicine physician.

I have reviewed Mr Joy's service medical records from May 2007 to November 2007. I have also reviewed a developmental counseling from 01, October 2007. Based on my review of his service medical records, I believe his sleep apnea today is more likely than not related to military service, as it was likely present and undiagnosed at that time.

Mr. Pog provides a history that suggests symptoms consistent with sleep apnea during his time of military service in 2007. At that time, he was under medical care for both depression and post traumatic stress disorder, both of which could have contributed to these symptoms, as could have the patients medications at the time.

However, I believe that it is more likely than not that Mr. (first name) did suffer from obstructive and possibly complex sleep apnea at the time of his military service, and that his symptoms, consistent with this disorder, were not recognized, due to his other medical problems.

Please feel to contact me for additional information if necessary.

Sincerely,

Dr SoandSo

Pog, I think the doctor's statement is probably good enough. It could be even stronger if the sentence; "I believe his sleep apnea today is more likely than not related to military service, as it was likely present and undiagnosed at that time". was written as:

I believe his sleep apnea today is more likely that not related to millitary service, as SMR's reveal the symptoms were present but probably mis-diagnoised at the time.

Every loop hole eliminated is a plus, but again it may be good enough. Berta's suggestion to find a buddy statement about the snoring would probably push this baby over the top. This suggestion in my case won my appeal, in my opinion. And if you did snore, trust me, your buddies will remember it!

Also, I believe a good doctor's statement that mirrors the guidelines and terms used in an IMO, from an accredited doctor that knows your case well, will substitute for an actual "IMO" and cost usually nothing! I'm sure the guys that make thousands of dollar per IMO would like you to believe otherwise.

JMO,

Hope this helps,

Blackbird

[carlie]

Carlie,

Let me see if I understand... For the benefit of doubt to be applied in a case you still need three things.

A current diagnosis of a disability as defined by the VA.

A history of cause, origin, or aggravation of said disability originating in active service.

And at least 50 percent likely hood of a nexus to military service.

pog,

No matter what - a claimant needs those 3 things.

BOD is a whole different issue.

Read those 3 cases again that I posted.

carlie