Would This Be A Decent Nexis?

[JHawks]

I am currently 70%. I recently put in a claim for "Bilateral Severe Carpal Tunnel Syndrome". I have been using a cane for several years in order to ambulate and my medial records clearly show that.

My question is based on a recent visit to the VA medical facility and my physician at that clinic. In here medical notes she states:

"Pt saw PMD because he was having trouble with arms and hands. He alternates using a cane in either hand. He has needed a cane in the last two years because he has braces of both lower legs due to OA and tendonitis. Pt. was sent to neurologist, Dr. Bxxxxxx, who did EMG which showed severe BL carpal tunnel syndrome."

In her consult to Physical Therapy she stated:

"Pt has h/o trimalleolar fx left ankle and tendonitis right ankle with bone spurs. He has been walking with a cane and alternating hands. He has developed severe carpal tunnel syndrome. Please evaluate if he is using the proper cane and how to use it without bending the wrists which will aggravate the carpal tunnel."

Would here statements in my records provide the nexus I need?

Edited September 30, 2010 by JHawks

[Capt.]

Hello JHawks,

Though I am still in the hamster wheel with multiple exposure diseases , I will say that most all of the Veterans victories come from SOUND Independent Medical Opinions or IMO's as called here. Wording the Nexus or opinion of the doctor means the difference of winning or losing. It is all about legal termonology. Yes it will be nice if you can get your VA doctor to write you a CORRECTLY done nexus but that does not happen often. Your best bet is to get a good doctor that is QUALIFIED to give you an opinion or nexus and that it always will be worded in a way to give the "benefit of a doubt" rule to be fully used against them. It is also important , that if you do not have your medical records, scientific evidence, mentioned in the Nexus it will probably get you a denial. If its a 50 / 50 call then you win.

Maybe you can get your VA doctor or another IMO write a Nexus that says something like.........

I have reviewed all of Mr.XXXX medical records and test. I have also reviewed scientific and medical reports listed below. (List each example that supports your case , especially any which specifically counters any VA opinion or statement, such as the acute and subacute defintions that the VA trys to use....if possible use the chronic). Patient has history of ......blah blah blah and it is my opinion that his severe carpal tunnel syndrome is as least as likely or not caused as secondary conditions directly related and caused by his blah blah blah. I am qualified to make this opinion as I have been a orthopedic surgeon ( or whatever) for over ________ years. I am also the president of ....have been a fellow in ......and am currently chief of staff ......

Well you get the idea.... Also sending in a Vitae or resume of your doctor is helpful.

If you want to get him to say that "it is the most likely cause" that will fly also but remember "as least as likely as not" will still swing it to your direction.

I would maybe mix my statement with some of Carlie and Jbass and Johns all into one with highlights from all.

But remember the most important point.......NEVER GIVE UP...... God Bless, C.C.

[halos2]

Perhaps something of this sorts per physician would be beneficial

Diagnosis:

Severe Bilateral Carpal Tunnel Syndrome

As manifested by:

Wrist, hand and arm pain; limitation of upper extremity motion, stiffness in joints, particularly wrists; grasp problems...etc whatever md's findings

Relate to:

Primary Diagnosis of OA and Tendonitis with use of Bilateral Lower Leg Braces; H/O Trimalleolax Fx left ankle and Tendonitis Right ankle with bone spurs;

Necessary use of adaptive equipment (cane) for mobility which aggravates alternately rt/left wrist currently and post last 2 yrs.

Resulting in:

Inability to ambulate safely without use of cane which aggravates wrist joints thereby increasing pain; Pain MD clinic appointment and referral to Neurologist for further exam/tests/evaluation; Positive test per EMG; Referral to PT for correct cane usage; Need for continual pain medication and adaptive wrist braces...etc...

The veterans diagnoses listed above, as well as use of bilateral lower leg braces have affected the veterans mobility and in order to enable the veteran to be mobile and for his safety a cane was ordered for use. With the bilateral usage of a cane for his ambulation it is more likely than not the direct result in his new diagnosis of Bilateral Severe Carpal Tunnel Syndrome.

(also they could address pain meds and s/e if necessary too...one could go on and on with this but I think you get the picture)

Edited October 3, 2010 by halos2

[john999]

Jhawks

You got to get a doctor to connect all the nexus dots for you. You cannot leave any blank spaces for the VA to slide in an alternative reason for your hand problems. The rater does not think beyond the regulations. You don't want any leeway in your evidence. You can win this claim if you get the right medical opinion.

[JHawks]

JHAWKS,just remember to keep it short,and straight to the point and they will read it

and concider it all my IMO has always been four,to six lines and they works well.Oldjoe

This is what I finally got from my doctor. Is this acceptable?

"He (patient) does have bilateral carpal tunnel syndrome, which he (patient) said he really did not have any symptoms until he started to use his cane. It certainly seems plausible that because of the temporal relationship that this has either been exacerbated or caused by this cane use".

[Berta]

The doctor needs to use the term “as likely as not”

He should bolster his opinion with a medical reference.

It took me seconds to find this one and it comes from the VA itself under their rehab and development

Link.

http://docs.google.com/viewer?a=v&q=cache:cpdp-pIug8cJ:www.rehab.research.va.gov/jour/99/36/2/chioutan.pdf+carpal+tunnel+and+use+of+cane&hl=en&gl=us&pid=bl&srcid=ADGEESjhh-gCaf37KouJFTnPNwmP21onFiAprLR-Wxb6zgnY0-wafu4qSvi3McZyG5mk3pCSKueEfBOactnfXPn3dl_XhHNOIm3O2g02rtkE1YdrVvXYbrPOHKrfmgMT2Lktuxz9tScR&sig=AHIEtbTzDi7NlxvXXg03TMuCqhcS-p3rQw

The link from “repetitive stress disorder" to the use of canes causing CST is found on page 2 of the pdf.

[JHawks]

JHawks.that looks alright but you figure the rater has a fifth grade education and dont understand

what you use the cane for you got to spell it out to them Carlie gave you a good opion of what it need to say and type this up to fit your SC disalibilty and ask your dr would he sign it tell him it has to be worded this way or VA wont accept it.

from carlie""

JHawks,

Something like:

In my opinion the veterans CTS is at least as likely as not secondary to his

service connected condition od XXXX.

The veteran is RX'd canes for the SC'd condition of XXXX,and must consistently use

canes on both sides for proper ambulation and to help prevent further injuries from falls.

There is no other medical reason of record for this veterans CTS.

This will work and all you need. Hey hope this help Oldjoe

Unfortunately it is the best I could get from my doctor. I will just hope and pray it will satisfy the rater.