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Want Assistance In Increasing My Claim


Rambo

Question

Hello as I have stated I am new to this forum and I am still trying to figure out if I am in the right area. Maybe I can get some direction.

Well, I filed a claim with the VA with 12 potential service connected disability and they gave me a rating of 60 % on four.

1. Service connected for degenerative joint disease and degenerative disc disease of the lumbosacral spine at 40 %

2. SC for gastroesophagel reflux disorder with chronic chest pain 10%

3. SC for left knee patellofemoral syndrome 10 %

4. SC of postoperative right inguinal hernia which was rated at 0 now at 10 %

5. SC for hemorrhoids denied

6. SC for neck injury denied.

7. SC for chronic seasonal allergic rhinitis with chronic headaches denied.

8. SC for scar of right eyebrow denied.

9. SC for pseudofolliculits denied.

10. SC SC for tinea pedis denied.

11. SC for bilateral hearing loss denied.

12. Sc for tinnitus denied.

Some of the claim they explained why I was denied but the one on tinnitus, I could not believe they denied that claim. I have been a Air Cargo Spealists and the field has now changet to Air Transpoetation and I have been exposed ot loud noise and did numerous engine run onload/off load (ERO). The only loud noise I have worked around is jets C-5, C-141, C-130, C-17, C-23, KC-10, 747, KC-135, DC-8, C-9, AN-124, IL-76 and all the fighters in the AF inventory that take off and land while working on the flight line for all those years.

In addition I have filed another three claims, one for the scar caused from the hernia operation, one for sleep apnea and one for my right knee although threre is no documentation of SC in my medical file. I believe that because the left is going the right has to compensate. On the sleep apenia, there is no documentation in my file of sleep apena but there is documentatin on +PND (Paroxysmal Noctural Dyspnea) I was told this is related to sleep apena. I currently have sleep apena and have a CPAP machine from my medical provider. Need some advise how to tackle this with the VA.

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You have to explain to them on the tinnitis denial how your MOS caused you to be exposed to acoustical trauma.

You gave a good explanation here.

If you didn't have proper hearing protection gear issued to you -tell them that.

You need to assess the Statement of the Case carefully and then respond with your NOD as to each point they made that was incorrect.

You need a valid nexus to your service for each disability or a valid reason they could be secondary to any SC you have now.

"some of the claim they explained why I was denied"

They gave you key elements to overcome.

If they said no inservice nexus in your SMRs-check your SMRs-

If they said no proof of neck injury-you need to get a buddy statement

or if it could be secondary to the DJD, you need medical evidence to show that.

Do you have copies of your SMRs and your VA medical records?

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Hello Berta, just got a chance to read your reply to my questions and issue. I have recently requested a copy of my VA c-file and once I receive them I will have a more clear understanding of how to proceed with my additional claims. How many buddy statement do I need to back some of my claims and I have seen my civilian doctor on several occasion for the neck pain. I also requested another copy of my medical records form the VA because they have my medical records from active duty.

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Here is a copy of what a Nexus Letter should contain:

THE NEXUS LETTER:

Nexus Letter and how to make it work for you.

A claim for a Veterans Benefits Administration (VBA) disability compensation award must be based on irrefutable evidence. If the claim leaves any doubt in the mind of the ratings specialist who makes that award decision, you may be denied.

This is often the case when the veteran alleged that an injury or illness that occurred in service has worsened over the years. While the condition may have been relatively minor then, it's significantly disabling today.

To show that there exists a connection between his/her documented service event (exposure to CBR elements, wounding, illness) and a condition today (cancer, worsening of original injury, etc.) requires that the veteran present a favorable opinion of an expert who agrees with his/her thought process. This is known as a nexus letter. A simple definition of nexus is: Tie; bond; link; connection or interconnection.

When writing a nexus letter, a few points to remember are in order.

• The letter should be as brief as possible while stating facts

• The author must be an expert.

• This is most often a medical doctor who is board certified in the area of health that's at issue.

• If cancer is the condition, an oncologist is preferred.

• If an old injury to a bone is in question, an orthopedic surgeon is the obvious choice.

• PTSD has become more controversial in recent years and it's accepted today that a clinical psychiatrist or psychologist is the gold standard for opinions related to the condition.

• The expert who signs the nexus letter must have thoroughly reviewed all available and pertinent medical records (to include Service Medical Records) and state that fact in the letter. If the expert can't reasonably verify that all records were reviewed, the letter won't be of much value.

• The nexus letter should be as detailed and complete as the circumstances dictate.

Although it may not always be an absolute requirement, it will lend a lot of weight if the writer of the nexus letter has recently examined the veteran.

The doctor who writes the letter does not have to use absolutes or conclusions in his or her statements. Opinions are made based on conjecture of observing facts and possibilities arising from those facts.

This means that the author isn't required to say that one thing definitely caused another only that it might have or is likely to have led from point A to point B.

The preferred language to describe an expert's opinion should express whether "it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) that (the condition) was incurred or aggravated during active service.

In practical terms, the nexus letter is a powerful tool for the veteran to use to establish a claim. Often the VA will recognize that the physician who writes your nexus letter is better trained, better experienced or spent more time examining you than a VA Compensation and Pension (C&P) examiner did. In many cases at the VARO level as well as the Veterans Board of Appeals and in higher courts, the expert opinion expressed in a nexus letter has been the deciding factor that wins a Veteran those well deserved benefits.

Many physicians, both civilian and VA doctors, are reluctant to write such a letter. Sometimes, they are concerned that there are legal pitfalls that can arise from writing disability letters and they want to avoid such. While there probably are some legal issues to consider, I'm not aware of any physician ever suffering any repercussions from writing a truthful, factual nexus letter.

In my experience, the physician is most often simply too busy to write such letters or isn't sure of the proper statements to make. Keeping it simple is your best chance for the doctor signing the letter. It is also best to have your doctor write the letter on his letterhead.

If the veteran’s personal doctor won't write such a letter, the veteran will have to seek out a physician who specializes in Independent Medical Examinations or IME's. The doctor who is a specialist in Independent Medical Examination is usually thought to be above reproach as their living depends on their reputation as an impartial reporter of facts. They will often know the language that's needed very well and they spend a lot of time examining the patient and reviewing the records.

The IME doctor may be expensive and the veteran must pay the bill up front and out of his/her own pocket. These IME opinions may cost from $600.00 to $1500.00 or more. There is no guarantee that the IME doctor will agree with the veteran’s thinking and if the report is not in agreement with the veteran, he/she will not get their money back.

Example of nexus letter;

DATE

Reference: VETERAN’S NAME

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.

Hello Berta, just got a chance to read your reply to my questions and issue. I have recently requested a copy of my VA c-file and once I receive them I will have a more clear understanding of how to proceed with my additional claims. How many buddy statement do I need to back some of my claims and I have seen my civilian doctor on several occasion for the neck pain. I also requested another copy of my medical records form the VA because they have my medical records from active duty.

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Most people do their C&P exams wrong. When it comes to your knee(s), remember to go slow. REAL slow. Stop at the beginning of pain and do not let them push you through the pain. Pain is the start of your disability. Do not get on that table. If you do, you will never get more than 10%. Sit in that chair that is in the office. Before you go to the C&P exam, down load the exam from the DVA's web site. Make sure they do a proper exam. If they eye ball how far you move your leg, then you want a second opinion. They are supposed to use a mechnical device to measure the degree of movement. I'd fax to 540-597-1792 and ask for a second opinion based upon they didn't do the exam properly. You will need to cite why (use the DVA's own criteria). This number is for the Roanoke RO (I'm a former state VSO). Once it is in the system, they have to honor your VALID request. Email me if you wish to talk off line. Most people do not do their C&P exam properly and thus get low balled. Like I tell my soldiers at WRAMC (I'm now with the Army's Wounded Warrior Program AW2) you have to play the game by the rules of the organization. It's like paying football by Rugby rules. It doesn't work. Play football by American Football rules an do DVA C&P exams by DVA rules.

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etihwr,

Please give credit to wherever you got the copy and paste information below.

There is a lot of copy write information and what you've posted here looks like some of it.

Here is a copy of what a Nexus Letter should contain:

THE NEXUS LETTER:

Nexus Letter and how to make it work for you.

A claim for a Veterans Benefits Administration (VBA) disability compensation award must be based on irrefutable evidence. If the claim leaves any doubt in the mind of the ratings specialist who makes that award decision, you may be denied.

This is often the case when the veteran alleged that an injury or illness that occurred in service has worsened over the years. While the condition may have been relatively minor then, it's significantly disabling today.

To show that there exists a connection between his/her documented service event (exposure to CBR elements, wounding, illness) and a condition today (cancer, worsening of original injury, etc.) requires that the veteran present a favorable opinion of an expert who agrees with his/her thought process. This is known as a nexus letter. A simple definition of nexus is: Tie; bond; link; connection or interconnection.

When writing a nexus letter, a few points to remember are in order.

• The letter should be as brief as possible while stating facts

• The author must be an expert.

• This is most often a medical doctor who is board certified in the area of health that's at issue.

• If cancer is the condition, an oncologist is preferred.

• If an old injury to a bone is in question, an orthopedic surgeon is the obvious choice.

• PTSD has become more controversial in recent years and it's accepted today that a clinical psychiatrist or psychologist is the gold standard for opinions related to the condition.

• The expert who signs the nexus letter must have thoroughly reviewed all available and pertinent medical records (to include Service Medical Records) and state that fact in the letter. If the expert can't reasonably verify that all records were reviewed, the letter won't be of much value.

• The nexus letter should be as detailed and complete as the circumstances dictate.

Although it may not always be an absolute requirement, it will lend a lot of weight if the writer of the nexus letter has recently examined the veteran.

The doctor who writes the letter does not have to use absolutes or conclusions in his or her statements. Opinions are made based on conjecture of observing facts and possibilities arising from those facts.

This means that the author isn't required to say that one thing definitely caused another only that it might have or is likely to have led from point A to point B.

The preferred language to describe an expert's opinion should express whether "it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) that (the condition) was incurred or aggravated during active service.

In practical terms, the nexus letter is a powerful tool for the veteran to use to establish a claim. Often the VA will recognize that the physician who writes your nexus letter is better trained, better experienced or spent more time examining you than a VA Compensation and Pension (C&P) examiner did. In many cases at the VARO level as well as the Veterans Board of Appeals and in higher courts, the expert opinion expressed in a nexus letter has been the deciding factor that wins a Veteran those well deserved benefits.

Many physicians, both civilian and VA doctors, are reluctant to write such a letter. Sometimes, they are concerned that there are legal pitfalls that can arise from writing disability letters and they want to avoid such. While there probably are some legal issues to consider, I'm not aware of any physician ever suffering any repercussions from writing a truthful, factual nexus letter.

In my experience, the physician is most often simply too busy to write such letters or isn't sure of the proper statements to make. Keeping it simple is your best chance for the doctor signing the letter. It is also best to have your doctor write the letter on his letterhead.

If the veteran's personal doctor won't write such a letter, the veteran will have to seek out a physician who specializes in Independent Medical Examinations or IME's. The doctor who is a specialist in Independent Medical Examination is usually thought to be above reproach as their living depends on their reputation as an impartial reporter of facts. They will often know the language that's needed very well and they spend a lot of time examining the patient and reviewing the records.

The IME doctor may be expensive and the veteran must pay the bill up front and out of his/her own pocket. These IME opinions may cost from $600.00 to $1500.00 or more. There is no guarantee that the IME doctor will agree with the veteran's thinking and if the report is not in agreement with the veteran, he/she will not get their money back.

Example of nexus letter;

DATE

Reference: VETERAN'S NAME

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.

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