Nexus Letter

[elcamino_77us]

Back in October of 2012, I reopened my case on my left knee trying to get it service connected along with a few other items. At the end of July, I had to have my left knee scoped. There was a tear of the menicus plus a lot of scarring tissue from where the cartliage had tried to repair itself from an "Old" Injury. The doctor who performed the scope said he didn't have any problem answering questions concerning my knee but didn't understand how to write a VA Nexus letter.

Does anybody have a set of questions that a doctor could answer that would help form a type of Nexus Letter?

Thank You

Bill

[Berta]

You are trying to get the knee service connected.

Therefore the doctor needs to find a service nexus in your SMRs.

Sometimes it is difficult for a doctor to find,in SMRs, exactly what a veteran needs., and time consuming,if they are not familiar with preparing IMOs.

We have the entire criteria here in our IMO forum.

Do you have info in your SMRs that you injured the knee in service?

Or, is the knee related in any way to the 40% SC disability you have now?

Here is the IMO criteria:

We have other posts as to Imos here too available under a search for Getting an IMO.

If you are represented by one of the major vet orgs, they might have a IMO template you could have the doctor use.

I imagine the DBQ might do too but I find those DBQs are faulty in many respects.

If you have secondary disability due to the main knee disability,from service, the doctor can cover that as well.

Not much info here to really advise too well.......has the knee been a chronic problem, with treatments ,since service for you?

Edited October 1, 2013 by Berta

[elcamino_77us]

Thanks Berta for responding!

I injured my left knee in 91' while on active duty. The Base Clinic opinion at the time was an MCL Strain. I have twelve entries in my SMR's for treatment of my left knee between 91- 95 including a Med Board. I have also seen several doctors since I was discharged concerning my left knee. However, the VA has continued to deny a service connection for my left knee. They stated that although I had injured my left knee while in service, that I did not have a current left knee disability.

I actually went through my SMR's along with my medical records since, including the VAs, and put together a Timeline for the doctor of my left knee. I was diagnosed with chondromalacia of both knees in 2002 by a private doctor and the VA also determined by MRI in 2010 that I had chondromalacia of both knees as well.

I recently received a copy of my C-File which took me 3 years to get. Most of the evidence which I had sent them, including the knee diagnosis of 2002 were not in the copies which I received. There were only two documents other than my SMR's that I received. It looked as if they had copied my SMR's multipal times and sent that to me to complete the request. Prior documents that the VA had quoted in their decisions were missing as well.

Again Thanks for the Reply

Bill

[Berta]

“I actually went through my SMR's along with my medical records since, including the VAs, and put together a Timeline for the doctor of my left knee. “

That is excellent! I know that was time consuming but that is always a beneficial thing to prepare.

“I was diagnosed with chondromalacia of both knees in 2002 by a private doctor and the VA also determined by MRI in 2010 that I had chondromalacia of both knees as well. “

Did the doctor state the right knee had been aggravated by the left knee?

“chondromalacia” was that specifically claimed with that medical term?

“I recently received a copy of my C-File which took me 3 years to get. Most of the evidence which I had sent them, including the knee diagnosis of 2002 were not in the copies which I received. There were only two documents other than my SMR's that I received.”

This crap VA pulls is one major reason we have a backlog. I dont think it is always just human error, I think it is deliberate and VA pulled this BS on me many times.

In my BVA case the BVA even took note in their decision that evidence the RO said they never got was right in the C file the BVA had received.

I call that the work of the MF .

(MF -Mysterious force who removes stuff from C files deliberately,so the RO can deny then puts it back in if the claim goes to the BVA.)

In your case do you have Proof of mailing anything you had sent to them?

This stuff makes me furious. When I gave testimony during Shreddergate ,I sent Sec Shinseki and the H VAC colored copies of 53 USPS green and white tracking slips of evidence my RO had ignored,by then , for years for my AO DMII death claim.

I had to fan them out on the scanner and it took 3 pages, to show the VA's address on each PO receipt.when I copied them.

I think the IMO will help you a lot.

“They stated that although I had injured my left knee while in service, that I did not have a current left knee disability.” Where are you at on the appeal? Have you filed the NOD yet, or are you going to respond within 60 days with an IMO, to the SOC?

[elcamino_77us]

Again Thanks Berta!!!

"Did the doctor state the right knee had been aggravated by the left knee?"

No, as both knees were the result of their own injuries. However, I'msure over time, they they played of of each other.

' “chondromalacia” was that specifically claimed with that medical term?'

Yes, this time when I re-opened the case.

"In your case do you have Proof of mailing anything you had sent to them?"

Not from that time period, I turned everything over to my VSO, The American Legion. There was an appeal filed by The American Legion in 2008, late in the case, that acusses the VA of only using evidence that supports its decision that, "All material evidence benifical to the appellant must be discussed in a statement of reasons or bases."

'“They stated that although I had injured my left knee while in service, that I did not have a current left knee disability.” Where are you at on the appeal? Have you filed the NOD yet, or are you going to respond within 60 days with an IMO, to the SOC?'

That decision was made in 2008 at the BVA. In July of 2012, I filed a new claim with the VA using the VSO from the State of Georgia. I asked for an increase on my right knee due to surgery along with a few other claims. Plus I reopened the case on my left knee. My case was sent to the Rating Phase last week. If the VA continues its normal course of deciding my claims, I will be denied as usual.

"I think the IMO will help you a lot."

I agree!!! I believe if I can get a Nexus Letter from the Doctor who did my scope, I will get my left knee Service Connected. However, I don't believe I'll be able to get the date retroactive back to my discharge.

Thanks,

Bill

[elcamino_77us]

This is what I've typed up for my doctor. Before I send it to him, how does it look? Does it need anything? Do you think I'll get the results I'm looking for? The Doctor had stated to my wife that the fibrocartilage represented an old injury to the cartilage where it had tried to heal itself.

Thanks

Bill

On 23 July 2013, you performed a partial medial meniscectomy to repair a medial meniscal tear of the Left Knee. Once inside, you notated that there were other medical issues with my left knee and that most were corrected.

The Post OP Diagnosis included but was not limited to; “early degenerative changes medial compartment, moderate degenerative changes of patellofemoral joint.” In your report, you went into depth the conditions which you found as you scoped my Left Knee.

I would like to ask you a series of questions concerning those conditions listed, namely but not limited to:

“The patellofemoral joint noted mild fraying of the superior portion of the patella but areas of full thickness chondral loss and fibrocartilaginous replacement of the Central portion of the femoral trochlea. Abraded chondroplasty of the frayed chondral surface of the patellofemoral joint was completed.”

“Inspection of the medial compartment revealed thinning of the lateral aspect of the medial femoral condyle with fibrillation and fraying and abraded chondroplasty was performed.”

1. Please state you full name and credentials including education, area of practice, years of experience.

2. Can you provide a current diagnosis of my Left Knee?

3. I provided you with a copy of my Service Medical Records and Civilian Medical Records including MRI’s and X-Rays concerning the treatment of my Left Knee. Have you reviewed those records?

4. Do you see a nexus/connection between the current condition of my Left Knee and the Injury/Treatment/Diagnosis in the review of my Service Medical Records? And if so, can you provide a rational to support your opinion?

Please Note When Dealing with the VA:

The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs when providing a rational to support his opinion.

These are the Medical statements regarding possible Service Connection:
Is due to- 100%
More likely than not- Greater than 50%
At least as likely as not- 50% (Benefit of doubt goes to Vet) but doesn’t happen
Not at least as likely as not- Less than 50%
Is not due to- 0%