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syne7

Nexus Letter (draft) continuing the Sleep apnea fight :).

Question

In my recent denial for sleep apnea secondary to service-connected asthma, the medical opinions stated that OSA has several primary causes, such as obesity, advancing age, sinus congestion etc... The VA provider referenced the many events of sinus congestion in my medial records and initial sleep apena diagnosis and implied is was more likely sinus congestion than asthma...

I am now looking to file a reconsideration and am thinking to service-connect the sinus congestion/post nasal drip with OSA as a residual.  Essentially, OSA secondary to Sinus congestion.

I would be interested in thoughts about this strategy:

1.  Does this seem like a viable or potentially helpful strategy?
2.  Does this nexus letter seem appropriate to try and connect sinus congestion?

Here is the Nexus Letter Draft:

XXXXXXXXXXX -- Sinus Congestion and Post Nasal Drip.

To whom it may concem,
I am wrriting this VA Nexus letter at the request of Mr. XXXXX has been under my care since 9/29/2015 for asthma and allergic rhinitis with clu·onic sinus congestion, and clu·onic post nasal drip .  Mr. XXXXXX's moderate to severe clu·onic sinus congestion and moderate to severe clu·onic post nasal drip are currently treated daily with maxintal medication therapy including saline sinus rinse, fluticasone and azelastine as well as salt water gargle.

I have examined Mr. XXXXX's VA Claims File (cfile) and service medical records. I am familiar with his medical history and have also performed physical exarninations over the course of his 8 visits to om clinic, most recently on 10/17/l 6.
It is my medical opinion that the veteran's sinus congestions and post nasal drip is more likely that not related to his military service and associated with his service-connected asthma; the rationale being that.  Mr. XXXXX demonstrated no prior history of asthma or allergic rhinitis including sinus congestion, and post nasal drip prior to military service, as annotated on his medical entrance exam, and was while in military service diagnosed with "reactive airway disease" in 1992 and noted to have a positive methacholine challenge in 1994 consistent with an asthma diagnosis, and was seen on multiple occasions for sinus congestion, post nasal drip, acute rhinitis, and upper respfratory infections.  Mr. XXXXX reports recurring symptoms since leaving service and often patients that develop astluna also develop other atopic conditions such as allergic rhinitis with symptoms or clu·onic sinus congestion and clu·onic post nasal drip.

Mr. XXXXX's medical record demonstrates that these sinus congestion and post nasal drip symptoms
manifested in service and have been clu·onic ongoing medical conditions up to the present time.
Please do not hesitate to contact us if you have any additional questions or needs.

Sincerely,


XXXXXX, MD

Board certified in Adult and Pediatric Allergy & Immunology, The American Board of Allergy and Immunology
Board certified in Internal Medicine, The American Board of Internal Medicine

 

Redacted Nexus Letter.pdf

Edited by syne7
file not redacted.

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Did your doctor write this draft, or did you?

It is very well done but ....this happened to me...a friend of mine is a minister and asked me to research a bible passage for him. To put the research he wanted into context,and since I was never asked to do this before , I wrote a brief sermon using my research.

He got pissed off at me because, as he said, he had been writing sermons for 30 plus years and here I give him one I wrote  without a biblical background like his. Then he did say it was good when he calmed down.

I just wonder how your doc would feel to see this...it seems perfect...he might be glad you wrote it yourself.

Or not happy with a patient doing it himself....

Do you have any article to support the nexus opinion from any good medical sites?

I wrote my own medical opinions for my FTCA. No IMO doctor.They were solid and based on the evidence and the General Counsel knew I had no MD after my name......and the top VACO cardio doc agreed with me.

Many of us here prepare excellent medical nexus statements for our claims without IMO/IMEs, by using our medical evidence.

But without that MD after our names, they will try to use a bogus VA opinion over a common sense nexus statement  that most of us could write and support with evidence.

I still think the last C & P I got (which they reversed the denial on right away when I raised hell,) was prepared by the guy who puts the paper cups into their VARO water cooler machines.

 

 

 

 

 

Edited by Berta

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Good letter indeed, but it fails to make a connection between OSA and asthama or sinus congestion.

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Yes, the VA provider that provided the opinion that denied the claim stated:  The VA doctor stated, "Moreover the veteran had risk factors of advancing age, males sex, obesity, nasal congestion, and a narrowed airway which either alone or in concert would have predisposed this individual to develop the sleep apnea condition."

Hopefully the reconsideration will take all these into account.

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I  have to agree with James, where is the connection between your sinus and sleep apnea, without that you will not prevail.

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57 minutes ago, Berta said:

Did your doctor write this draft, or did you?

This is the draft he sent me to review as he has not written a VA letter before and wanted to ask if it would meet my needs.

I asked him for a nexus letter for sinus congestion/PND because the VA examiner said my OSA could due to sinus congestion.

I did not ask him for an OSA letter, because he does not treat me for that. 

However, I am hopeful that if I connect sinus congesion, I can then connect it to OSA based on the VA Providers opinions.

 

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