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

[syne7]

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 October 27, 2016 by syne7
file not redacted.

[jamescripps2]

If that actually is just a draft, ask the doctor add to it in making the OSA connection on that same letter. He would be able to opine on the OSA,no matter what he treats you for. Focus on what you need done to make the connection and and just ask for it.

Berta is right, you might consider writing your own letter. If you can get the doctor to concur and sign your letter then it is just as probative as if he/she had written it. Better yet, ask the doctor to transfer the letter to their letterhead.

[jamescripps2]

I  have written some of my own letters and asked a doctor to read and if they could concur, then sign on the bottom line. I looked up this example from my VAMC medical records to post here. The nurse asked me why I was there, I showed her the completed form and told her that I needed the doctor to read it and then sign it on the bottom line if it was in order. That nurse went bonkers on me. She yelled that the doctor would need to examine me before signing anything. She refused to let me see the doctor and proceeded to make a future appointment two weeks out. I kept that appointment and returned with the same form. I made the same request. The doctor read the completed form, concurred with it and signed it for me. All is well that ends well.

LOCAL TITLE: PRIMARY CARE NURSING ASSESSMENT STANDARD TITLE:

PRIMARY CARE NURSING NOTE DATE OF NOTE:

JAN 04, 2016@10:09 ENTRY DATE: JAN 04, 2016@10:09:49

AUTHOR: EPPS,DENORIS J EXP COSIGNER: URGENCY: STATUS: COMPLETED

Reason for Walk-In: PATIENT WALKED INTO THE CLINIC WITH A&A FORM FILLED OUT AND REQUEST PROVIDER TO SIGN AT THE BOTTOM LINE

Signs/Symptoms:DENIES ANY PAIN

[Buck52]

So the most important issue is to see your Dr...if you can get an appointment  just don't say anything to the Nurse  then when its your time to see the Doc..POP it on him.

good advise from James

[syne7]

29 minutes ago, Buck52 said:

So the most important issue is to see your Dr...if you can get an appointment  just don't say anything to the Nurse  then when its your time to see the Doc..POP it on him.

good advise from James

This letter came from my Doctor.

 

[Buck52]

OIC

Well did you look him in the eye and tell him what you need?

just be openly honest, and ask him to write you a letter  connecting them to one another(disability's)  this is called a Nexus letter

just take some medical records pertinent to what your asking  maybe DD-214 ec,,ect and ask for his opinion .

the Dr can keep it short but get to the point..b/c you don't need a long drawn out letter,,,,those raters will not read all of it.

And that usually spells a denial.

jmo

Edited October 28, 2016 by Buck52

[jamescripps2]

I am still learning Buck, next time I won't tell the nurse what I need, I'll just say it is personal. That ole gal acted like she had just caught me in the commission of a crime. She was so proud of herself that she noted my perceived  transgression in my medical record.