Nexus Letter Submitted, Now What?

[fowrward1]

I submitted a claim for my left knee, lower back, anxiety, and depression.  It was denied in under 30 days.  My VSO submitted a reconsideration with additional records from my private doc, but that was also denied in under 30 days.  My VSO then suggested I get nexus letters that state my current conditions are 'as likely as not' due to injuries/circumstances suffered during my service.  I recently submitted nexus letters from my private doc for my knee and back, but my VA doc would not write a letter for my anxiety and depression, both of which she has diagnosed me with.  The letters I did submit were concise (a couple of paragraphs), both indicated my current conditions and that they are 'as likely as not' due to the injuries/circumstances and events of my military service.  For my anxiety and depression I just submitted my VA medical record with notes of each appointment I had.  All of this was submitted as a reconsideration.

I asked my VSO what I could expect next and he mentioned C&P exams are likely.  My question is, does it sound like I have submitted enough for the VA to schedule C&P exams?

Thanks

[kanewnut]

On 10/20/2018 at 5:00 PM, fowrward1 said:

My question is, does it sound like I have submitted enough for the VA to schedule C&P exams?

I would think so.

[vetquest]

One would believe so but we can never be sure.  If you are denied again make sure you take your case to the BVA.  The BVA seems to be the place where a lot of claims are settled in the favor of the veteran.  It seems the RO's are in the business of denying claims.

[pwrslm]

Mental Health diagnosis from NON VA providers are ok unless its PTSD. Do you see anyone outside of the VA for anxiety and depression? How exactly is the anxiety and depression linked to your active duty service. Can you document the reasons that you think caused this condition? 

Without a little help, even the MH experts can not do this. You have to have laid out a solid case that you believe in before the MH experts will even try to help. VA docs really hedge against making statements even though the VA policy tells us that they are responsible to do so.  I think its an inside joke on veterans to be honest.

[doc25]

Do you want the bad news first or the good news first?

I'll give you the good news first. You have nexus letters for physical conditions and that's good, because when one doctor says you have a condition and a C&P examiner gives you an unfavorable exam the TIE must go to the veteran. That's the good news.

Here's the bad news. If you don't have an in-service diagnosis for depression and anxiety, unfortunately, it will be denied as a direct-service claim. There is another way to get it granted on a SECONDARY basis. But, it's going to take some work on your part and time.You will need to service-connect your knee and lower back first.

 

Depending on the severity of your knee and lower back conditions, if either or those or both keep you from achieving "activities of daily life" or(ADLs) ;such as exercise, work that requires bending, squatting, etc. this can cause or aggravate depression and anxiety.

To Secondary connect a condition you must meet these requirements:

1. Must have a service-connected disability

2. Current diagnosis of disability

3. Nexus of opinion stating the minimum threshold phrase "at least as likely as not" and a rational linking #1 and #2.

 

[broncovet]

Suprise Suprise!  VA docs wont (usually) write a nexus!  Imagine that, considering VA pays them.  YOu will need an IMO/IME for mental health conditions in order to get service connection.  

[doc25]

11 hours ago, broncovet said:

Suprise Suprise!  VA docs wont (usually) write a nexus!  Imagine that, considering VA pays them.  YOu will need an IMO/IME for mental health conditions in order to get service connection.  

Yup.

According to fowrward1 his depression and anxiety was diagnosed by his VA doc, which is why I provided another route to Secondary service connect the depression or anxiety.

It took me two years to Secondary connect OSA to PTSD meds.   I was denied twice on a Secondary basis,even though I had a sleep study done and was diagnosed with it; was issued a CPAP machine. The VA pulmonologist filled out the  Sleep Apnea DBQ. I used that as new and material evidence to re-open the claim, got a C&P exam and the examiner concurred with the pulmonologist. 

The C&P examiner did the nexus and provided the rationale for a favorable decision.

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE

    CONNECTION ]

 

    a. The condition claimed is at least as likely as not (50% or greater

    probability) proximately due to or the result of the Veteran's service

    connected condition.    

 

    c. Rationale: This is a 36 yr old Veteran who has been SC at 70% for PTSD

    since 06/28/2015 he also has Obstructive Sleep Apnea (diagnosed on

04/27/09).

    A study" Association of Psychiatric Disorders and Sleep Apnea in a Large

    Cohort" concluded: Psychiatric comorbid diagnoses in the sleep apnea group

    included depression 21.8%, anxiety 16.7%, posttraumatic stress disorder

    11.9%, psychosis 5.1 and bipolar disorder 3.3 %. Compared with patients not

    diagnosed with sleep apnea, a significantly greater prevalence (P<0.0001)

was

    found for mood disorders, anxiety, posttraumatic stress disorder, pyschosis,

    and dementia in patients with sleep apnea. Sleep apnea is associated with

    higher prevalence of psychiatric comorbid conditions in Veterans Health

    Administration beneficiaries. This association suggests that the patients

    with psychiatric disorders and coincident symptoms suggesting

    sleep-disordered breathing should be evaluated for sleep apnea.(

Sharafkhaneh

    et.al. Sleep, vol. 28, Nov. 11, 2005)