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

[broncovet]

You mentioned you have a VSO. While many Vets advocates suggest NOT having a VSO, I think its okay when you fully understand that the VSO sitting across the desk is (ultimately) paid by VA per the number of POA's he has.    Once you understand this VSO works and is paid for by your opponent at law, then you can understand and keep up with this, disregarding bad advice VSO's often give like:

1.  Dont appeal this..be happy with what you got, you could get a reduction instead.  

2.  Dont apply for "benefit x", because you wont be approved anyway.  (I was "dropped" from representation  by the VFW, as they did not think my claim would succeed EVEN when I had the "full" Caluza triange documented!!!   Again and again, Vets who have the "full" caluza triangle are awarded benefits, over and over again, in appeals.)  

3.  VSO's pretty much, "Dont" return Vets phone calls.  

     When ever I get this "horse puckey" from a VSO I drop him.   Its a red flag your VSO can not be trusted.  

[vetquest]

One advantage of having a VSO is that you can use him to document all information sent to the VA.  Most VSO's should have a computer and scanner.  Have them upload all documents sent to the VA so that you have proof that document x was submitted on "this" date.  This comes in very handy when the VA tries to lose a document or not report it as evidence on your decision.

[broncovet]

This is true, Vetquest, provided this is a "Good" VSO, who keeps meticilous records, and that is not "all" of them.  More often than not, when we seek a VSO we are paired with "the one available", which is often a rookie, or, a VSO with a poor reputation, since the great VSO's have a great reputation and are often "booked up" when we seek them.  

[RTKOOC]

I would look at the reason you were denied. If you don’t have a documented in service injury or event then it will be denied as not relating to service regardless of what a private doctor states. You would need to provide evidence of injury like a buddy statement.

Edited October 23, 2018 by RTKOOC

[fowrward1]

On ‎10‎/‎21‎/‎2018 at 6:12 PM, pwrslm said:

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.

Thank you for the reply.  My VA doc has documented the reasons and link to active duty service.  Based on the process so far, I do plan to schedule an appointment with a doctor outside of the VA for a medical opinion to include with my reconsideration.

[fowrward1]

19 hours ago, doc25 said:

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)

 

 

Thank you both for your replies.  I'm new to the process so after years of persuasion I'm finally seeing what my buddies have been exposed to in filing claims.  The secondary connection is realistic with my knee, I've had increased pain and limited ROM since after my service.  I currently go to physical therapy and my doc has said that surgery is the only option if I don't notice any improvement.