Private Doctor Nexus Statement

[deedub75]

Hello All,

I'm new to the forum although I've been on the site to read comments in the past.  

 

 

I've been battling the VA for years trying to get SC for my knees and my back.  I am claiming bilateral knee tendinitis and and bulging disc in my lower back secondary to my service connected right ankle injury and bilateral pes planus.  Every time I appealed, the VA kept sending my claim back to the same NP that keeps denying me over and over.  Every time new information was presented she would come up with a different reason to deny me.  She just keeps doubling down on false information.  First, she said I had a normal gait.  I provided a copy of my exit exam stating I had an abnormal gait.  She then said my gait wasn't bad enough.  My case ended up at BVA where the judge remanded it basically saying that the examiner was ignoring my abnormal gait and other issues.  She then denied it again saying that my age and weight was the cause of my knee and back issues.  I have put on weight but when I originally filed these claims and attended exams I was around 170 pounds or so.  

A couple of months ago, I decided to ask my orthopedic surgeon if he'd be willing to write a nexus statement for me.  I asked him if it was possible that pes planus and a bad ankle could cause knee and back issues and he said it absolutely can.  He couldn't believe that the VA would say it was impossible.  I found a nexus statement online and actually wrote it for him.  I gave him a handful of my records to review showing that the VA had diagnosed me with knee and back issues so he was comfortable saying that he revived my VA records.  I sent this in as a supplemental claim and got a call today from a contract company for a C&P exam.  I was kind of surprised that exams were ordered but I figured that maybe they want to find out the current severity of my conditions.  The person did mention medical opinions which have me a bit worried now.  

I believe I am seeing a general practice nurse practitioner.  If this NP says my knee and back issues are less likely than not caused by my SC pes planus and right ankle, could she really override what my board certified orthopedic surgeon says?

 

[Berta]

I hope your surgeon's IMO/IME followed the criteria here at hadit.Did he bolster his opinion with excerps from some well known medical site treaticesor abstracts?Did he provide VA with a Curriculum Vitae or any statements as to his orthopedic medical background.

Have you googled the NP to see what expertise they have in the same field of your disabiity that your surgeon has?

If the VARO ignores the surgeon's opinion, that is a CUE and can be reversed fast-as I and a few others here experienced under CUE-----  violation of 38 CFR 4.6.

By now anyone here could write that CUE for you using the CUE templates we have.It would be EASY.

"At least if it goes back to the BVA the judge will see my nexus statement from my board certified orthopedic surgeon who has been treating me for the last 6 years vs. this NP who keeps making up new reasons to deny me"

Have you complained to the contractor who hired here ( LHI,VES or QTC?

Have you complained to the White House Vets Hot Line?  855-9482311

"At least if it goes back to the BVA the judge will see my nexus statement from my board certified orthopedic surgeon who has been treating me for the last 6 years vs. this NP who keeps making up new reasons to deny me"

Make sure the BVA has a copy of your independent medical opinion.Send it to them yourself if you get denied again. I had a BVA case and also had 3 IMOs.

The BVA was the only  VA entity who read them. I even got a double DRO review under CUE and the DRO handed them back to my vet rep saying she could not read them. BVA awarded that claim.

A few years ago the VA denied an accrued claim I had by failing to consider at all, my sole piece of evidence.

It was a HBP claim regarding my dead husband.I sent them a CUE the next day.They awarded in 3 weeks.

My evidence came from the Top cardiologist at VA Central who also had expertise in HBP.

It was a VA Opinion that awarded my FTCA/1151 wrongful death claim decades ago.

This doctor was still at VACO so if they tried to knock down that opinion, I would have aggressively fought back.

Why would the VA ( the C & P exam they did was ludicrous) attempt to knock down their own top cardio doctor?

------they will try anything because they think we widows are stupid..... and they think many vets will get so fed up that they will Give Up!    

I LOVE using the VA's own regulations against them!!!!!!!!!!!!!!!!!! We must NEVER give up!!!!!

 

 

 

[vetquest]

21 hours ago, deedub75 said:

If it's not approve through this supplemental claim, it will go back to the BVA.  It was there before and was remanded back to the same NP who was originally denying it.  The judge was skeptical of this NP's reasoning.  I wish the judge would have just granted it.  At least if it goes back to the BVA the judge will see my nexus statement from my board certified orthopedic surgeon who has been treating me for the last 6 years vs. this NP who keeps making up new reasons to deny me.  

Deedub75, I would definitely go to the BVA if not approved.  I found out a long time ago that it seems the only VA employees with reading comprehension are at the BVA.  I once had a BVA appeal where I was sent for remand and received a highly unfavorable C&P from a VA doctor who had done my original C&P.  The VA cited my IMO and did not even mention the two VA C&P's other than to say that when there is positive and negative evidence it is like sandlot baseball and the tie goes to the runner.

[Guest]

I know it is the sentiment of the board that VA can't read. At one time this was my own belief until I had to get a lawyer for one of my claims. I was told by VA that I had no claim and no chance of getting service connection.  I started reading 38 CFR part 4 and the more I read, the more I thought I understood about my claims. To make a long story short, I was denied my claim, BVA remanded my claim for service connection and then back down and denied my claim after the local VARO refused their remand.  My claim finally went to CAVC and I got a new remand and this time BVA granted my claim. I was finally granted service connection by BVA but the local VARO office low balled my rating.  I filed a new NOD and finally got my increase but the VARO again screwed up my effective date.  I filed a simple reminder to BVA about my CAVC remand and I was granted an EED.  Now I know VA can read, they just want veterans to give up and go away but I still have some fight in me after losing everything.  So my suggestion is, hold your breath, steady your hands and squeeze the trigger.  Now in no way this in anyway suggest you go out and harm someone. It means to do your due diligence and your homework and take your claim to CAVC if you have to. The evidence was always in my file, since the CAVC read it, I know BVA and the local VARO read it.  

[deedub75]

On 3/2/2020 at 11:39 AM, JKWilliamsSr said:

Even with a good IMO/IME the rater will still ignore the evidence you submit.  This is something I am repeatedly learning.  For lack of a better word and I hate to say things like this but I think they are just lazy.  There could be an argument that they are short staffed and undermanned and when you add that to the pressure of needing to quickly complete claims things could be missed.  The problem here is that the errors should be made in favor of the veteran and not against.  My claims have an IME that was for every disability that was claimed. 

My recent Supplemental claims was closed this weekend and I was only awarded 10% for Bilateral Pes Planus.  There were 10 claims on this supplemental including "Bilateral Pes Planus with Plantar Fasciitis" which was diagnosed in service.  They gave me Pes Planus and completely ignored the Plantar Fasciitis and on top of that I submitted Private Medical Records showing cortisone shots for treatment of my Plantar Fasciitis.  So  a clear error was they did not adjudicate the Plantar Fasciitis.....that is just one of many I am sure. 

My C&P exam for feet was bad and they completed the supplemental claim before I could challenge the exam.   I think this was intentional because early on they gave me a C&P exam for my back and 30 days later I was able to review the results.  The examiner did everything wrong and made things up that I never said.  This is contradicted by the lay statements I submitted when I filed my claim so it is proof that the examiner never reviewed it.  Hell he did not even use a goniometer.   Well I challenged this exam submitting a memorandum to the VA and it was completely ignore.  Nothing was done about it.   It will come to bite them in the ass because it was a matter of record and no matter what they still have to account for it. 

I am going the BVA route and I am hiring an attorney.  While I think my claim is a slam dunk I learned there is no such thing with the VA and I am going to have a qualified seasoned veteran take care of this for me even if I have to overpay.   Getting 70% to 80% of something is better than 100% of nothing. 

I wouldn't say that the VA ignored my IME.  I wanted to get my claim out of the hands of the same NP who has written negative medical opinions at least 3 times now.  Before my last claim was denied, I did send in a letter asking for a different examiner but it was ignored.  DAV said I needed to get an IMO or send it back to BVA so I decided to ask my personal surgeon to write the letter.  I did follow the template.  The letter did work in that I am getting new exams with a different examiner outside of the VA.  I get why new exams were ordered because they need to check the current severity of my conditions but the they also going to provide new medical opinions which I don't understand why.    

When I claimed pes planus and plantar fasciitis, the VA basically combined them and rated them as one in the same.  The did give me 30% but I thought it should have been 50% as bad as my feet are.  I also claimed achilles tendinitis and they said it was inextricably combined with my pes planus and plantar fasciitis so they wouldn't even give me a rating on it.  

 

[deedub75]

Well, I had my C&P exams through LHI which is one of the VA's contractors.  It was scheduled for 75 mins and I was probably in there on 45 mins or so.  The NP got there late so it didn't start on time.  She was very short with her questions and attitude.  I sat down and she asked me questions for about 15 mins or so and the actual exam was probably another 20 mins or so.  I felt like I was ordering soup from the Seinfeld's Soup Nazi!  She asked if I had any records and then told me obligated to read them.  I had a copy of my nexus letter from my orthopedic surgeon and she said she had already seen it.  I also had a copy of my disability retirement letter from CBP that said I was being retired from federal service due to failed back surgery and chronic pain.  She asked me when I was retired and what kind of work I did.  I was doing finance work at a desk job.  She did take a copy of the letter since I told her VA didn't have it and she said she'd scan it in. When I was leaving she thanked me for my service and apologized for the pain she caused during the exam and there was quite a bit of pain.  

I've had luck in the past with contract doctors vs VA doctors but I couldn't get a read on this examiner.  

[deedub75]

Well, from what I can tell my nexus letter work.  I had C&P exams this past Friday, March 13.  I checked in eBenefits today and I can see ratings for all things that I claimed and some I didn't claim.  The effective date of 2/3/2020 is what's bothering me now.  2/3/2020 is the day that I submitted my supplemental claim with the nexus statement from my doctor.  These knee and back claims are old.  I think I originally claimed them back in 2011 and they decided and denied back in 2013 I believe.  I've kept them open since then where they were denied during a de novo review in 2015 and I think I got a supplemental statement of the case in 2015 or 2016.  BVA remanded them in 2017 and then I entered RAMP where they were denied again in February 2019.  I looked on va.gov and it's not showing the the claim has been closed so I'm hoping they are now working through the dates.  

degenerative arthritis of the spine w/ IDVS	40%	Service Connected		02/03/2020
left knee tendonitis/tendonosis	10%	Service Connected		02/03/2020
right knee tendonitis/tendonosis	10%	Service Connected		02/03/2020

 

left knee tendonitis w/ tarsal tunnel

10%

Service Connected

02/03/2020

mid lumbar scar	0%	Service Connected		02/03/2020
right lower extremity radiculopathy	10%	Service Connected		02/03/2020
left lower extremity radiculopathy	10%	Service Connected		02/03/2020