supplemental acceptable records

[SPO]

I'm still working on my supplemental and I wanted to see if you all thought these documents would be acceptable medical records.  They are the online versions I can get from my 2 different rheumatologist's patient portals.  They show diagnosis for Inflammatory polyarthropathy, and psoriatic arthropathy, and back pain (it seems they are all just different ways of saying psoriatic arthritis). Take a look and let me know what you guys think.  One thing I noticed is one doctor named most of the joints I have issues with, but missed my ankle.  Should I ask him to edit and add that in, or just let it go?  He agreed to do a DBQ and nexus letter, so I don't know if that is necessary.  Also, just so everyone knows the VA has never seen these records before.  Please let me know if I missed anything in redacting.  Thanks

PHR mar 2020_Redacted.pdf PHR sep 2019_Redacted.pdf Rheum_Redacted.pdf

[GBArmy]

SPO As you probably know, you need the Caluza Triangle for success in your claim. What is the event or illness evidence in the service? If you didn't provide that on your original claim,  you need to provide now. If you don't have it, wait and see what is in your c-file. Under findings on your decision letter, what did they list, if anything? I looked at your documents and there is mention of your problems but not necessarily a diagnosis that you have the disability, or the severity of your conditions. So, if they denied on your original claim  for "no Clinical diagnosis", on  a supplemental claim you want new and relevant info.Yes, you do need a IMO from your doc that says you have "x" and these are the reasons why they are connected to your service time. (Need the words "as likely as not").The VA can't use a dbq furnished by your doc to make their decision, but if his IMO talked specifically to symptoms that correlate to the rating levels on the old dbq, it will make it easier at your c&p. They will take the easy way out and just rubber stamp the original decision again if you don't nail it. Maybe i'm wrong, but my experience seems to indicate that if the VA denies a claim initially, you have to strongly address the "reason" of the denial. Do a great job on your submittal; if you think you can just submit because you don't have all the info ,but it is good enough to submit, it probably isn't.

[SPO]

I'm trying to make sure I hit all the triangle elements and it might be splitting hairs, but if you look on the forms under the heading "encounters" there is a column of diagnoses.  Psoriatic/inflammatory polyarthropathy and back pain are listed there.  Also, I know there is a medical opinion in my file that says my arthritis is secondary to psoriasis, with medical references, which I think should cover the Nexus. also getting another letter from my treating doctor.  So  1. The nexus is covered by that medical opinion and the letter my doc is writing. 2. the in service event is psoriasis(already service connected), and this is secondary to that. 3. these documents and the letter will provide the missing diagnoses.

As always, the help is incredibly appreciated

[SPO]

Ok, so my doctor has now hesitant to write a letter.  There is a medical opinion the va requested giving me a nexus to the primary service connected condition, and these documents.  Is this enough to overcome a denial for no diagnosis without his letter?

[GBArmy]

SPO If your own doc is now hesitant to write the nexus, a red flag just went up. Do you know why? Is it because he doesn't want to spent the time and effort to do it, he wants to get compensated to do it, or, he doesn't think there is a strong enough link for him to say it is his opinion? Your medical opinion on nexus isn't acceptable. It is almost always necessary to have a medical doc IMO when going after a secondary, IMHO. 

[SPO]

Disregard my previous,  after I sent him the template and info for the letter he changed course.  Below is the template he agreed to write/sign.  I believe he is going to include a statement that all the affected joints experience painful motion.

To Whom It May Concern,
I am Dr. ___ . I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the aforementioned veteran 's claim.
I have personally reviewed his medical history pertinent to this condition (the records reviewed will be listed here). I have also reviewed records pertinent to and have noted the already diagnosed and service connected psoriasis.
Mr. ****** is a patient under my care since 09/27/2019 . His diagnosis is psoriatic arthritis of the left and right feet, left and right ankle, left knee, right hip, lower back (sacroiliac), left and right should, left and right elbow, left and right wrist, left and right hand.
I am familiar with his history and have examined Mr. ******* in person while he has been under my care.
Mr. ****** has no other known risk factors that may have precipitated his current condition.
After a review of the pertinent records it is my professional opinion that it is at highly likely that Mr. ****** condition is a caused by/secondary to his service connected psoriasis.
In my personal experience and in the medical literature it is known (explanation of connection between my psoriasis and psoriatic arthritis with any literature references, if possible)
Signed.
Dr._________
(please list contact info, and credentials)

Edited May 1, 2020 by SPO

[Hucast21]

Those are not the magic words.

Rewrite it with this: “After a review of pertinent records, it is my professional opinion that it is at least as likely as not that Mr. ****** condition is secondary to his psoriasis.”

”Highly likely” without comparing it to something else is subjective.

Always remember this when it comes nexus letters:

• is due to” (100% sure)
• “more likely than not” (greater than 50%)
• “at least as likely as not” (equal to or greater than 50%)
• “not at least as likely as not” (less than 50%)
• “is not due to” (0%)