Example of Nexus Letter

[Ddsr]

Doctor's Letter Head

Date:

Subject: Medical history of Mr. Veteran

Reference: C-File # and/or Social Security Number

To the Department of Veterans Affairs:

I am the primary care provider for Mr. Veteran. In my capacity as a primary care provider, I have cared for Mr. Veteran since 01/07/20xx.

While I've provided care for Mr. Veteran, I've become familiar with his active duty medical history from 07/24/19xx to 08/07/19xx and from VA medical records from 19xx to present, past and present ailments and I've reviewed pertinent parts of his military record that document his injury, disease and clinical conditions related to the events that occurred.

I am aware that Mr. Veteran was injured during his active duty military service on or about 1981 in Fort Army while (events description, time and place).

A primary condition the veteran suffers is Lumbar Paravertebral Myositis (an Inflammatory Myopathy) and an L4-L5, disc desiccation and disc narrowing. MRI reports note sacralization of the L 5 representing a developmental abnormality and also that paraspinal muscle spasm is suggested.

Further noted are mild thoracolumbar dextroscoliosis as well as mild spondylosis and degenerative endplate changes. Schmorl's nodes in the superior endplate of L3. L3-L4 and L4-5 degenerative disc disease are seen. There is an L4-5 small posterior disc bulge and small posterior central disc herniation and L2-3 vertebral hemangiomas.

Mr. Veteran has chronic pain due to his injuries. The veteran suffers radiculopathy with pain, muscle control difficulty, tingling, numbness and weakness in the legs, likely due the sacralization of L4-L5.

Mr. Veteran suffers increased fatigability because of his chronic back pain. Standing for more than 15 minutes will make him become weak and exhausted.

There are multiple other clinical conditions diagnosed that are more likely than not secondary to or aggravated by the primary back condition(s).

The veteran takes numerous medications for both the primary condition as well as secondary conditions that are aggravated by said primary back condition. (Medicines and secondary conditions are listed separately.)

The veteran is not a likely candidate to be rehabilitated.

After examining Mr. Veteran, his chart and medical records it is my opinion that Mr. Veteran is totally and permanently disabled due to the above discussed back condition. The veteran cannot hold gainful employment as a result of the injury he sustained while in the military. It is also my opinion that it is more likely than not the that the physical traumas suffered during the veteran's military service as noted in his record (description of events and dates) caused, contributed to and aggravated the totally disabling back condition(s).

Respectfully,

Dr. Physician, MD

Diplomat of the American Board of Internal Medicine

[broncovet]

If this is a VA physician, this should fly.  But, if this is a private physician, you need to include this doc's CV (medical education and experience), and, you need a medical rationale as to "why" the doctorn made such an opinion.  

The VA LOOOOOOOVES to disregard nexus when the doctor did not give a medical rationale as to why he rendered such an opinion.  

In addition to this, you would probably need a Voc rehab assesment to confirm that you can not do ANY job, not just your present job.  Again, the VA LOOOOOVES to deny these types, because, you have not ruled out sedentary employment.  Many people with back injuries go to work as accountants, computer programmers, or other sedentary occupations.  Your Voc rehab assesment should demonstrate why you would not be a good candidate for retraining into a sedentary field.  

As an example, if you have never ran a computer before, and you are 63 years old, your voc rehab assement could demonstrate its unlikley you could be retrained as a computer programmer, as it requires an "advanced" knowledge of computers, which you would be unlikely to master before your retirement age.  

Edited July 9, 2020 by broncovet

[Vync]

@broncovet does make a good point. The VA will go out of their way to first identify a way to deny on a technicality.