Nexus letter

[Bunbowsky]

Can you look at this please and let me know what you think. My neurologist wrote this for me 

To Whom It May Concern,

 

Mr. ________ has come to my office as a patient for his neurological and sleep condition. I am a board certified Neurologist. I am also certified and specialize in sleep medicine. Mr. ______has been diagnosed with obstructive sleep apnea (OSA). I am currently treating him for this diagnosis.

 

Mr. _______ with confirmed OSA diagnosis treated with positive airway pressure therapy (CPAP). It is possible,or at least than not (50% or greater probability) that OSA is associated with or due to service-connected PTSD diagnosis. However, a direct casual relationship cannot be definitely ascertained.

 

If there is any questions or concerns, please feel free to contact me in my office.

 

 

Sincerely,

 

 

 

My question is? Is this a valid nexus letter?

[Buck52]

Yes It looks pretty good for a OSA dx  but Hey they won't deny that you have a diagnose for it

 If your trying to get compensation  you need to prove you had it in the military  or you need to prove it is from a  service connected secondary condition that is related to your OSA ,= Either with   I.S.R .or buddy statements

Just because you have a Diagnose for OSA /Sleep Apnea  and were prescribe a C-pap machine  Don't necessarily mean you will be approved by the VA FOR COMPENSATION ,your going to need to prove it was caused by your military service or secondary to a .s.c. condition that you have..

And a Qualified Dr to state such.  he/she needs to give their medical opinion has to how it is related or caused by your PTSD.

Like ....>THE MEDS YOU TAKE FOR PTSD , SLEEP MEDS, ANXINETY  MEDS,  ect,,,ect,,,.AND GIVE A MEDICAL  DETAIL AS TO WHY THESE MEDICATIONS WILL CAUSE YOU TO HAVE OSA, HE/SHE NEEDS TO STATE ''AND IT IS MEDDICALLY NEEDED FOR THIS VETERAN TO USE HIS C-PAP MACHINE  EVERY NIGHT'' DUE TO HIS SERVICE CONNECTED  **% PTSD AND IS IS LIKELY AS NOT THE MEDICATIONS HE IS TAKING FOR HIS PTSD.

IF HE SAYS ALL THAT  THEN I BELIEVE YOU HAVE A 90% APPROVED CHANCE.  (JMO)

Edited December 6, 2020 by Buck52 (see edit history)

[GBArmy]

I agree with Buck52 Needs to show why PTSD is causing OSA. I don't like the "It is possible"; just say it is in my professional opinion after years of practice and in this specialty that "IT IS AS LIKELY AS NOT, at least 50% probability that..."The doc has to refer to medical journals or studies, or other actual medical evidence and relate that to your symptoms. It is not likely to be a successful claim unless you get a stronger IMO/nexus.

[Slick]

4 hours ago, Bunbowsky said:

Can you look at this please and let me know what you think. My neurologist wrote this for me 

To Whom It May Concern,

 

Mr. ________ has come to my office as a patient for his neurological and sleep condition. I am a board certified Neurologist. I am also certified and specialize in sleep medicine. Mr. ______has been diagnosed with obstructive sleep apnea (OSA). I am currently treating him for this diagnosis.

 

Mr. _______ with confirmed OSA diagnosis treated with positive airway pressure therapy (CPAP). It is possible,or at least than not (50% or greater probability) that OSA is associated with or due to service-connected PTSD diagnosis. However, a direct casual relationship cannot be definitely ascertained.

 

If there is any questions or concerns, please feel free to contact me in my office.

 

 

Sincerely,

 

 

 

My question is? Is this a valid nexus letter?

 

[Slick]

I azlso have a problem with the wording of "it is possible......"  Needs to be more definitive as to the substance of the NEXUS letter, specifically as Buck and GB Army stated.

Suggest take a look at Board or Appeals  https://www.index.va.gov/search/va/bva.jsp cases and see how the court ruled, what evidence was submitted and what judges said.

I'm not saying cut and past, but we (and our NEXUS letter writers) need to speak their language..

Search the sight looking for OSA secondary to PTSD.

 

[Berta]

We have a full forum here on IMO/IMEs-

And a nexus depends on what is in your SMRs and/or Personnel file. Unless the doctor can fully support the disability, as secondary to an established SC disability.

If an independent doctor does not have a copy of those records, from your military service, the VA will surely disregard their opinion on an inservice nexus.

They must give a full medical rationale as to why one SC has caused another SC, use the correct wording, and support the opinion with any good treatises, abstracts, etc.

 

 

[Berta]

 

 

"7. The criteria for service connection for obstructive sleep apnea as secondary to PTSD are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310."

https://www.va.gov/vetapp19/files4/19128152.txt

https://www.index.va.gov/search/va/bva_search.jsp?QT=sleep+apnea&EW=secondary+to+PTSD&AT=granted&ET=&RPP=10&DB=2020&DB=2019&DB=2018&DB=2017

Veterans with OSA ( Sleep apnea) often have a better chance to obtain direct service connection, if they had evidence of sleep problems in their SMRs ( r Personnel files) and/or with buddy statements of unit members who testify they snored loudly when they slept. I have an article searchable here for what a good Buddy Statement needs, and buddys cab often be found at their unit web site, or at TWS.

"ORDER

New and material evidence has been received, and the petition to reopen a claim of entitlement to service connection for sleep apnea is granted.

Service connection for sleep apnea is granted.

FINDINGS OF FACT

1. Evidence received since the April 2007 rating decision is new and material, as the evidence is not cumulative or redundant, it has not been previously considered by decision makers, and it raises a reasonable possibility of substantiating the claim.

2. The Veteran is currently diagnosed with obstructive sleep apnea.

3. Symptoms of obstructive sleep apnea began in service and have been continuous since separation."
https://www.va.gov/vetapp19/files7/19155320.txt
The BVA search feature :
https://www.index.va.gov/search/va/bva.jsp

Slick, Thank you for posting the BVA search link- I feel it is one of the BEST tools veteran have in order to determine what evidence they need, and the denials are just as important as the awards the BVA can make.

It frustrates me to see BVA has to remand so many claims, for what the ROs should have done in the first place. 

Unlike our ROs, the BVA can read.

Unfortunately many vets are unwilling to read long BVA decisions, that I have posted here ever since the BVA went online.

Your vet rep wont take the time to do that- it is up to us claimants to seek knowledge from any possible source on VA claims issues.

Some hold multiple decisions on many issues the veteran has claimed but they only need to read the part that applies to their disability.

BVA cites established VA case law ( CAVC precedent decisions), OGCPrec Ops, as well as M21-1MR excerpts, and those references, too, are invaluable.

A BVA decision itself only applies to the specific vet or widow/widower it is rendered to, but if the BVA makes a legal statement , that statement can be used as evidence.

BVA made a legal statement in a decision to me that they rendered moot ,long ago, because I had won the claim by then at the RO level and my vet rep never withdrew the appeal.

I used that legal statement , and sent the RO the entire past BVA decision for a subsequent claim I had.

It was, in essense ,a legal clue, if I ever proved direct SC death in the future and many years later,I did. 

My RO cannot read, but the General Counsel VA can and they had to order my VARO to pay me over one important aspect of that claim....in the older BVA moot decision, after they denied it at first.

 

 

 

 

 

 

Edited December 7, 2020 by Berta
heavy fog (see edit history)