Nexus Letters Question

[Johhny_Drama]

Happy Friday Eve

Question about nexus letter. I had 2 doctors provide nexus letters to support my claim. I made sure to read the help guides and have a better understanding of what is required as in the verbiage and what nots. I read some articles and wanted to include to support my claim. My VSO said if it comes back as denied he can supply case file to support my claim. You can review past cases etc. Can I also add medical references from Pubmed or medical journals on your own to support the claim? I have 2 nexus letters and I included a reference page with medical journal information. The doctor didn’t quote medical journal but mentioned my specific issues. Will providing this help? 

[Berta]

I will try to read your past posts-but I think you are trying to get a higher rating for PTSD, due to OCD, caused by or aggravated by your SC PTSD.

Was the claim filed for higher PTSD rating or for TDIU?

Was this anything to do with a  remand from the BVA in 2018? ( I thought I caught that under a search here from one of your posts.)

Or is this a new claim?

If so, can you give us the Docket # and Citation # ?

You stated :

"Question about nexus letter. I had 2 doctors provide nexus letters to support my claim."

If they are Phycologists or psychiatrists, then, if they followed the IMO/IME criteria here at hadit, their opinions should be properly considered, along with any C & P examiner's opinion.

"I made sure to read the help guides and have a better understanding of what is required as in the verbiage and what nots. I read some articles and wanted to include to support my claim. My VSO said if it comes back as denied he can supply case file to support my claim. You can review past cases etc. "

Yes, anyone can  find VA case law on the net . I review past VA cases all the time at the BVA web site. However they do not hold up well to support most VA claims, as evidence- because those decisions are unique to the specific claimant.

Perhaps your VSO meant the US CAVC cases. If they are of a Precedential nature, they could be used in support of a claim - depending on the USCAVC decision.

Then again BVA cases reference many long standing CAVC decisions, and excerpts from 38 USC / CFR  so maybe the VSO meant that-

"I also add medical references from Pubmed or medical journals on your own to support the claim? I have 2 nexus letters and I included a reference page with medical journal information. The doctor didn’t quote medical journal but mentioned my specific issues. Will providing this help? "

Possibly- but it so much better for a IMO/IME doctor to add their own citations of medical abstracts, publications etc, that would support the claim. 

There are plenty of articles on the net that show the medical nexus between PTSD and OCD such as:

?????

(I got this error message

 

"The link could not be embedded because of an unexpected error: error: "Something went wrong. Please try again.".

Oh good , it posted here----

https://www.verywellmind.com/trauma-ptsd-and-ocd-2797516

If you google PTSD and OCD a lot of medical abstracts, articles ,etc will pop up.

It is far better to have a IMO/IME doctor use their own references however, because they will have the most recent studies, abstracts etc on what would support the claim.

 

 

[Berta]

A rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is granted."
The decision explains why the rating is not higher than 70%.
------------------
https://www.va.gov/vetapp20/files4/20024814.txt
"ORDER

Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is denied. 

Entitlement to a total disability rating based on individual unemployability (TDIU) is granted from August 2, 2018."
(this is why I asked if you applied for TDIU)
In part the above decisions states:
"The Board emphasizes that the determination of whether a veteran is unable to secure of follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question.  Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013).  Given the August 2018 VA examiner’s favorable findings, coupled with the Veteran’s competent and credible reports, as well as her level of education and occupational background, the Board finds that she is unable to secure or maintain a substantially gainful occupation due to her PTSD with OCD.  Accordingly, a TDIU is established from August 2, 2018."

This case cites Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013)

Is this your BVA  remand,if you did have a remand? 
https://www.va.gov/vetapp20/files8/20053571.txt
 

[Berta]

https://www.va.gov/vetapp21/files3/21011177.txt

"ORDER A rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is granted."

The decision explains why the rating is not higher than 70%.

------------------

https://www.va.gov/vetapp20/files4/20024814.txt

"ORDER Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted from August 2, 2018."

(this is why I asked if you applied for TDIU)

In part the above decisions states:

"The Board emphasizes that the determination of whether a veteran is unable to secure of follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). Given the August 2018 VA examiner’s favorable findings, coupled with the Veteran’s competent and credible reports, as well as her level of education and occupational background, the Board finds that she is unable to secure or maintain a substantially gainful occupation due to her PTSD with OCD. Accordingly, a TDIU is established from August 2, 2018."

 

This case cites Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) You can google it but I do not think it will help you-

the BVA articulated clearly why this veteran was denied PTSD rating increase but was awarded, instead, TDIU.

 

Is this the remand,if you did have a  BVA remand?

https://www.va.gov/vetapp20/files8/20053571.txt

 

 

[Johhny_Drama]

17 minutes ago, Berta said:

https://www.va.gov/vetapp21/files3/21011177.txt

"ORDER A rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is granted."

The decision explains why the rating is not higher than 70%.

------------------

https://www.va.gov/vetapp20/files4/20024814.txt

"ORDER Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted from August 2, 2018."

(this is why I asked if you applied for TDIU)

In part the above decisions states:

"The Board emphasizes that the determination of whether a veteran is unable to secure of follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). Given the August 2018 VA examiner’s favorable findings, coupled with the Veteran’s competent and credible reports, as well as her level of education and occupational background, the Board finds that she is unable to secure or maintain a substantially gainful occupation due to her PTSD with OCD. Accordingly, a TDIU is established from August 2, 2018."

 

This case cites Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) You can google it but I do not think it will help you-

the BVA articulated clearly why this veteran was denied PTSD rating increase but was awarded, instead, TDIU.

 

Is this the remand,if you did have a  BVA remand?

https://www.va.gov/vetapp20/files8/20053571.txt

 

You’re a godsend and I appreciate all of your help. I’m going to reply to your first post to me. 

[Berta]

I was wrong about the BVA remand https://www.va.gov/vetapp20/files8/20053571.txt.

Some of your past posts are confusing to me- and regard other issues-

https://community.hadit.com/topic/73405-appeal-granted-and-closed/page/2/

https://community.hadit.com/topic/73267-time-for-cp-examiner-to-send-results/

but then again the issue you have now seems to depend on whether you would meet the TDIU criteria if you are unemployed, or perhaps you meet the criteria for 100% schedular.

Your VSO seems very willing to help you- and he/she knows far more about your PTSD/OCD claim than we can know, in the limits of the internet.

It has not been denied yet and I assue they will give you C & P exam at some point for this new claim.

 

[Johhny_Drama]

To Berta

this is for my OSA being aggravated by my service connected PTSD. My doctors both wrote nexus letters and my VSO looked over and said he thought they looked great. We will see how this goes. We are responding to the denial and new evidence is the nexus. So I’m going for secondary here and I know it’s a uphill challenge. 
 

The other post you may have read was my c&p exams that I completed in June. I am battling this 30 percent flat feet issue. I have SC 30 percent plantar fasciitis bilateral and in 2016 or 2018 they denied me at increase stating I didn’t mention orthotics. I had my podiatrist make 2 pairs after reviewing everything and I gave it a shot for 2 years. They didn’t show improvement. I was issued a night splint due to my Achilles’ tendons being super tight. During the last 2 years I tore my calf muscle simply walking across the room in my house. And to top it off i now have heal spurs on both feet that feel pretty damn painful. These are the changes in the last 2-3 years since I applied for a increase. 
 

I found out they kept my feet rating at 30. Even though the report stated the custom inserts didn’t work. I have pain full to the touch feet, tight flexing Achilles’ tendons, basically every single item in the box that warrants 50. They mentioned in order to get 50 you need to show these items ...I’m thinking who is looking at my claim because that’s everything that I’m going through. It’s beyond mind blowing. They said the new heel spurs I never had are already rated with the 30 percent rating. I thought they warranted their own rating. They are a separate issue. And no rating on my Achilles’ tendons even though they feel like they might snap. So I had 30 percent and I requested increase to 50. I requested heel spurs, torn muscles, and Achilles tendinitis as secondary. And after all this I got nothing as in nothing changed. 
 

my VSO is reviewing and seeing what is going on before we move this to higher level. I can’t believe anyone of this. But I guess I should be use to it. So that’s the current situation.