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NEXUS OPINIONS STATEMENTS

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Dustoff1970

Question

There is a misconception put forth on some veterans benefits forums that a MD doctor's formal nexus opinion is almost always needed for a vet to be granted disability benefit claims from the VARO and BVA.  This is not correct and misleading to the vet in an important way.

I have since 1985, 1998 to present days successfully won almost a dozen claims and BVA, CAVC court appeals without the benefit of a formal doctors nexus statement and representing myself with only one recent exception.  In all these claims and appeals I have used my extensive file copies of active Army, VA, VAHC, and private medical treatment records, hospital discharge summaries, test and lab results, doctors and nurses notes, medical prescriptions, along with other non medical evidence to win these claims and appeals. This evidence has served as the required nexus connection always.

Out of many dozens of VA C&P Exams over many many years did I receive one exam that gave a favorable opinion to my claim.

Here are just a few of many examples where I did not need a nexus statement from an MD or anyone else to win my claim.

1. PTSD and PTSD increases that were based solely on my Army Vietnam and Japan and VA medical treatment records.

2. TDIU based upon only my VA and VA medical treatment records and my submitted statements and forms

3. P&T TDIU rating since 1998 based mostly on my own submitted evidence, forms and one VA C&P favorable exam

4. VN Agent Orange IHD Ischemic Heart Disease claim based only upon my DD214, DD215 and other evidence of VN service and             private treatment records, test results.

5. VA VOCAB Training for both Accounting Degree and additional civilian helicopter pilot license

6. U.S. CAVC Court CUE appeal I won thru a court remand and based upon many years of VA medical and non medical evidence.

7. Loss of Use Disability Claim based upon medical and non medical records only with no doctor's nexus opinion.

This comment is not legal advice as I am not a lawyer, paralegal or VSO.

https://www.facebook.com/Vietnam-Dustoff-Medevac-112614780575067/?ref=pages_you_manage

BA Degree Finance & Tax Accounting, Former SEC CFP, Former Army Guard and Civilian helicopter pilot to Two Texas Governors, 

Advanced FAA and British CAA/Singapore Helicopter Airline Transport Pilot IFR License, FAA and CAA Helicopter Instrument Instructor Pilot License for all Weather Flight, etc. etc. 

Former volunteer Army medevac Pilot Vietnam with Purple Heart, CMB, DFC medal, AMs 1970,

Former volunteer UN civilian solo helicopter rescue pilot 1980 south China Sea (Saved over 1000 VN boat people)

759060655_combinedphotoofPerkinswith498thburningUH-1HmedevacJune91970-Copy(2)-Copy.thumb.jpg.5713e1dd50a3ea1381dd90afeb5e68e4.jpg

 

Edited by Dustoff 11
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9 hours ago, dubadoo said:

I didn't apply for SC until 10 years after retiring from the NG.

I was surfing the forums, and everyone was saying you need 3 things. I got hung up on the nexus part thinking now I have to find a Dr. to give me one. 

The VA Doctors I talked to didn't want to give me one, so I didn't submit for several months. I kept reading the forums more and more and got discouraged. In the meantime, I got treatment and a lot of x-rays (feet, ankles, knees, back, elbows, shoulders, neck...).

I finally said screw it and sent a claim in for 4 issues minus the nexus. I included copies of SF600s on injuries. I was granted SC on 3 of 4. The denial didn't have paperwork submitted.

I was encouraged by the findings and said to myself screw it again. I'll just throw a bunch shit against the wall and see what sticks. I rifled through my med files and sent all the SF600s I could find minus the nexus and ended up with 14 more SCs (2 are 0%). I got 100% in 2 tries. I was shocked. I got 2 SC that were added that I didn't claim.

I guess the nexus was given by the examiners from the 2 C&Ps?

I definitely see how the nexus can help though.

If your service medical records have conditions in them then service connection is pretty much a slam dunk.  You do not need a nexus from any doctors because the VA should grant you direct service connection based on 38 CFR 3.304.  What percentage (if any) is determined by your symptoms.  The VA can give you service connection and only give you 0%

This is where needing an outside nexus letter can come into play.  If you get an unfavorable opinion from a va examiner you have to counter that evidence. It is most common to need additional evidence for secondary conditions.  For example, you are service connected for your knees and after a while you start having back issues.  This could be caused by a variety of reasons but it is commonly noted that foot, knee and ankle issues can cause back issues because of gait changes.  However, the VA examiner gives an opinion that your back condition is not caused by your service connected disabilities.  The VA uses that opinion to deny you.  

You can argue by submitting evidence that shows how a back condition can be caused by knee issues and it should have been submitted with your claim.  There is plenty of evidence out there that shows that.  BUT......the VA will still deny in a lot of cases.   A big issue is overcoming a negative opinion from the VA examiner. A nexus letter from an outside source would help with that. Many civilian doctors will not write one for you.  If you get your treatment from the VA they will tell you that they not allowed to even though the law says differently.  So the only way is by a doctor that specializes in these letters.   By law if you have evidence in favor and evidence against the benefit of doubt rule applies and service connection is granted.  This rule is often ignored at the VARO level which is why so many people win at the BVA level.

I will pretty much give this advice to anyone.   File all claims before reaching out to an outside source. There is absolutely zero need to get a nexus letter until the claim is decided.  See what the VA will do.  If they deny you based on a negative opinion from their examiner then I would suggest getting an outside nexus letter.  For me it was the difference maker.  It took me 20 years to get to 100% and took an IMO I got in 2019 to do it.

 

Edited by JKWilliamsSr
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46 minutes ago, JKWilliamsSr said:

If your service medical records have conditions in them then service connection is pretty much a slam dunk.  You do not need a nexus from any doctors because the VA should grant you direct service connection based on 38 CFR 3.304. 

This statement is misleading and off.

 

Direct service connection (SC) means that a particular disease or injury was incurred in service. This is accomplished by affirmatively showing inception during service. There are three components to proving direct SC. These are

A current disability

An event, injury, or disease in service, and

A link or nexus establishing that the current disability had its onset or inception in service.

For those that do not understand what a nexus statement is and or a medical opinion, they are the same thing and can come from the VA C & P exam or a VA C & P contracted exam like LHI, VES, or DBQ, or QTC, or even privately paid opinions by the veteran. All these things are the exact same thing with different titles.

The bottom line is that the VA requires a medical professional to give his/her medical opinion even if the medical professional only reviews the veteran’s records to give his/her opinion and rationale. It is not likely that once a veteran files a claim that the regional office would/will just grant the veteran’s claim without a medical opinion.

Some say that they did not get/need an IMO/IME or medical opinion but that is exactly what they got when the VA sent them to a C & P exam and the examiner stated that their condition/disability is as least likely as not caused by or related to your military service. 

M21-1, Part IV, Subpart ii, Chapter 2, Section B

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2 minutes ago, pacmanx1 said:

This statement is misleading and off.

 

Direct service connection (SC) means that a particular disease or injury was incurred in service. This is accomplished by affirmatively showing inception during service. There are three components to proving direct SC. These are

A current disability

An event, injury, or disease in service, and

A link or nexus establishing that the current disability had its onset or inception in service.

For those that do not understand what a nexus statement is and or a medical opinion, they are the same thing and can come from the VA C & P exam or a VA C & P contracted exam like LHI, VES, or DBQ, or QTC, or even privately paid opinions by the veteran. All these things are the exact same thing with different titles.

The bottom line is that the VA requires a medical professional to give his/her medical opinion even if the medical professional only reviews the veteran’s records to give his/her opinion and rationale. It is not likely that once a veteran files a claim that the regional office would/will just grant the veteran’s claim without a medical opinion.

Some say that they did not get/need an IMO/IME or medical opinion but that is exactly what they got when the VA sent them to a C & P exam and the examiner stated that their condition/disability is as least likely as not caused by or related to your military service. 

M21-1, Part IV, Subpart ii, Chapter 2, Section B

To clarify.   The point I was making is that you should not need an OUTSIDE nexus letter if your SMR's show the condition you are claiming.  I did not say outside letter in my original post.

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6 minutes ago, JKWilliamsSr said:

To clarify.   The point I was making is that you should not need an OUTSIDE nexus letter if your SMR's show the condition you are claiming.  I did not say outside letter in my original post.

WOW, I do not believe I used the word letter at all. Based on the regulation a medical opinion is needed.

This is accomplished by affirmatively showing inception during service. There are three components to proving direct SC. 

 

A current disability

An event, injury, or disease in service, and

A link or nexus establishing that the current disability had its onset or inception in service.

Edited by pacmanx1
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1 minute ago, pacmanx1 said:

WOW, I do not believe I used the word letter at all. Based on the regulation a medical opinion is needed.

A link or nexus establishing that the current disability had its onset or inception in service.

Ok.... You don't need a nexus from outside DOCTORS... is that better.?  Dude you are arguing semantics.    I merely meant to say that if a disability is in an SMR you do not need to get a nexus from any outside source.   The fact that it is in your SMR's should be enough.    Key work "SHOULD" .

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Semantics, im sorry to say,  are exactly what the regulations are, and they were written based on whatever Congress approved. The VA isn't the only bogyman, here.

Just having a condition in your SMRs is not service connection. You are missing the 1st part- it needs to be a diagnosed current disability, or persistent recurring symptoms, i.e. that 2 day bout of indigestion after Thai food in your sick call notes 10 yrs ago is not GERD now. Just because you have headaches NOW doesn't mean its related to service THEN, and just because you had headaches in service THEN doesn't mean its related to having a headache NOW.

 

There are hundreds of 'acute' conditions that show up in an SMR that are not chronic- they happened once and they're done. They don't meet the threshold for element 1 or element 3, an indication of plausible association with an in-svc event. 

Edited by brokensoldier244th
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