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Need example nexus letter for Secondary spine conditions to existing back conditions

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There are some examples in this post that I posted a while back. Given to me by one of my VSOs. Read through both, take a copy of both, to your doctor(s), so they know what is needed by you, and expected by the VA.

Semper Fi,

Sgt. Wilky

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A secondary nexus is less complex than regular nexus.  You need not provide an "in service event" because that was already established in your back issue service connection.  

First of all, your nexus letter should include a CV detailing the (doctor's) education and experience in treating back conditions (or conditions related to back conditions).  Understand, this doctor is acting as an "expert witness" and if he lacks experience/training in the applicable field, then the nexus wont fly.  If your friend has a PHD (doctor's degree) in basketball, he cant opine on your back issues.  

After the CV, probably including the doctors medical license number, then your wording needs to be similar to "its at least as liklely as not that the Veteran's (secondary back condition) is due to the back injury suffered in service".  

You are not done yet.  The doctor needs to opine "why" he drew such a conclusion.  



Sample: (Hypothetical case..do not use my sample). Date of exam:  March 2, 2023.  

    (include docs CV, it has to be closely related to your condition)

    I examined the Veteran's records. (Must have.  IMO's have been rejected which fail to note an examination or review of the Veterans medical records).  

    Based on these records, and my examination, In my professional opinion, its at least as likely as not that the Veteran's service connected back injury caused arthritis.  The records show the degenerative arthritis was first diagnosed by Dr. Jameson, in an exam with xray confirmation  on May 14, 2019.  (Neglecting this "first diagnosed" part will likely result in a poor effective date, dont skip it, otherwise, VA will likely use the date of the exam). 

In a study by Harvard University in 2018, it was concluded that 88 percent of back injuries resulted in degenerative arthritis of the spine.  My experience confirms their research, most of my patients with back injuries develop arthritis within 12 months, many of which are "not just" limited to spinal arthritis, but knee and hip arthritis as well.   A recent patient, in 2019, who suffered a back injury developed arthritis in just 8 months.  

     This Veterans diagnosis of degenerative arthritis is confirmed by xray.  


Joe Smith, MD, board certified in back surgery, and arthritis.  Medical license number 12345678.  



The actual letter will likely be longer than this and include details of medical diagnosis, along with medical language you and I can not pronounce.  

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Sgt. Wilky

I have seen both those letters before. (via someone else) As a matter a fact I think I use the No. 1 letter as an example for both my primary care MH and an independent MH person for a discharge up grade. Thanks' for sharing.

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