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Denied supplemental claim

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Diverse TX Taco


Denied fully developed claim Sept 22 for GERD, Barretts esophagus, gastritis secondary to PTSD.  VSO said it was from lack of NEXUS letter.   Got NEXUS submitted supplemental and denied again.  Asking for informal conference and will appeal if needed.  Advice?    Is VA increasing denials?   You can probably read into that last question. 

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My advice is to thoroughly read over the "nexus" letter, and make sure it has all these things:

1.  Establish the doctor writing the nexus is competent to render professional opinion.  This often means you need to submit a CV of the doctor's training and experience, that he is, indeed, qualified to make a professional opinion about (gerd).  If the doctor making the nexus statement has a Phd in basketball coaching, he may not be competent to opine that PTSD caused your GERD.  If this is your IMO, YOU have to establish competency, the VA wont do that for you.  The nexus does not always need to be done by an MD, other medical professionals may work.  In other words, an Audiologist, is competent to opine about hearing loss, whether or not they have a Phd degree.  

2.  The nexus needs to be "in a form" the VA can understand.  If your doc said, for example, "your GERD could (may, maybe, might, could possibly, etc) be due to PTSD, that wont fly.  It needs to say, with greater than 50 percent certainty, that your GERD was caused by PTSD.  "At least as likely as not" works great.  

3.  The doctor needs to explain "Why" he made such an opinion.  "In a 2019 study by Harvard Medical reasearch doctors, it was found that PTSD caused GERD symptoms 94..8 percent of the time"...kind of a thing.  

4.  The IMO should be signed by the doctor.  And he should give his medical license number, so VA can check to see if his medical license has been revoked.  

     If your nexus is lacking any of these things, it can be rejected.  

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