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Primary Care Nexus Letter Medical Opinion (Format or Examples)

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Hello fellow Vets-

I'm working with my primary care who is very willing to help provide me with a quality Nexus Letter. I've explained to him how the language and information needs to be very particular. I have searched this website and found a few things. I found the one below posted in 2018. Would anyone be able to tell me if this is still current? Is this complete and accurate or claims in 2024? I appreciate any input suggestions or pointing me to a location I may have missed.

Posted November 26, 2018

There must be some deficiency in the current nexus, else the judge would not ask.  

There is info here on what a nexus letter must contain.  A few things are:

1.  The doctor making said opinion is qualified, that is, an expert in the applicable field.  

2.  The nexus statement is in the "format" approved by VA.  Unacceptable are terms like, "might be connectd to service" or "maybe connected to service".  Also unacceptable is it "could be" related to service, or that its possibly related to service.  That is, it needs to be unambigious.  

3.  The doctor provides a medical rationale as to why he formed the opinion.  

4.  The doctor indicated he "reviewed your medical records".  

5.  Of course, the nexus is in writing.  

      Absent any 1 or more of the above, and your nexus is suspect and its probably not gonna fly.  Even worse than "no nexus" is "nexus-like" reports that are missing one of the above.  

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Welcome to hadit.  

   Two things:

1.   Have the doctor submit his/her CV.  (Its sort of like his/her resume, detailing professional training and experience.).  Your doctor needs to demonstrate he/she is an "expert witness", and has considerable professional training and experience treating and diagnosing your type of injury/illness.  This like "board certified in Orthopedics" is great.  

2.  VA LOVES to search for the phrase "at least as likely as not".  In other words, "the Veteans hearing loss is at least as likely as not due to noise exposure from loud guns and jet engines exposure during military service".  

     Keep the CAluza's in Mind:

A.  Current diagnosis.  

B.  Event in service.  

C.  Nexus.  

You cant have a nexus, "without" an event in service.  A doctor can not create an "event in service", that needs to be in your file.  A doctor who examines you in 2024, can rarely testify he saw you injured in 2006 in the military carrying a 180 pound back pack.  Why?  Because he was not there.  However.  A buddy of yours who served with you can testify, "Yes, we had to carry 180 pound back packs for 12 miles.  Most of us either hurt our backs our our ankles that day.  It was brutal".  

Your buddy can testify he saw you and maybe also carried that back pack, because he was there.  Your doctor, can opine that 180 pound backpack carried for 12 miles a day, every day for 12 weeks is at least as likely as not the reason you have a back injury.  




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Sgt. Wilky&  broncovet... thank you for this input. I have spent hours learning so much from Hadit. This is one of the best resources I have found available.  I already briefed my doctor on the importance on the phrase "at least as likely as not" so I'm covered in that aspect. Each of the items he will provide an opinion on are either presumptive or in my active duty medical records. 

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Ok.  Here is a sad truth:

When VA calls and sets you up with their c and p examiner, "this examiner is presumed competent" UNTIL/Unless You or your representative challenge the competency of the examiner.  

But, when you pick the examiner, you get no such presumption.  YOU have to demonstrate the competence of the examiner.  Of course, its probably because Veterans have tried stuff like having their brother in law, who has a phd in physical Fitness, render a competency opinion on your diabetes, when he has zero training on diagnosing and treating diabetes.  A "doctor's degree" (Phd) is not good enough unless he/she can demonstrate he/she is an expert witness in your issue.  (Knee, hearing loss, back, etc)

The va doc gets a presumptive, your doc does not.  

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We have created a forum area to upload document examples of VA Forms, Nexus letters, IMO's etc. I have a ton of them that I have collected over the years. I will be posting them as I go through them. If you have something you are looking for I may have it PM me.

VA Forms and Template Repository

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