The Importance of Published Medical Reports (Treatises) in IMO and Nexus Letters
Proving a nexus between a veteran’s disability and his military service requires both factual and scientific evidence. In most cases, especially for the veterans who served in Vietnam, service records are difficult to obtain; most records have been either damaged or lost. Without these records it is difficult to prove that a current disability was caused by injuries that occurred 40 or 50 years ago.
Most veterans, however, have already established service connection for some disabilities and the question is usually whether their current disabling condition is related to the service-connected disabilities. The determination of secondary disability is no longer factual, but rather strictly a scientific question. A veteran only needs to show that the scientific community supports his claim that condition x is related to his service-connected disabilities.
To deny a veteran’s claim, the VA must have an equally qualified scientist state that there is no scientific connection between the claimed condition and the service-connected conditions. Even then, the VA must accept the IMO based on the benefit of the doubt doctrine.
Read More: Nexus LettersNexus Letters and IMO Letters for Disabled Veterans
NEXUS LETTERS AND INDEPENDENT MEDICAL OPINION (IMO) FOR DISABLED VETERANS
What is a Nexus?
There are three steps involved in a claim for service connection according to Caluza v. Brown, 7 Vet. App. 498. First, the veteran must present satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease [38 U.S.C.S. 1154(b)]. Second, the VA must determine whether that evidence is consistent with the circumstances, conditions, or hardships of such service. The third and final requirement is demonstrating that there is a nexus (a link or a connection) between the current disability (requirement #1) and the precipitating disease, injury, or event that occurred during the period of military service (requirement #2).
Our Results
In the last 10 years we provided 1560 IMOs to veterans to support their claims
455 cases were denied at the initial claim and we accepted representation
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IMO Sample
One of my clients posted this sample IMO letter on Hadit http://www.hadit.com/forums/topic/55854-anyone-use-david-anaise-md-jd/
Testimonials
Posted by Mike
April 11, 2022
I reached out to Dr Anaise for a records review and his Expert Medical Opinion provided via an IMO Letter for a Sleep Apnea claim – secondary to PTSD that I was going to submit. I requested his services because I knew how difficult winning this claim can be with the VA and that he was the right expert for the job. I submitted my relevant medical records to him and within a week I had a very detailed IMO letter to support my claim. My sleep apnea claim was processed and approved in less than 2 weeks by the VA and I know for a fact, it was in large part due to Dr Anaise’s IMO letter. His IMO Letter left no question unanswered and ensured the success of my claim. I would use his services again in the future! Highly recommend!
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Sleep Apnea and Headaches/Migraines
Sleep-related symptoms are associated with painful conditions, partly because pain may interfere with sleep and vice versa. This dual cause and effect relationship has been known for many years through clinical experience with headache patients.
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Sleep Apnea Secondary to Service-Connected Sinusitis, Rhinitis or Deviated Septum
Upper respiratory conditions (sinusitis) result in distortion of the upper airway, which contributes to the development of sleep apnea.
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Sleep Apnea Secondary to Service-Connected Tinnitus
Approximately 60% of patients with tinnitus experience disturbances of the normal sleep pattern.
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Sleep Apnea is a Unique Veteran Disease caused by PTSD and tinnitus and not only by obesity
For VA rating purposes, the veteran needs to show that he suffers from sleep apnea; whether of the obstructive type, central type or mixed type.
What should I do if the VA modifies the rating for obstructive sleep apnea?
In February 2022, the VA proposed to modernize the rating criteria for DC 6847, “Sleep Apnea Syndromes (Obstructive, Central, Mixed)” and retitle that DC as “Sleep Apnea Syndromes (Obstructive, Central, or Mixed)”.
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Obesity is not the ONLY cause of obstructive sleep apnea.
The VA examiner almost always opine the the veteran’s obstructive sleep apnea is caused by obesity and as obesity is not considered a disability his claim is denied.
Sleep Apnea Secondary to Service-Connected Cervical Spine Abnormalities
Patients with cervical spine abnormalities secondary to spondyloarthropathy or rheumatoid arthritis are known to have a very high incidence of obstructive sleep apnea. Sleep apnea is a risk factor for high mortality of rheumatoid arthritis (RA) patients.
Sleep Apnea Secondary to Service-Connected Diabetes Mellitus
There is a high prevalence of obstructive sleep apnea in people with type 2 diabetes and abnormal glucose metabolism.
Sleep Apnea Secondary to Service-Connected Gastroesophageal Reflux Disease (GERD)
GERD occurs in up to 60% of OSA patients; comparatively, it occurs in only 20% of the general population. Several studies showed that OSA was more common in GERD patients than in the general population.
Posttraumatic Osteoarthritis
Medical research clearly shows that soldiers are especially susceptible to osteoarthritis after discharge from the service, and that osteoarthritis may manifest itself many years after the initial injury. In addition, due to gait issues, an affected limb can result in the development of osteoarthritis in proximal joints.
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