Question:
Can you tell me what weight the Nexus letter really plays in the overall decision on compensation claims? It seems the VA picks and chooses as it pleases. When dealing with chemical poisoning, wouldn't it be appropriate to get a Nexus from a Toxicologist Phd who really possesses the knowledge to determine if a link exists to military service? Is there any regulation that deals with how the VA acknowledges and treats a Nexus letter? It seems like VA Regional Offices all work under different rules. It's hard for a veteran to know what set of rules their VA Regional offices uses. I've tried to read the CFR requirements. It appears that if you can prove active service, have a medical diagnoses, and provide a Nexus linking the diagnoses back to the service, the claim should be approved. However, I see Regional Offices picking the Nexus apart - mentioning that well they didn't say this, or they didn't say that, even though the Nexus states: More likely than not. The lives of veterans depend on how the person reviewing the case feels that day. Shouldn't be that way.
Jim's Reply:
We don't use nexus letters very much these days. The nexus letter has pretty much been displaced by DBQs and Independent Medical Opinions or IMOs. The DBQ may be completed by a VA doctor or contract C & P examiner and the IMO is usually an expert disability physician you pay to do a complete medical (and other) record review that can arrive at a conclusion that links cause and effect...or not. The VA always wants to see an opinion from an MD or DO, not a PhD toxicologist. While the toxicologist may have a world class CV a mile long, without the MD or DO that correlates a medical opinion with other findings, VA isn't buying it. The PhD may publish a scientific paper that an MD/DO can use to support a medical opinion but without the physician opinion you don't have much. For what it's worth, it's the job of the raters at regional offices to pick apart opinions we offer. If they do it fairly and reasonably, that's fine...otherwise, not so much.