Why does VA reject private medical opinions?

Nexus letters written by medical experts can be some of the strongest possible evidence in a VA disability case. However, getting the right expert to write your letter is an important part of the process. Many private doctors are unable or unwilling to author the type of letter that is necessary to secure a favorable result. 

The good news is that nexus letters for veterans are typically sufficient to help secure benefits from the VA. With the support of a strong letter written by a qualified expert, you may be able to get the benefits you deserve. Let Elite Medical Review Associates help you maximize your recovery for any service-connected conditions.

The Lack of a Strong Conclusion

One of the problems of having a private physician write your nexus letter is that they are likely inexperienced with the process. These doctors often couch their conclusion in vague language in order to avoid making a strong statement either way. In some scenarios, they might gloss over the specifics of your condition without giving their opinion at all. 

This is a problem for your case, given that VA nexus letters require a conclusion. Their purpose is to convince the decision makers at the VA that your condition is serious, and that it is directly linked to your military service. 

The conclusion to your letter should be clear and convincing. While it does not have to guarantee without any doubt that your disability is linked to your service, it must find that your condition is as likely as not related to your time in the military. In other words, there should be at least a 50 percent chance of a service connection. Letters that do not lead to this conclusion typically result in rejection.

Reliance on Your Own Statements 

The value of a VA nexus letter is that it is written by a medical expert who has reviewed your records and conducted research into how your condition may be linked to your service. This value is greatly diminished if the letter written on your behalf simply regurgitates your own statements.

The VA is looking for a conclusion from a medical expert based on their own research. These letters should compare your records to similar cases in scholarly journals and publications. When a letter primarily restates your own claims, the conclusion it offers might be rejected by the VA.

Misstatement of Facts

The first step in the process of writing a VA nexus letter for veterans is to provide a statement of the facts. This is a review of the nature of your injury as well as the details of how it is linked to your service. Any error by the doctor when providing these details could be problematic for your case. 

The VA is likely to consider the rest of the letter with skepticism if it includes substantial factual errors about your medical or service history. Even if they were unintentional or relatively minor, the decision-makers at the VA could determine that they represent a lack of understanding of your case in general. This can lead them to disregard the opinion offered in your nexus letter.

Lack of Medical Evidence

An opinion is a critical part of a strong nexus letter, but that conclusion must be based on something. There must be medical evidence that leads your physician to conclude that your disability is connected to your service. Often, this is done by referencing your medical records and correlating them to details of your service. A letter is likely to be rejected if it fails to adequately rely on the information included in your medical records. 

Another key aspect of these letters is the use of medical research. Authors may provide references to scholarly journals that are relevant to your condition. They may also draw conclusions by comparing your condition to the research. The failure to connect these dots could lead to a rejection.

Inconsistencies

Inconsistent statements are also a major red flag for the VA. When reviewing the letter supplied by your doctor, they will likely be concerned when medical observations do not line up with your own statements or medical records. 

For example, it is problematic if the author builds their conclusion around the existence of symptoms you never mentioned or even potentially denied in your own statement. The VA is likely to reject the conclusion of a letter that includes factual disagreements with your medical documentation or buddy letters.

Lack of Expertise 

There are many different types of medical professionals who are allowed to author a VA nexus letter. Often, these letters are written by physicians who are licensed to practice medicine in the United States. However, other professionals, including nurse practitioners, physician assistants, and even chiropractors, can provide a strong nexus letter under the right circumstances. 

Of course, not every disability is the same. Some cases are more complex than others, and it is helpful to have a medical professional with experience treating your condition writing a letter on your behalf. For example, psychiatrists are generally in the best position to make the case for PTSD claims. While an opinion from a chiropractor could be useful for a chronic back pain claim, they are less likely to be successful when weighing in on the cause of PTSD or other mental health issues.

Get Nexus Letters that Will Help Win Your Case

You are often best served by having your VA nexus letter written by a medical professional familiar with the process. At Elite Medical Review Associates, our team of trusted medical experts is ready to review your documentation and provide you with a strong nexus letter. Reach out as soon as possible to discuss how we might be able to help with your claim.