Why Your VA Claim for a Medical Nexus Opinion Might Get Denied and What You Can Do About It

 Posted on November 12, 2024 in Uncategorized

Have you invested time, money, and energy into securing a VA medical nexus opinion only to hit the wall of a denied claim? You're not alone. While a medical nexus opinion can be a crucial piece of evidence in substantiating your claim, it's not a foolproof ticket to approval. Unfortunately, many veterans find themselves in this frustrating position. Understanding why denials happen and what you can do about them can be empowering and may ultimately lead to a successful claim.

In this blog, we'll dive into why your claim might get denied even if you have a supportive medical nexus opinion and provide actionable steps to take afterward.

Reasons Why You May Be Denied

The VA Didn't See Your Nexus Opinion

 Believe it or not, one of the most common reasons for denial is that the VA simply didn’t see your medical nexus opinion. With the sheer volume of paperwork involved in claims processing, crucial documents can get buried, misplaced, or lumped together with other records. To check if this might be the case, review your VA rating decision carefully and look for the 'Evidence' section. If your nexus opinion is not listed, it’s likely that the VA missed it.

The VA Did Not Give It Adequate Weight

Even if your medical nexus opinion is seen, the VA might not give it the weight it deserves. The VA can't outright ignore positive evidence, but it can downplay its significance by stating that its own examinations hold more probative value. When this happens, it’s crucial to understand that the VA must provide a reason for finding your evidence non-probative. The "benefit of the doubt" rule should apply if the negative and positive evidence is equally balanced, but often this rule is not honored correctly.

Inadequate Medical Nexus Opinion

Sometimes, the problem lies in the quality of the medical nexus opinion itself. Many veterans are duped by so-called experts who offer cookie-cutter opinions that lack detailed rationale or specific connections to service. These opinions often fail to cite the correct records or present misleading information. It’s vital to scrutinize your opinion to ensure it meets the standard required by the VA before submitting it.

Other Factors in Your Claim

Even if your nexus opinion is satisfactory, other elements of your claim might be problematic. A successful claim requires more than just a nexus; you must also demonstrate a current disability and an in-service event, injury, or disease. If either of these elements is lacking, your claim will be denied. Review your rating decision to understand the exact reasons for rejection and consider seeking help from a VA-accredited attorney or representative.

Steps to Take After a Denial

 After a denial, you generally have three main options: Higher Level Review, Supplemental Claim, and Appeal to the Board of Veterans Appeals.

Higher Level Review

If you believe the VA simply overlooked your evidence or misapplied the law, a Higher Level Review might be your best bet. Request an informal conference where you can discuss specific issues, like the missed nexus opinion, with a higher-level reviewer. This step involves filing VA Form 20-0996 within one year of the denial.

Note: check out our recent episode on Higher Level Review

Supplemental Claim

A Supplemental Claim is your go-to if you can provide new and relevant evidence. This is ideal if your initial medical nexus opinion was inadequate, and you’ve since obtained a more comprehensive one. To initiate this, file VA Form 20-0995. Remember that while you can file a Supplemental Claim anytime after denial, doing it within a year of continuous prosecution may preserve your original effective date.

Appeal to the Board of Veterans Appeals

 If your region’s VA office has continuously denied your claims, it may be time to escalate to the Board of Veterans Appeals. While this process can be lengthy, often taking three to four years, many veterans find that judges at this level are more apt to understand and correctly evaluate their claims. With this option, you get three sub-options: submission of new evidence, direct decision on the record, or a hearing. Use VA Form 10182 for this process.

Navigating the complexities of VA claims can be daunting, but understanding why denials happen is the first step in overcoming them. Whether it's due to an overlooked document, an underestimated nexus opinion, or another element in your claim, there are steps you can take to address and rectify the situation. Seeking help from a VA-accredited attorney can also offer invaluable guidance and improve your chances of a successful appeal.

If you find yourself stuck in the denial loop, don't hesitate to reach out to experts who can provide the support and insight needed to effectively navigate the VA claims process. For additional assistance, schedule a meeting with our team - https://calendly.com/vetlawoffice