Jump to content


Photo

Getting An Independent


This topic has been archived. This means that you cannot reply to this topic.
33 replies to this topic

#1 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 21 February 2009 - 06:53 AM





Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim.



Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability can be very costly.



However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO.



A Valid IMO must contain the following:



The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs.



Also the doc needs to have all prior SOC decisions from VA particularly those referencing any VA medical opinions or a copy of the actual C & P results.



The doctor should define their medical expertise as to how their background makes their opinion valid.



In other words a psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.



The doctor must have some valid medical expertise that makes his/her IMO valid.



The doctor should state their opinion in terms of “as least as likely as not”, or “More than likely” as to the present disability and the nexus to the veteran’s service medical records or other SC disabilities, if the medical evidence warrants them to agree with the claim.



They should then refer to specific medical evidence to support their conclusion.



They should rule out any other potential etiology if they can-but for service as causing the disability.



They should briefly quote from and cite any established medical principles or treatises that support their opinion.



They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record.



They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion.



They should attach a full Curriculum Vitae if possible or list their expertise within the opinion and tell VA of any special medical background they have that also makes their opinion valid. (For example, how long they have treated patients with the same disability, any articles they have written, or symposiums attended etc,)



It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion.



A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records.



Send the VA and your vet rep copies of the signed IMO.



And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence.



PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes times to find and have the VA approve of a payee.



















#2 oldman273

oldman273

    E-6 Petty Officer 1st Class

  • Chief Petty Officers
  • PipPipPipPipPipPip
  • 311 posts

Posted 23 April 2009 - 11:26 PM

Thanks so much I am at this point in my claim my IMO is a Neuro surgeon who had avised me that my back could not be fixed adn not to waste the money. We tried Physical theraphy but now I have the very bottom disc L5 S1 is completley gone and the other 3 aboe it are bulging also. A bad back is a house of cards.

I did want to ask is it good to also bring the last C/P exam from the VA on my back? I saw myself where the artheritis is thrown out as a result of my SC back I hope to get that and the nerve dammage caused by the bulging disc. I do want to know do I get him to see how the rating scale is used in the VA Rental put up the most complete back infromation I could use but I will e-mail him also have a good day and thanks for your work on behalf of us vets...... I just went back and read the C/P stuff I will need thanks...

Edited by oldman273, 23 April 2009 - 11:27 PM.


#3 Raybob

Raybob

    E-3 Seaman

  • Third Class Petty Officers
  • PipPipPip
  • 42 posts

Posted 16 May 2009 - 03:36 PM

Question on getting an IMO before I have retired from active duty.

I will be retiring from active duty in one year. I have already attended a briefing by the VA on how to accomplish all the paperwork.

My original plan is to go to a VSO (such as DAV, AMVETS etc) to have them review my medical records and assist me in completing the VA forms AND the form I will take in for my final Service Retirement Physical Exam. The items the VSO will identify will go into my final physical for additional support and documentation. Then, after this exam is completed and the paperwork is done, I plan to file (through the VSO) all the VA paperwork.

Here in the DC area, we now have the Benefit Delivery at Discharge (BDD) process whereby, if I file my 21-526 with VA 6 months before retirement, I will have my rating upon retirement (actually get get a good "estimate" within a few weeks of filing of it if I also file for VA Disability Assistance Transition Program (DTAP) rather than waiting several months after retirement

MY QUESTION IS: Should I use just the VSO to have them review my records and prepare the "disabilities" I take into my final Service Retirement Physical???...
-OR-
Should I go out and get an independent IMO to take to my retirement physical which might more adequately "connect the dots" that are throughout my career medical records?

My hope is to have everything substantiated so it can also be documented in my retirement physical paperwork. My biggest concerns are "connecting the dots" since that is often NOT done and substantiated before one retires, so I can show they are all during my period of active service.

Thanks for any advice. Happy to answer any questions.

Trying to live up to my boyscout motto of "Being Prepared!"
Cheers
Raybob

#4 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 19 May 2009 - 05:18 PM

Sorry no one had answered you yet-

I hope my post is still here as to exactly what an IMO needs to contain.

I sure admire anyone who gets their ducks in a row like you are doing-

You obviously have some documented disabilities and maybe some secondary conditions-
if this stuff is well covered in your SMRs you might not need even need an IMO.

Are you comfortable telling us what you intend to claim for comp?

You have already gone through a MEB? And do you have the results?

Or no MEB but retirement-do you mean you are a lifer or becoming a veteran after many years of service but not 15-20 years?

Edited by Berta, 19 May 2009 - 05:18 PM.


#5 hollywoodnc

hollywoodnc

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 147 posts

Posted 24 May 2009 - 08:35 AM

What I find sickening is that Veterans have to spend "Out of Pocket", to prevail in a claim.

My record is riddled with bogus opinions, by less than competent doctors at the VA.

Some of us cannot always afford to see private doctors. Additionally, I'm having a hard time trying to find a reputable Ortho-Neuro doctor who will take the time to render a bona fide opinion (on my old hip injury, and how it contributed to a spinal condition), which dates back to the mid seventies.

I also have issues about this doctor Bash, who rapes Veterans for a IMO. You really have to wonder if he's not taking advantage of people who clearly don't have the advantage to a fair and just medical exam by a gov't. employee.

So, when you look at the big picture, we are shafted either way. If you're on your death bed, you'll prevail; until you drop dead, THEN the scumbags deny your claim. Either way, you're F*cked!

#6 free_spirit_etc

free_spirit_etc

    E-9 Master Chief Petty Officer

  • Master Chief Petty Officer
  • PipPipPipPipPipPipPipPipPip
  • 1931 posts

Posted 25 May 2009 - 01:44 PM

Be sure to get a COPY of your discharge physical!!! If you file a VA claim upon retirement - the VA becomes the "keeper of your records." My husband's discharge physical has disappeared. Of course, the VA keeps telling me to check with the Records Center - and the Records Center tells me the VA has it.

The VA had it at one time, because earlier decisions refer to it. But they don't have it now.

Also - make sure you get copies of any DOCTOR's notes. When my husband asked the Base for his Medical Records, he was given a bunch of very brief computerized pages.

He went back to find out why his records were so brief. They said he hadn't asked for the Doctors Records (which are somehow different than the Medical Records)Of course, these were Post-Service Records, so it might be different.

As far as getting an IMO - you might want to consider it. This would mostly concern the severity of the disability. But it might also concern the occurance.

Or you might consider waiting and see what they come up with first - and then you will know more of what you will need in the way of an IMO.

Also make sure you keep getting treatment for Service Connected Conditions - and you might want to consider getting a non-military non-Tri-Care provider for this, if the military or Tri-care provider balks at writing any opinions for the VA.

Actually, my husband's military provider was going to write my husband an opinion letter, but then told us the base attorney told him that he couldn't.

Good luck,
Free


Question on getting an IMO before I have retired from active duty.

I will be retiring from active duty in one year. I have already attended a briefing by the VA on how to accomplish all the paperwork.

My original plan is to go to a VSO (such as DAV, AMVETS etc) to have them review my medical records and assist me in completing the VA forms AND the form I will take in for my final Service Retirement Physical Exam. The items the VSO will identify will go into my final physical for additional support and documentation. Then, after this exam is completed and the paperwork is done, I plan to file (through the VSO) all the VA paperwork.

Here in the DC area, we now have the Benefit Delivery at Discharge (BDD) process whereby, if I file my 21-526 with VA 6 months before retirement, I will have my rating upon retirement (actually get get a good "estimate" within a few weeks of filing of it if I also file for VA Disability Assistance Transition Program (DTAP) rather than waiting several months after retirement

MY QUESTION IS: Should I use just the VSO to have them review my records and prepare the "disabilities" I take into my final Service Retirement Physical???...
-OR-
Should I go out and get an independent IMO to take to my retirement physical which might more adequately "connect the dots" that are throughout my career medical records?

My hope is to have everything substantiated so it can also be documented in my retirement physical paperwork. My biggest concerns are "connecting the dots" since that is often NOT done and substantiated before one retires, so I can show they are all during my period of active service.

Thanks for any advice. Happy to answer any questions.

Trying to live up to my boyscout motto of "Being Prepared!"
Cheers
Raybob


Edited by free_spirit_etc, 25 May 2009 - 01:45 PM.


#7 12R3G

12R3G

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 134 posts

Posted 26 May 2009 - 12:23 PM

Raybob

I retired just over a year ago and filed using the BDD program as well. I brought a typed list of issues for SC to my seperation "physical"--in the AF it's now just a review & dr visit. I tried to think of everything that is/was in my SMR, but missed a few. Ever had "shin splints"? Crazy, but they are a rateable condition as are flat feet and tinnitus. Who knew. Fortunately for me, the intial C&P exams caught the flat feet & tinnitus.

My point is, a list can't hurt and is a good reminder for you; if they add it to your SMR (mine was attached to the clinical notes printout for the appt) so much the better.

Do go to see a VSO before your seperation physical and get them to help you 1) prepare your claim, and 2) prepare your list of medical issues for your visit with the doctor--it's not like he's going to read your entire SMR before the appt, and the list helps him/her find the relevant entries in your SMR. Actually, your claim should contain every condition you are submitting, so making the list for the retirement physical should be easy.

Read CFR 38 pertaining to disability ratings...read the Clinicians Guide prior to the C&P exams (wish I'd had that last year).

Get your SMR before you depart on terminal leave. The the records section will release it to you to handcarry to the VA. Make a copy of everything--scan if you can--before passing to VA. Ever hospitalized? Ask for the inpatient treatment records--they may not be in the SMR.

IMO is key for service connection--but if you file for VA benefits while still on active duty under BDD it pretty much makes the case for SC. That's the big hassle...getting service connected for something that crops up 2, 10, 20 years later. The other hassle is for something chronic, but that you "sucked up" (shin splints come to mind) or blew off going back to the doctor because it was too much trouble--so, feel free to visit the doctor during the next year to get chronic conditions documented.

Good luck!

#8 Raybob

Raybob

    E-3 Seaman

  • Third Class Petty Officers
  • PipPipPip
  • 42 posts

Posted 01 June 2009 - 05:22 PM

Thanks to all!! This is GREAT for preparing for my medical reviews and paperwork. I attended a brief by the VA which was excellent and they went over how best to complete the paperwork... I think I may go a couple more times to make sure I get it all accurate. Also, I will be at a briefing where the DC DAV Field Service Superisor will come speak to us about how they support the process as a VSO - they office right in the VA office in downtown DC. I've already copied my medical records thru last Jan... and just need to review them to get the latest and also the stuff they have online. Also, I requested and received DVDs of my x-rays and MRIs from the hospitals I used back in San Antonio the last 3 years. Trying to do my homework, and all of your suggestions are very helpful! Thans for all you do! Cheers, Ray

#9 Raybob

Raybob

    E-3 Seaman

  • Third Class Petty Officers
  • PipPipPip
  • 42 posts

Posted 01 June 2009 - 05:26 PM

Thanks, Berta. I am still active duty and will retire with 34 years next Spring. I have not had any MED or my retirement physical yet. I plan to get all my SMRs together (to date), go see the local DAV VSO and have them review my SMRs, take what they write down in with me to my retirement physical, then get the results from that and update/prepare my VA 21-526 forms.
Cheers
Ray



Sorry no one had answered you yet-

I hope my post is still here as to exactly what an IMO needs to contain.

I sure admire anyone who gets their ducks in a row like you are doing-

You obviously have some documented disabilities and maybe some secondary conditions-
if this stuff is well covered in your SMRs you might not need even need an IMO.

Are you comfortable telling us what you intend to claim for comp?

You have already gone through a MEB? And do you have the results?

Or no MEB but retirement-do you mean you are a lifer or becoming a veteran after many years of service but not 15-20 years?



#10 CRYPTOTECH

CRYPTOTECH

    E-5 Petty Officer 2nd Class

  • Banned
  • PipPipPipPipPip
  • 117 posts

Posted 01 June 2009 - 08:25 PM

I paid for mine and so so glad I went that route. I had two VA shrinks write up opinions but they didn't know what the VA needed and the wording wasn't right. I was even going to write up the damn letter myself and just get her to sign off but thought otherwise. An IMO from an independent entity is valuable and that's why there's a fee. They know the what's needed and specialize in IMO's. Consider it an investment that will pay off 50,000% for you in the future. You got to do the dirty to sometimes get the shine.

Frank

What I find sickening is that Veterans have to spend "Out of Pocket", to prevail in a claim.

My record is riddled with bogus opinions, by less than competent doctors at the VA.

Some of us cannot always afford to see private doctors. Additionally, I'm having a hard time trying to find a reputable Ortho-Neuro doctor who will take the time to render a bona fide opinion (on my old hip injury, and how it contributed to a spinal condition), which dates back to the mid seventies.

I also have issues about this doctor Bash, who rapes Veterans for a IMO. You really have to wonder if he's not taking advantage of people who clearly don't have the advantage to a fair and just medical exam by a gov't. employee.

So, when you look at the big picture, we are shafted either way. If you're on your death bed, you'll prevail; until you drop dead, THEN the scumbags deny your claim. Either way, you're F*cked!



#11 SKELABONES

SKELABONES

    E-2 Recruit

  • New User Review
  • Pip
  • 2 posts

Posted 06 September 2009 - 10:45 PM

Question on getting an IMO before I have retired from active duty.

I will be retiring from active duty in one year. I have already attended a briefing by the VA on how to accomplish all the paperwork.

My original plan is to go to a VSO (such as DAV, AMVETS etc) to have them review my medical records and assist me in completing the VA forms AND the form I will take in for my final Service Retirement Physical Exam. The items the VSO will identify will go into my final physical for additional support and documentation. Then, after this exam is completed and the paperwork is done, I plan to file (through the VSO) all the VA paperwork.

Here in the DC area, we now have the Benefit Delivery at Discharge (BDD) process whereby, if I file my 21-526 with VA 6 months before retirement, I will have my rating upon retirement (actually get get a good "estimate" within a few weeks of filing of it if I also file for VA Disability Assistance Transition Program (DTAP) rather than waiting several months after retirement

MY QUESTION IS: Should I use just the VSO to have them review my records and prepare the "disabilities" I take into my final Service Retirement Physical???...
-OR-
Should I go out and get an independent IMO to take to my retirement physical which might more adequately "connect the dots" that are throughout my career medical records?

My hope is to have everything substantiated so it can also be documented in my retirement physical paperwork. My biggest concerns are "connecting the dots" since that is often NOT done and substantiated before one retires, so I can show they are all during my period of active service.

Thanks for any advice. Happy to answer any questions.

Trying to live up to my boyscout motto of "Being Prepared!"
Cheers
Raybob



#12 SKELABONES

SKELABONES

    E-2 Recruit

  • New User Review
  • Pip
  • 2 posts

Posted 06 September 2009 - 10:45 PM

Question on getting an IMO before I have retired from active duty.

I will be retiring from active duty in one year. I have already attended a briefing by the VA on how to accomplish all the paperwork.

My original plan is to go to a VSO (such as DAV, AMVETS etc) to have them review my medical records and assist me in completing the VA forms AND the form I will take in for my final Service Retirement Physical Exam. The items the VSO will identify will go into my final physical for additional support and documentation. Then, after this exam is completed and the paperwork is done, I plan to file (through the VSO) all the VA paperwork.

Here in the DC area, we now have the Benefit Delivery at Discharge (BDD) process whereby, if I file my 21-526 with VA 6 months before retirement, I will have my rating upon retirement (actually get get a good "estimate" within a few weeks of filing of it if I also file for VA Disability Assistance Transition Program (DTAP) rather than waiting several months after retirement

MY QUESTION IS: Should I use just the VSO to have them review my records and prepare the "disabilities" I take into my final Service Retirement Physical???...
-OR-
Should I go out and get an independent IMO to take to my retirement physical which might more adequately "connect the dots" that are throughout my career medical records?

My hope is to have everything substantiated so it can also be documented in my retirement physical paperwork. My biggest concerns are "connecting the dots" since that is often NOT done and substantiated before one retires, so I can show they are all during my period of active service.

Thanks for any advice. Happy to answer any questions.

Trying to live up to my boyscout motto of "Being Prepared!"
Cheers
Raybob



#13 Vync

Vync

    E-8 Senior Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPipPip
  • 1396 posts

Posted 12 October 2009 - 07:55 AM

I have a doc visit this Thursday for my lower back. I called about a dozen doctors regarding an IMO. Only one in my area said they could do it for $800, but I will have to save up for that because my insurance says IMOs are not covered. I agree that having to save up a lot of cash to get an IMO is just crazy.

Also, my entrance physical says nothing of back problems. However, my exit physical indicates explicitly that I have a history of back problems. Somehow, the VA could not connect the dots there...

#14 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 13 October 2009 - 01:17 PM

Did you NOD their decision and point out the in service evidence to them?

Did they list this as Evidence in the SOC or simply just ignore it?

What was their exact wording of the denial?

Do you have copies of your SMRs that reflect the back problems?

Did you highlight these copies and send them to the VA to support the claim?

Did yoiu attempt to get any buddy statements to prove the inservice nexus (link) to the back problems?

#15 Vync

Vync

    E-8 Senior Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPipPip
  • 1396 posts

Posted 13 October 2009 - 02:33 PM

Berta,
Thank you for responding.

Did you NOD their decision and point out the in service evidence to them?
Yes.

Did they list this as Evidence in the SOC or simply just ignore it?
They listed some, but not all of it. I sent them what they were missing.

What was their exact wording of the denial?
Here's the denial letter from the NOD I filed, but I can't find the original denial letter. I will probably need to go to the VARO and review my records, including getting a copy of my C-file.


We determined that the following condition(s) was/were not related to your military service, so service connection remains denied: back disability 0%.

Decision
The previous denial of service connection for back disability (also claimed as upper and lower back condition) is confirmed and continued.

Evidence (I am paraphrasing, for privacy purposes)
- Service treatment records
- ER treatment records
- Orthopedic treatment records
- MRI report
- Epidural pain block treatment records
- Neurologist treatment records

Reasons for Decision
The claim for service connection for back disability (also claimed as upper and lower back condition) is considered reopened. However, the evidence continues to show this condition was not incurred in or aggravated by military service.

The service treatment records were considered in deciding your claim. Private medical records show you have been diagnosed with degenerative disc disease and chronic low back pain with lumbar disc displacement. You have received lumbar epidural steroid injections.


Do you have copies of your SMRs that reflect the back problems?
Yes, I have everything.

Did you highlight these copies and send them to the VA to support the claim?
Yes. I made sure that I sent them only copies the records related to the problem.

Did yoiu attempt to get any buddy statements to prove the inservice nexus (link) to the back problems?
I do not have any buddy statements, but my ex-wife did provide an objective statement of what she observed while we were married. However, we were not married while I was in the military.


Based on the "incurred by or aggravated by military service" statement, they obviously ignored something because:
1. Entrance exam shows no back problems.
2. Service treatment records show numerous injuries and treatment for back problems
3. Exit exam indicates 'history of back problems'.

Thanks,
Vync

#16 Vync

Vync

    E-8 Senior Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPipPip
  • 1396 posts

Posted 13 October 2009 - 03:41 PM

Talk about timing, I just got another claim denial in the mail from the VA. I posted the text of it here:

Lower Back Claim

I'll follow up with my claim problems there.

#17 halos2

halos2

    E-8 Senior Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPipPip
  • 1488 posts

Posted 14 October 2009 - 03:32 AM

Responding to the bottom of this page with your comments: No back probs prior to service, problems in service re:back and exit exam notes back problems...I have basically the same documentation...Health condition upon enlistment physical Good, no back problems...Back injury in-service with months of treatments/therapy/pain medication/bed rest/no relief of pain/pain radiating to legs/given a corsett to wear/and discharge physical denotes health condition fair with all the back problems noted...yet I have been fighting for my due justice since 03. Case is at BVA. Good luck with your claim for your back. I presented 2 IMO's/IME's and they took the word of a flunky Nurse Practitioner whom the VA demoted from ever doing C&P's again...and the beat goes on...


Berta,
Thank you for responding.

Did you NOD their decision and point out the in service evidence to them?
Yes.

Did they list this as Evidence in the SOC or simply just ignore it?
They listed some, but not all of it. I sent them what they were missing.

What was their exact wording of the denial?
Here's the denial letter from the NOD I filed, but I can't find the original denial letter. I will probably need to go to the VARO and review my records, including getting a copy of my C-file.


We determined that the following condition(s) was/were not related to your military service, so service connection remains denied: back disability 0%.

Decision
The previous denial of service connection for back disability (also claimed as upper and lower back condition) is confirmed and continued.

Evidence (I am paraphrasing, for privacy purposes)
- Service treatment records
- ER treatment records
- Orthopedic treatment records
- MRI report
- Epidural pain block treatment records
- Neurologist treatment records

Reasons for Decision
The claim for service connection for back disability (also claimed as upper and lower back condition) is considered reopened. However, the evidence continues to show this condition was not incurred in or aggravated by military service.

The service treatment records were considered in deciding your claim. Private medical records show you have been diagnosed with degenerative disc disease and chronic low back pain with lumbar disc displacement. You have received lumbar epidural steroid injections.


Do you have copies of your SMRs that reflect the back problems?
Yes, I have everything.

Did you highlight these copies and send them to the VA to support the claim?
Yes. I made sure that I sent them only copies the records related to the problem.

Did yoiu attempt to get any buddy statements to prove the inservice nexus (link) to the back problems?
I do not have any buddy statements, but my ex-wife did provide an objective statement of what she observed while we were married. However, we were not married while I was in the military.


Based on the "incurred by or aggravated by military service" statement, they obviously ignored something because:
1. Entrance exam shows no back problems.
2. Service treatment records show numerous injuries and treatment for back problems
3. Exit exam indicates 'history of back problems'.

Thanks,
Vync



#18 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 23 August 2010 - 02:01 PM

I wanted to bump the IMO criteria up- had many questions lately on IMOs.

There is no IMO criteria in 38 CFR. I based this criteria on my IMOs from a former VA doctor who knew exactly what the VA needed to have in an independent medical opinion.

"Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim.



Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability can be very costly.



However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO.



A Valid IMO must contain the following:



The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs.



Also the doc needs to have all prior SOC decisions from VA particularly those referencing any VA medical opinions or a copy of the actual C & P results.



The doctor should define their medical expertise as to how their background makes their opinion valid.



In other words a psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.



The doctor must have some valid medical expertise that makes his/her IMO valid.



The doctor should state their opinion in terms of “as least as likely as not”, or “More than likely” as to the present disability and the nexus to the veteran’s service medical records or other SC disabilities, if the medical evidence warrants them to agree with the claim.



They should then refer to specific medical evidence to support their conclusion.



They should rule out any other potential etiology if they can-but for service as causing the disability.



They should briefly quote from and cite any established medical principles or treatises that support their opinion.



They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record.



They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion.



They should attach a full Curriculum Vitae if possible or list their expertise within the opinion and tell VA of any special medical background they have that also makes their opinion valid. (For example, how long they have treated patients with the same disability, any articles they have written, or symposiums attended etc,)



It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion.



A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records.



Send the VA and your vet rep copies of the signed IMO.



And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence.



PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes times to find and have the VA approve of a payee."

I need to add here that a secondary condition to an established SC condition wold not need the IMO doctor to read all of the SMRs.
They just have to state with medical rationale why the second claimed disabilty is due to (secondary to) the initial SC disability.

DIC claims IMOs are different and the IMO doctor needs the death certificate and any autopsy findings and any past C & Ps as well as the entire clinical record (to include SMRs in most cases) and copies of any and all private records.

Contributing causes of death on the death certificate ,if service connected, should warrant a DIC award.

Say the vet dies and the Death certificate reads, immediate cause of death ,cardiac arrest
with cerebral ischenmic event
contribting.
Say this vet had SC DMII and then died due to the massive brain stroke.
An IMO could reveal with full medical rationale that the brain ischemia ,as likely as not was caused by the diabetes due to diabetic cardiomyopathy, evident as atherosclerotic heart disease, proven by past ECHO, causing a clot that passed into the veterans brain.

I am not a doctor but the point here is that an IMO regarding a veteran's death can make the difference between the spouse getting a denial or a DIC award.
A good IMO doctor will state medically- step by step- how the veteran's cause of death was contributed to by any SC condition, if the medical evidence supports that finding and that is a medical rationale.

#19 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 13 January 2011 - 08:33 AM

bumping it up again

I just noticed I developed the DIC criteria before the new AO IHD presumptive came into play.


If a AO vet with DMII died of IHD or CAD which VA said had preceeded their DMII -I bet the VA denied many DIC claims on that basis and the new AO IHD regs would allow that claim to be reopened under Nehmer now.

VA in my case did pull out a past IHD CUE claim I had pending and sent it to the Nehmer people but I didn't wait for that and I filed a new AO IHD claim too.

AO widows and widowers whose claims (for DIC and Accrued) now fall under Nehmer (denied in the past for what is now an AO presumptive and had accrued claims as well as DIC denied) can -if successful under the new regs obtain ALL accrued beneits due the veteran in their lifetime as well as potential favorable EED and retro amount.

I check with a NVLSP lawyer 2 weeks ago on that and-it does not matter if the widow/widower filed for accrued within the one year after death traditional accrued claim deadline either as long as the veteran had a pending claim regarding an AO condition at time of death.

(Or a claim that can easily be construed as a AO condition.)



My article on survivors and the new AOs will be coming soon at VAWatchdog,.org.and I will post a link to it at hadit.

Edited by Berta, 13 January 2011 - 08:50 AM.


#20 Cm Burns

Cm Burns

    E-5 Petty Officer 2nd Class

  • Chief Petty Officers
  • PipPipPipPipPip
  • 246 posts

Posted 16 July 2011 - 09:04 PM

How many months of the va medical records do they need to have in order to do the imo... i know the cnp and decisions but i have 1000s of pages of med records so i just want to now what they need. thnx

#21 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 19 July 2011 - 12:57 PM

What medical records an IMO doctor needs depends on the type of IMO-

If it requires a service nexus statement-they need the SMRs and all available med recs.

If it is for a secondary condition, then they would possibly just need the records that transpired since the original condition was service connected so they could give a full medical rationale for why the additional condition is secondary.

For my initial IMOs I sent in 6 years of med recs plus all SOCs, SSOC and C & P exam results.But my husband had many additional VA med recs yet they were not needed by the VA for that specific claim.

For my pending AO IHD death claim, I needed very few med recs and a few other documents.
They only asked me for one additional thing and said it has been ready for decision since April 2011.

It all depends on the claim and most IMOs would probably require the whole shibang.

I always advise sending the IMO doctor a cpover letter describing the type of opinion your are seeking and then you can tab and mark specific records that he or she would need their attention called to.

For example an MRI narrative I enclosed done on my husband was expanded on in the doctor's entrees during his hospitalization. Unlike the typed MRI narrative,it was very difficult to read the doctor's handwriting.

After I decifered it all, it was very critical info for my past claims.

Some med recs contain lots of extemporaneous stuff which may or may not be relevant to a claim. Best to send them all to the IMO doctor if in doubt.

#22 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 17 October 2011 - 07:23 AM

bumping it up

#23 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 21 December 2011 - 08:42 AM

I realized the actual verbage isnt in this post I made so here it is from tmoe :

"Is due to- 100%
More likely than not- Greater than 50%
At least as likely as not- 50% (Benefit of doubt goes to Vet)
Not at least as likely as not- Less than 50%
Is not due to- 0% from an post by carlie

here is a link http://www.google.co......-8&oe=UTF-8"

Although some IMO docs might state this a little differently, this is what the VA is familiar with so best that they use this verbage.

#24 COOL BREEZE

COOL BREEZE

    E-7 Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPip
  • 696 posts

Posted 24 December 2011 - 01:20 AM

Regarding the statement -"Not at least as likely as not- Less than 50%". Is this grounds for an automatic disapproval if the VA doctor doing your compensation exam indicated this on the standard form?

Sorry didn't mean to hijack your post-saw this and had a immediate inquiry relating to mine before I get another independent doctor.

#25 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 24 December 2011 - 06:21 AM

Thanks for bringing that up as I didn't check the copy and should have!!!

"Not at least as likely as not- Less than 50%"

I don't think that is the exact wording VA uses and will check that.

If a VA doc says 'less likely then not', the VA will deny the claim.

#26 COOL BREEZE

COOL BREEZE

    E-7 Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPip
  • 696 posts

Posted 24 December 2011 - 10:50 AM

Well, I guess that takes care of that issue. Time to start working on a new claim.

#27 carlie

carlie

    Moderator/Admin/HadIt.com Elder/SVR Radio Panelist

  • Admin
  • PipPipPipPipPipPipPipPipPipPip
  • 21716 posts

Posted 24 December 2011 - 11:46 AM

Medical statements regarding possible Service Connection:
Is due to- 100%
More likely than not- Greater than 50%
At least as likely as not- 50% (Benefit of doubt goes to Vet)
Not at least as likely as not- Less than 50%
Is not due to- 0%

#28 qwiksting

qwiksting

    E-5 Petty Officer 2nd Class

  • Chief Petty Officers
  • PipPipPipPipPip
  • 223 posts

Posted 20 April 2012 - 07:13 PM

Carlie, do you think it would be a wise idea for me to get an IMO. My claim is on appeal at BVA. I am not in front of a VLJ yet, but soon. Can I submit it as evidence with a waiver of consideration from the regional office?

#29 qwiksting

qwiksting

    E-5 Petty Officer 2nd Class

  • Chief Petty Officers
  • PipPipPipPipPip
  • 223 posts

Posted 24 April 2012 - 06:03 AM

Well went yesterday for IMO. Doctor is going to test me tomorrow. He said something off the wall that I didn't understand to begin with. He said my condition could be caused by sleep apnea. I have been out of the military since 2005 and was never diagnosed with sleep apnea. I only had problems with GERD. Anyway, we'll see what he comes up with, probably the same as the VA, although the VA disregarded their own evidence.

#30 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 24 April 2012 - 08:09 AM

There is considerable info on the net, such as:
http://www.acidreflu...sleepapnea.html

associating GERD with sleep apnea.

"I have been out of the military since 2005 and was never diagnosed with sleep apnea. I only had problems with GERD"

It those problems were documented in your SMRs and/or you have already been SCed for GERD, then a medical statement from this doctor ,confirming what he said, along with a full medical rationale, will gain you SC for SA as secondary if the SA is claimed.

Is he familiar with and following the IMO criteria here at hadit for the proper wording of an IMO that VA would be familiar with?

Edited by Berta, 24 April 2012 - 08:10 AM.


#31 qwiksting

qwiksting

    E-5 Petty Officer 2nd Class

  • Chief Petty Officers
  • PipPipPipPipPip
  • 223 posts

Posted 24 April 2012 - 11:19 AM

Yes, i spoke with him at length about the VA, and he is well aware of the 5P's regarding the VA. I am not SC for GERD yet, I am awaiting a VLJ to look at my appeal, but I thought it was interesting that he brought that up. I didn't even know what sleep apnea was, except maybe for snoring, let alone it was tied to GERD. I have never been told or treated by the VA, not military for it. I have been discharged for over 7 years now. I basically told him I needed his IMO on my condition, I presented all Records (VA, Military).


I guess if I am diagnosed as having sleep apnea, he feels it could be related to my GERD, which started in Service. I have a BVA appeal pending on GERD,.....What should I do? Just proceed with the appeal, then re file another claim of SA?

Edited by qwiksting, 24 April 2012 - 11:24 AM.


#32 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 24 April 2012 - 11:59 AM

"I have a BVA appeal pending on GERD,.....What should I do? Just proceed with the appeal, then re file another claim of SA? "

Could he prepare an IMO to support the GERD claim and then add his medical rationale as to the secondary?

Send a copy of the IMO to the BVA under your BVA docket number and waive further RO consideration on that claim.

Then ask the VARO for the sleep apnea as secondary to the GERD.

The BVA wont have jurisdiction over the sleep apnea part of the claim or that part of the IMO but by the time the BVA decision comes, the newer SA claim could sure still probably be in progress at the RO level and you would have an IMO that covers the apnea as secondary as well as the GERD.

Others might disagree with this so weigh what they say here too as to filing the new claim for SA as secondary to GERD..

I guess I am counting on the VA being so slow that I expect the BVA decision (hopefully an award) to come faster then how long a newer claim could take.

How long has your claim been at the BVA?



The biggest problem here is getting the GERD SCed.

Make sure the IMO doc refers directly todated medical entries in your SMRs for the GERD claim.

Edited by Berta, 24 April 2012 - 12:03 PM.


#33 qwiksting

qwiksting

    E-5 Petty Officer 2nd Class

  • Chief Petty Officers
  • PipPipPipPipPip
  • 223 posts

Posted 24 April 2012 - 03:56 PM

I understand what your saying Berta, I just hate to muddy up what is in progress. If I submit another claim, will it slow down my BVA appeal? If feel extremely confident based off of the "record" it will show I should be SC for GERD already. I am getting an IMO to solidify my claim, and if in the process the etiology of my SC for GERD happens to be sleep apnea, should I file another claim after my BVA appeal or before it. Thats what i was wondering. I don't know how the BVA operates and if they see another SC condition that is not yet SC, will they look at that as well. you answered my question, thanks

#34 Berta

Berta

    HadIt.com Elder/SVR Radio Panelist

  • SVR
  • PipPipPipPipPipPipPipPipPipPip
  • 28061 posts

Posted 25 April 2012 - 07:09 AM

“Thats what i was wondering. I don't know how the BVA operates and if they see another SC condition that is not yet SC, will they look at that as well.”

They might 'see' it, but they will not make a decision on it.

Unlike the VAROs, the BVA has a queue system.

So I dont think a new claim, filed at a RO level, would impact at all on the queue.

I was at the BVA with claims pending at the VARO level and the BVA mentioned them in my BVA decision but they were' held up' in affect only for the time period that the BVA actually worked on the BVA claim.(maybe 6-8 months)

They were ,in fact, held up by the RO regardless of my BVA appeal.

I almost forgot I had a BVA claim in 1995- 1996 too, but that did not hold up 2 claims and the awards I got from the RO in 1997-1998 on a different basis of claim.

Under the Archives at the SVR radio link is a show I did recently on how the BVA works.
http://www.hadit.com/svr.html

Unfortunately one hour is not long enough at all to really explain the BVA and how they think.

These are all lawyers who,in my opinion, have their finger on the pulse of the VA claims process.

The BVA is a fascinating entity and ,in my opinion, the only part of the VA claim system that knows what they are doing. They focus solely on VA case and evidence in preparing their decisions.

If the claimant's Duty to Assist rights have been impaired in any way, hey will try to resolve that issue with a remand.Although a remand adds more time to a claim, those DTA rights are often critical to the outcome.

I have read BVA decisions for as long as they have been on the net-maybe 15 years and I have only seen a handful of decisions in the past 10 years that I felt should be appealed to the CAVC.

While BVA might not be perfect, it is, for many, the fairest shake they will get from the VA and the BVA will definitely read their evidence.




Even though I just won my AO death claim, I discussed another potential claim with the NVLSP lawyer I was assigned and am going to file it with the evidence attached to the claim ( it is a no brainer and the evidence I have comes from a Top VA cardiologist in DC ) and also I am attaching right away Waiver of further VARO consideration as I have no faith in my RO and want them to send it to the BVA as soon as they deny it.

With the recent hearings on the backlog, 'potential 'hold ups or 'how long will it take' questions have become moot points.