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    • How to get your questions answered.

      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
    • Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests.

      Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests. Please check the little home I am carving out for our SVR partners. http://www.hadit.com/svr.html
    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

      Hi I've updated our HadIt.com Pass It On Cards. They are in a PDF format you can print them out cut them there are 12 to a page. If you have found HadIt.com helpful and would like to pass it on to other veterans this is an easy way to do it.I hope you find them helpful, feel free to leave a few anywhere veterans gather, veterans centers, veterans hospitals, public libraries, be creative. Please make sure though, that if you want to leave some at any business you ask permission first.Here you go http://www.hadit.com...it_on_cards.pdf
    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ http://www.hadit.com/forums/index.php?/topic/40963-va-fl-10-34/ http://www.hadit.com/forums/index.php?/topic/40964-va-fl-10-32/ http://www.hadit.com/forums/index.php?/topic/40966-va-fl-10-30/ http://www.hadit.com/forums/index.php?/topic/40967-va-fl-10-26/ http://www.hadit.com/forums/index.php?/topic/40968-va-fl-10-25/ http://www.hadit.com/forums/index.php?/topic/40819-va-fl-10-24e1/ http://www.hadit.com/forums/index.php?/topic/40818-va-fl-10-24/ http://www.hadit.com/forums/index.php?/topic/40817-va-fl-10-22/ http://www.hadit.com/forums/index.php?/topic/40814-va-fl-10-04/ http://www.hadit.com/forums/index.php?/topic/40969-va-fl-10-03/ http://www.hadit.com/forums/index.php?/topic/40812-va-fl-10-02/ http://www.hadit.com/forums/index.php?/topic/40808-va-fl-09-52/ http://www.hadit.com/forums/index.php?/topic/40806-va-fl-09-50/ http://www.hadit.com/forums/index.php?/topic/40970-va-fl-09-41/ http://www.hadit.com/forums/index.php?/topic/40971-va-fl-09-38/ 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Getting An Independent

34 posts in this topic

Posted · Report post

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.

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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...

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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

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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?

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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!

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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

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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!

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Posted · Report post

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

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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?

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Posted · Report post

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!

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Posted · Report post

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

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Posted · Report post

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

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Posted · Report post

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...

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Posted · Report post

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?

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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

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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.

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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

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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.

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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.

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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

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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.

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bumping it up

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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.com/search?client=safari...-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.

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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.

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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.

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