Berta

Read First If Getting An Imo

33 posts in this topic

Tbird has very good info at the hadit Home page on IMOs.

I reworked a topic I posted here some time ago.and maybe it can be found better now:

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

VA plays a war game called the War of the Words. The proper wording of an IMO is critical to VA's acceptance of it, as probative evidence.

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 and 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 and a copy of the actual C & P results is even better. The SOC or SSOC could parse or manipulate critical statements in the actual C & P exam.

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

They should be willing to attach to the IMO their CV (Curriculum Vitae that contains their medical background and any other info pertinent ,such as any symposiums they attended, articles they had published etc etc,if possible, that show their expertise .)

A psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.

They need to have expertise in the field of the disability you have claimed to make their IMO valid.

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 then refer to specific medical evidence to support their conclusion.

They must use these terms: (VA is familiar with these terms)

"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 “

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. (unfortunately many PTSD claims these days depend on a VA MH professionals diagnosis of PTSD and an IMO diagnosing PTSD will not be accepted by the VA. See our PTSD forum for the 2010 regs on that.

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.

IMO docs must avoid words like 'maybe', 'possibly', 'could ' or 'might' be related to, or any other wording that VA could construe as speculative and then disregard the IMO for that reason.

On the other hand the IMO doc should look for any purely speculative statements in the C & P exam report or in the C & P and overcome those statements by stating they are mere speculation and have no medical basis.


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 some cases) and copies of any and all private records.

They need the rating info on the vet and what his or her SCs were for.

If the immediate cause of death is NSC but a service connected disability substantially contributes to death, the VA should award DIC.

Often this type of DIC claim definitely needs an IMO to clarify a substantial contribution to a NSC death.

1151 IMOs are different too.

The IMO doctor must identify the exact nature of the negligence with direct referrals to the med recs.

Then the IMO doctor must make a strong medical statement with a full medical rationale that the veteran has a documented disability that is directly due to the VA's negligence and give a full medical rational for that.

It is a good idea for a 1151 IMO doc to also add abstracts or citations from known medical practices in the 'standard medical community' to bolster a 1151 claim.

What I mean is showing the VA proof that non VA doctors (the standard medical community) would have taken different steps to diagnose and treat the veteran and the VA's “omission” of these proper medical steps caused the veteran's additional and documented disability.

Hope this all helps someone.

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"The SOC or SSOC could parse or manipulate critical statements in the actual C & P exam."

Yep....

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Berta, I have detected a pattern they are starting to use against IMO's. If you get an IMO the VA will likely defeat it by using the words Tele IMO.

It may be a good thought for the veteran to seek an IME instead because a vet should be examined by the doctor.

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There's no doubt in my mind that an IME should take place for an IMO.

pr

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Berta,

Great post.

I always suggest getting an IME that also contains an IMO when possible.

I say if you think you can't afford it - go collect aluminum cans for recycle money,

eat ramen noodles for months, stand on the corner with a need some help sign . . .

put together every penny you can and get the damned IME/IMO, and be sure it's done right the first time.

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You are all Correct on the IME.....I didnt even think about that when I wrote this.

Sometime ago Dr. Bash mentioned ,maybe on a SVR show, that he does IMEs whenever required.

For many claims he doesn't need to (and IMO docs cant do IMEs for DIC claims), but you all made a great point.

An IME can also determine the exact level of disability for rating purposes,that might be a far greater level than the VA could determine.

And a good IMO doctor can also raise secondaries ,due to the disability claimed, and give a full medical rationale for them as well and then the claimant should claim the secondary conditions too.

I need to find the cover letter I sent to Dr. Bash for my IMOs.That might help someone out there to use as a template.

Or maybe just make one up as a generic template.

Thank you all for adding the points about the IME.!!!! (Independent Medical Exam)

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