Berta

I sure hope you mean- evidence--- when you say Ammo----- As I recall this was a PTSD claim (USN?)denied due to lack of verified stressors.Please correct me if I am wrong- Also I think you sent them a buddy statement-which they should have considered but might not have given it any weight. If you give us more info perhaps we can help find corroboration of the stressor. Most ships and military units have web sites and there might be something you overlooked- was this an incident that would have been in the Navy Times, or in the ships logs? Some ship's historys are on line too. If this involved the death of a sailor, it should have a way to confirm that- Was the buddy statement an eye witness acoount and did the buddy tell the VA what put him in same place as you at same time to witness the stressor? Such as same MOS etc. Would your CO or Ship's Captain have recollection of this and provide a statement? Did you send letters home about this event and would a family member or friend back home be able to send additional buddy statement to support it? Do your personnel records have any nexus statements as to the stressor? Or as to a change in your performance due to the stressor? You never told us much about the stressor-maybe we could help more if we knew what it was- The only real "ammo" with the VA is clear and convincing evidence. Do you have a service org representing you -and what do they suggest?

Regarding the NOD: I would send them along with it, "My records don't show a diagnosis of otitis media" - I'm filing for otitis externa, plenty of diagnosis and records on that!" In this claim it states: "The maximum disability rating under the Schedule for disease of the auditory canal or otitis externa is 10 percent" How did they state the denial of it as secondary? This part of this BVA decision is odd---the rating criteria was changed in 1992- "The rating criteria of both the original and revised versions of Diagnostic Code 6210 are the same. The only change in the revised criteria is re-designation of the disability as chronic otitis externa. Accordingly, there is no prejudice to the veteran in the Board considering both the original and revised rating criteria in the first instance, since they are the same and neither is more advantageous to the veteran in assessing his claim. See Bernard v. Brown, 4 Vet.App. 384 (1993)." Are they saying that it does not matter whether this is media or externa? http://www.va.gov/vetapp01/files01/0102254.txt (re-read your post -not time to send those records with the NOD-I guess-)

Interesting scenario- I think the CUE outcome would depend on the date of the claim being cued.The limiting date of Bell is July 21, 1992. Because-in Bell V Derwinski- the Constructive Notice Rule comes into play- http://72.14.205.104/search?q=cache:NIzab3...=2&ie=UTF-8 OG Pres Op # 12-95 "2. In Bell, the Court of Veterans Appeals held that medical records concerning a claimant which are in VA’s possession at the time VA adjudicators render a decision on a claim will be considered to be evidence which was in the record before the adjudicators at the time of the decision, regardless of whether such records were actually before the adjudicators at the time of the decision. The court’s decision was based on the principle that VA adjudicators are deemed to have constructive notice of all medical records in VA’s possession, whether or not they have actual notice of such records. The decision in Bell was made in the context of a determination as to whether records which were in VA’s possession, but were not actually in the record before the AOJ or Board, could be considered part of the record on appeal to the Court of Veterans Appeals for purposes of 38 U.S.C. § 7252(B), which limits the court’s review to “the record of proceedings before the Secretary and the Board.” 3. In Damrel v. Brown, 6 Vet. App. 242 (1992), the court indicated that the constructive-notice rule of Bell may also be applicable in determining the content of the record before an AOJ in a prior final adjudication for purposes of clear-and-unmistakable-error determinations under 38 C.F.R. § 3.105(a). The claimant in Damrel had been evaluated by VA as totally disabled for insurance purposes since 1966, but evidence of that evaluation apparently was not considered by the AOJ in 1967 in evaluating his claim of total disability for compensation purposes. The claimant asserted that the AOJ committed clear and unmistakable error in 1967 by failing to award a total disability rating based upon the evidence of his VA evaluation for insurance purposes. The Court stated that, under the constructive-notice rule in Bell, the AOJ would ordinarily be deemed to have constructive knowledge of the VA insurance records. However, the court held that the con- structive-notice rule was first announced in Bell and was not applicable to decisions rendered prior to the issuance of the Bell opinion. Accordingly, the court held that the AOJ’s failure in 1967 to consider evidence of the claimant’s evaluation for VA insurance purposes could not constitute clear and unmistakable error, because such evidence was not actually before the AOJ in 1967 and could not be deemed to have been before the AOJ under the constructive-notice rule in Bell. "

I think the initial disability Application has an oath on it like this. Or maybe the TDIU form? I always throw in this oath- on some of the evidence-I have sent . I did for my Sec 1151 DIC and FTCA claim and also in support of my present claim when I relayed to the VA what two VA doctors had told me. I also added that I undertand I could be found guilty of perjury if I knowingly make a false statement. I only do this when there were situations that I had to state what a VA doctor said to me regarding something or other about Rod's care. I dont know where I got that idea - but then again-I also asked the VA to use their subpeona power's and ask the doctors to testify to it -if they did not believe me. The medical evidence actually bears out whatever I said anyhow. I have seen only 2 or 3 cases at BVA over the years where a veteran was found to have actually lied on their disability claims. The Office of Inspector General has some cases too though. I cannot imagine this happens much.

Thank you both--- With the loss of the post service private medical records this claim seemed so hard to resolve but the widow found a lot in the veteran's Tricare medical records.Death due to heart disease and heart disease treated in the veteran's Tricare records-within months of discharge. Unfortunately there seemed to be no accrued benefits- but she would be eligible for REPS too if they award SC death. REPS is a Social Security program that restores 2 years of entitlement thus- If a child of a deceased veteran gets SSA death benefits until 18, the spouse also gets an SSA benefit ,based on the decedent's SSA ,until the child is 16. If REPs is awarded upon VA award for direct service connected death, this restores two years of the spouse's SSA benefit. The Omnibus Reconciliation Act took away these two years of SSA death benefits for spouses with children under 18, about 20 years ago. The VA-to their credit - will restore this benefit via REPS for eligible spouses of veterans deceased due to their service.

Ricky- he sure sounds like a great doctor- with a very good take on what the VA needs- and he is -like you are- anticipating the land mines. I have 3 IMos -2 from Dr. Bash and a freeby brief one from a former VA doctor- I also found a pathologist last week-who will prepare an additional one too if I need it- What I have is excellent already but if I need another way of looking at the evidence- this pathologist has different evidence to focus on, unlike what the other IMOs consider. Then again I don't know how they can go against what I have- but I don't trust them to consider it all properly.Since submitting the initial IMOs in Nov 2004 (2 years ago)no SOC from the VA ever mentioned them at all or ay additional medical evidence I sent-from the med recs-even after a DRO-POA conference to bring them up- I think when I filed a FTCA claim in Sept. for destruction of them,(they must be gone if they were not considered) it helped trigger the VA to read them. I "talked" to Dr. Bash the other day by email- he thinks I should send these IMOs to my Congressman and Senator- but yet I am waiting to see if they are actually considered this time.His concern is that in Feb it will be four years without resolve of this claim.The claims have had continuous movement since their return from the BVA so I can only wait and see.

I saw here today a topic regarding a disability noted within one year after service- It is my understanding that only Presumptive chronic conditions as within 38 CFR 3.307,3.309, which-by medical evidence-became manifested to at least 10% within that year after service- are service connectable as presumptive. All other conditions not on the presumptive list would still need service linkage. That is my take on the presumptive regs- any thoughts? (this is not regarding POW regs or AO regs) I have a claim from one of my vet orgs that is dependent on fitting into the presumptive regs for heart disease- It is a DIC claim and many post service private medical records were lost in a fire at the private hospital where the veteran was treated. Yesterday I was informed by our vet org President (VCV,ltd) that the widow has found additional medical records which would appear to show the veteran definitely had heart disease within 2 months after discharge-they are being mailed to me--- cardiovascular disease is presumptive in the above regs- but the problem might be the 10% medical criteria for presumption. Am I interpreting these presumptive regs wrong? This is a good read on these regs: http://www.va.gov/vetapp02/files02/0207112.txt The veteran exhibited poliomyletis within months after service. poliomyletis is not on the presumptive list. The BVA said:"The veteran was hospitalized by VA in September 1953, and he gave a history of onset of fever and aching on the third Sunday in June 1953. Acute anterior poliomyelitis with onset in June 1953 was diagnosed. This is more than 35 days after the veteran's discharge from service, and it is therefore probable that, if the disease the veteran had in June 1953 was polio, it was incurred after service. Id. Two IMos were not found as probative: "The statements from Drs. Lester and Granberry have no probative value, even if the diagnosis of polio were certain, because they do not ascribe a time to the onset of the disease." BUT: The January 2002 VA expert medical opinion affords an alternative theory of the cause and time of onset of the veteran's left upper arm atrophy. The VA expert concluded that the veteran contracted the infection in service that was diagnosed as left palmar space infection in April 1953. He concluded that the veteran's left upper arm atrophy is neuralgic amyotrophy directly resulting from the infection contracted in service that presented in April 1953. These conclusions provide the elements of proof required to grant service connection atrophy of the left upper arm due to neuralgic amyotrophy diagnosed after service as determined by all of the evidence of record, including that pertinent to service. 38 C.F.R. § 3.303(d). ORDER Service connection for atrophy of the left upper arm due to neuralgic amyotrophy (claimed as a residual of poliomyelitis) is granted." ANother point in this claim is that the two IMO docs failed to opine on the time of onset and this rendered their opinion moot. As 1968 Army stated-a few days ago- even though the nexus of your disability might need proof as it stands- still the IMO doctor must state a nexus and service etiology. Had these IMos docs specifically refrred to the SMRs- which the VA doctor did- the nexus factor in them could have awarded this claim faster.

While I was researching for a local vet I found this article from The Journal of Clinical Diabetes regarding diabetes and it's potential links to GERD and many other gastrointestinal disorders. Might help someone here with a claim: http://journal.diabetes.org/clinicaldiabet...42000/pg148.htm

Jim-just my opinion but I feel you should expand on the assault by the doctor. Tell them exactly what happened and why it was an assault. I think this would be the most important issue to the IG-and anything you have to shows you talked to the VAMC administrative officer about this doctor. Is your Congressman formally looking into this too?

An MRI with contrast would tell them more- I feel you should not worry about this yet as you dont have enough info-----it might be more common then it sounds---- But I am surprised that the Doctor said this was from depression- and not an organic cause---do you have depression as caused by your PTSD?

Kenny-I know how you feel -my claim was with appeals team and went back into rating board Friday- it has been there many times already---I wish there was a good answer to your question-how long------ it is so hard to know what they are doing with claims sometimes- Do you feel that you have enough medical evidence to succeed? It is agonizing and a national disgrace that disabled vets have to wait like this. You have plenty of company -veteran- most of us are waiting and waiting---- Regarding the Remand- do you feel that whatever the BVA asked for -is in your c file?

John- this WONDERFUL and of course we are all anxious that you will pursue for the TDIU-and I hope the retro is correct- BUT enjoy and relax for now--------- Whew-------another success story- to a vet who helps many many vets here!!!!! John-your advise and input is always something I look forward to. And this is sure an inspiration to all others who are waiting for a proper award.

WOW!!! another great find from you Carlie- GREAT WORK! I see the decision was in 1995,haven't read it all but somehow he subverted the Constructive Notice Rule in Bell V Derwinski on claims prior to July 1992. CUEs are not impossible to succeed in- but still ---difficult to win.

There are quite a few arthritis claims at the BVA web site. Either the veteran claimed it as secondary to another SC condition,with medical evidence of the link- or the veteran's SMRs revealed it in service. My neighbor has just been told by a VA doc that his arthritis , in back , hips and knee is more than likely due to a severe back injury well documented in his SMRs. This was supported by recent MRI results.

He should sue them! I wonder just how often this type of medical error occurs.

http://webisys.vetapp.gov/isysquery/irla5f7/11/doc "III. Conclusion The Board's conclusion that the veteran is not entitled to an effective date prior to November 9, 1984, is a clearly erroneous finding of fact which must be set aside. 38 U.S.C. ù 7261(a)(4) (formerly ù 4061 ). In addition, the Board's unsubstantiated opinion regarding the level of the veteran's back pain must be set aside, pursuant to 38 U.S.C. ù 7261( a)(3)(A). An effective date of not later than October 25, 1984, must be assigned in accordance with the facts of record. Because the Court has found that the Board's analysis of the veteran's symptoms arising prior to October 25, 1984, does not contain an adequate statement of reasons or bases and is deficient in its failure to consider or discuss the impact of the veteran's pain on the severity of his low back disability prior to 1984, the Court is presented with an inadequate record to review in connection with the question of the appropriate effective date for the increase. Consequently, the Board's decision is reversed, and the matter is remanded to the Board for prompt readjudication of the effective-date question, in accordance with this opinion, including a critical examination of all of the evidence of record and a full written justification. See Fletcher v. Derwinski, 1 Vet.App. 394, 397 (1991). On remand, the appellant will be free to submit additional evidence and argument on the question at issue, and the Board will "seek any other evidence it feels is necessary" to the timely resolution of this claim. Ibid. When all of this evidence has been assembled, the Board must assess whether the veteran is entitled to the benefit of the doubt with regard to an effective date in February 1984, or earlier, for his increased disability rating. See 38 U.S.C. ù 5107(B); Gilbert, 1 Vet.App. at 55. Accordingly, the motion by the Secretary of Veterans Affairs for summary affirmance is denied. A final decision by the Board following the remand herein ordered will constitute a new decision which may be appealed to this Court only upon the filing of a new Notice of Appeal with the Court not later than 120 days after the date on which notice of the new BVA decision is mailed to the appellant." REVERSED AND REMANDED. -------------------------------------------------------------------------------- Copyright © 2001 Odyssey Development. All rights reserved. Home.

An interesting claim-he proved Benefit of Doubt.(Relative Equipoise) The VA should always consider Benefit of Doubt when the evidence is equally for and against the claim. I don't trust them to weigh evidence properly.I feel the positive evidence needs to outweigh the negative. I am surprised that this vet succeeded.He did have documented symptoms of anxiety while in service so this was the nexus.

"They should be requested to review the record and reconcile their opinion as to etiology" This is what a clear nexus would provide.An etiology that could not be qquestioned. What I think is one doc is saying- this disability is due to your service- the other one is saying it is not. Etiology: cause or origin- Proof of a strong nexus is an etiology that could resolve all of this- Has the VA fully considered any proof you have offered of the causal event or circumstances that would lend one to have anxiety disorder? I felt the BVA was looking for more information on the servicewoman who drowned.They did not mention anything else as I recall as a significant stressor. This is certainly what would be for most people a stressor, an event unexpected and unusual enough to cause anxiety and stress. EVen if the doctor's can reconcile their diagnosis and even agree on an anxiety disorder, the VA still needs proof of the actual stressor-the event that caused the anxiety disorder. The BVA saw that this could be a proven stressor as the death of any service person -while in service- could be proven.I think this is why they mention this event in the remand. Maybe I am looking at this wrong but I have had many PTSD vets who had to do considerable work to prove their stressor. Even those in combat did not necessarily have the evidence on their DD 214 to fulfill the stressor requirement. I helped some vets do tracings from the travelling wall to support deaths of their buddies in Vietnam. Not only did they need some background info to find the names on the Wall but then they also had to make sure VA knew they served with this buddy in the same unit in an operation at same time of the buddy's death.Not all operations are combat. One vet's buddy died due to friendly fire explosion.A land mine he was stringing suddenly blew up.The vet had to prove he was in same unit- had the same MOS and had 2 other witness statements that this buddy death had occured.He used an obit from the hometown newspaper too. I feel that regardless of the military circumstances -the stressor in your case might still need more proof. PTSD is an anxiety disorder and in this way your claim would involve the same inservice linkage as a PTSD claim would. Surely your private doctor might have documented this drowning event.

I found one of the few PTSD to heart disease claims at the BVA that was awarded. http://www.va.gov/vetapp98/files2/9813272.txt "Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence supports the grant of service connection for cardiovascular disability secondary to service-connected PTSD." also "when aggravation of a veteran's nonservice- connected condition is proximately due to or the result of a service-connected disability, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation" The veteran claimed heart disease as secondary to his PTSD-a widow would have to do the same thing- this veteran had considerable medical evidence, three independent opinions, -to include some VA medical support-whch proved that his PTSD contributed to/aggravated his heart disease. It seems that he got these opinions from doctors at the hospital that performed heart surgery, which was independent from the VA.

I agree with the suggestion that others have made-to get an independent medical opinion from a psychiatrist who can definitively state your present disability and it's nexus to your service. A good psychiatrist, with the use of many psychiatric tests, can provide a medical rationale and test results that could overcome this whole rigamorale- it seems the VA never did any tests at all-it would certainly provide more medical evidence in your behalf. These psychological tests are very accurate as I understand, in determining proper diagnosis. Once he/she -the IMO doctor -rules out PD, and diagnoses anxiety/depression-the only thing left is proof of the nexus-the link of the diagnosis to proven events during your service that would warrant a service connected rating. I dont understand how they awarded a pension based on anxiety yet now say you have PD.

I understand now-- another thing too is- if you have already been sent to the BVA and send them (the BVA)new evidence- such as an IMO from Dr. Bash -they will remand. He put a handwritten note on his last IMO to me in August-that I should contact my Congessman about the way my claim was being handled but I already had contacted a Senator-and the IG- he did not take it lightly that his first opinion was completely ignored and that my POA's email to me seemed to support that they didnt care that it had been ignored.

Via VA Watchdog --the latest NVLSP statement: http://vawatchdog.org/nfNOV06/nf110506-4.htm

I agree that DRO review would be the best bet-however- I found your original post. It is most unusual for a coroner to put PTSD on a death certificate. I have never seen this done. Even with this listed on the death certificate you have-the VA will want clear cut medical evidence to link your husband's PTSD to his fatal heart disease. BVA cases have succeeded with PTSD contributing to death but they required strong medical opinions with a full rationale. Also -for accrued benefits- the claim must be filed within one year of death-and the veteran had to have or be eligible for higher rating in their lifetime- by medical evidence. What I mean is I re-opened my deceased husband's claim for higher rating after he died.He was 30% SC PTSD at death. I had medical evidence that warranted a higher rating for him in his lifetime. Based on the medical evidence they awarded posthumous 100% PTSD. You need not only medical proof of the higher rating for accrued benefits (assuming you re-opened a claim he had pending) and also definitive medical opinions that his PTSD contributed to his death. We have had recent discuss here under IMO topics and this will show you what we mean. At the BVA web site there are claims that awarded DIC based on PTSD contributing to the veteran's death due to heart disease. They were supported with independent medical opinions that stated the linkage with a full medical rationale. Do you have all of his medical records? And all old VA decision documents -SOC etc.Did any doctor anywhere in them state a possible linkage? Reason I ask- in an old SOC I have one of Rod's doctors stated that his SC PTSD had aggravated and excerbated his cerebral vascular disease.(from peripheral arterial disease and contributing to his death)Another VA doc in an old SOC also supported that the veteran's catastrophic PTSD had definitely affected his physical health. I forget how he put that.It was a linkage.The VA,itself , is re-opening this as a claim for direct SC death. Yet they also are working on an Agent Orange claim I have there too which is supported by much more medical evidence and 3 IMOs. You will have to consider getting a good independent medical opinion.(IMO) Did he have any private cardiologist that might give you one for little or no cost? Unfortunately these IMos can often be costly. They are also the only way- in many cases- to get a proper award for SC or DIC. In the IMO topic there is more information on IMOs. I get DIC under Sec 1151.I proved the VA caused Rod's death. I never even considered getting an IMO and should have.It took me many months of studying cardiology and brain disease to succeed. It was a long battle. But the evidence of my charges was in the med recs.Yet that was not easy to find. But it was unmistakable malpractice for 6 years. After that experience I have 3 IMOs for my present claim and have contacted someone who can prepare another if needed. This is expensive but the only way I have to get VA to admit to another misdiagnosed condition-a service connected condition which directly caused the veteran's death. The VA in the 1151 claim- stated many times that I was not competent enough to render a medical opinion. But my opinion succeeded and was concurred with by VA Med Team in DC. They stated this again when I filed my present AO claim.I pointed out my competency by sending them the VACO report and my charges. They never read that. I also pointed out that since the VA could not provide competency to properly diagnose the veteran's heart disease and numerous strokes, as well as administering improper meds- it was therefore "more than likely" that they did not properly diagnose and treat his diabetes. They ignored that too. They also ignored my initial IMos. Since then they have been working on my claim with ALL of the evidence.Long story as to getting to that point- They (VA) will be quick to tell a widow that the widow lacks the competency to render a medical opinion on their husband's death. Only a good independent medical opinion from someone with a full medical rationale can help a claim like this to succeed. You might need to send a cardiologist all psychological treatment records as well as all other medical records. You might need a psychiatrict statement too but this would also support the accrued PTSD rating claim. Was the veteran autopsied? That too might be critical to your claim. It was to my DIC claim. When you find an IMO doctor I strongly suggest that you ask the doctor to consider if the veteran's PTSD meds or any other facet of his VA medical care could have possibly contributed to his heart disease. If they make a finding that this is quite possible , you can file a Sec 1151 claim and -if the opinion is strong enough-they could award DIC under Section 1151. My last DIC claim took over 3 years -this present one- 4 years in January- I am not saying your claim will take that long- but only strong medical evidence will award you DIC.

"The Va knew that your husband was a diabetic, they just ignored it. Did you or your husband ever suspect the diabetes?" Only when a VA doc told him he believed diabetes was the cause of all of his problems.(1992) He ordered a fingerstick test but it was never done.The glucose readings were high fasting readings.Rod was transferred back home days later and nothing on his discharge cert indicated a further need for the fingerstick test and minimal meds were prescribed.After he had been misdiagnosed for 3 weeks with a major stroke in the local VAMC, we didnt even think about the fingerstick test anymore. I tracked this former VA doctor to Calif and he provided me with a brief opinion that Rod's glucose readings were definitely too high when he treated him. The VA admitted to causing Rod's death due to malpractice 9 years ago. But they only used the charges I made when I sued them-heart disease misdiagnosed,, strokes misdiagnosed and inappropriate meds.They agreed to that but did state that multiple errors of malpractice had occurred. I did not know he had diabetes until 2003, when my daughter-home on leave from the mil heard me talking to an AO vet with diabetes and she insisted I file the Agent Orange claim. She pointed out Dad's symptoms and I had no idea there was any link to his heart disease and strokes. There is no diabetes in our families. I started to read all I could on DMII and immediately filed the claim. I then went through the medical records very carefully and sure enough I found the evidence of diabetes, untreated-just like his other misdiagnosed problems. The VACO said his medical care had been indefensible. I won the settlement by my own medical opinions supported by evidence from the med recs.It was not easy.And this took three years. In this case-the 2003 claim , the RO ignored all of my medical evidence,to include 2 IMos and sent the claim to the BVA. I got it remanded very fast and supplied them with an additional IMO. I told regional counsel two weeks ago that I will play their game until they tire of it. I will get another IMO if I have to.He agreed that he was aware of what they put me through in the past and knew why I had filed an additional FTCA claim against them.One more way to get them to read my IMOs.I also told him I now can pinpoint the day they decided to cover up Rod's heart disease. It is right there in the med recs.He was not the attorney that handled my FTCA but he knew of it and I think he is the one who cued them on something 2 years ago-regarding a old CUE I did not pursue but which the RO granted with orders from Regional counsel. The RO re-opened a different SC death claim in my behalf this past August.(After they heard from a Senator) That was real nice of them-covering their rear ends like that- I will take it if they award on this one but NOD it because it is not based on Agent Orange or diabetes. They know there would be a big difference in the retro if they award the claim they are re-opening. Josephine-things have changed since the days I won FTCA and Section 1151 death award without an IMO and without a lawyer. ROs are not reading the evidence like they used to. Sos are not familiar enough with the claims they are getting. The violations of the VCAA make things even worse. I never got a proper VCAA notice but I did find a case in 2006 where the widow didnt get one either and the BVA remanded it and said the RO had to suggest that she get an IMO. I will use that case if needed-if they continue to ignore my IMOs-I have the BVA's words that say they should have told me to get one. When I was with the Prodigy Veterans BBS and also Vet link-1980s-we never talked about getting IM0s to support claims. These days they can be critical to a claim and as 1968 said, they have to be worded properly for the VA to fully consider them.

Kkp -the BVA makes much better decisions then the RO- I am not sure what Dr. Bash means by what you said-but if you sent the RO good medical evidence and you can establish the nexus- maybe you should wait and see what they (the RO) does next-did they send you a formal I-9 form? The CAVC backlog reduction could begin to even affect the BVA backlog -maybe- this would be great- Some of the cases I have read at the CAVC this year did not seem to have much merit. It is hard to get awards out of the CAVC but it does happen. I just read a recent 2006 CAVC decision. The veteran had an IMO and argued that the VA gave more weight to their medical examiner. However CAVC stated that the private physician failed in any way to support the nexus factor-with medical rationale. This bears out the excellent post by 1968 Army here today on IMOs. "The Board provided an adequate statement of its reasons or bases for its reliance on the May 2004 VA examination in lieu of Dr. Emerson's opinion. Specifically, the Board found that Dr. Emerson's opinion was "an insufficient medical nexus opinion" because (1) he "provided no rationale to support his opinion that the veteran's current heart disorder [was] related to [the veteran's] service- connected psychoneurosis. He simply states that the two are related without providing any explanation of the medical principles or rationale supporting his conclusion;" and (2) "there is no indication that Dr. [Emerson] actually reviewed the veteran's claims file, including the service medical records." R. at 10. In contrast, the Board placed greater probative value on the VA examination ." The veteran was Pro se at the Court (not a good idea) and in all this time the veteran did not attempt to get a better opinion with a good rationale from the private IMO as to the actual nexus he needed.Of course he lost at the court.