Imo Per Dept Of Va

[luvHIM]

After a response from Vike17 on another one of my threads, I decided to do a little research today. He made a statement about me perhaps needing to get an IMO or medical statement from a doctor. Well, it occurred to me that they were obviously two different things.

And, according to Department of Veteran Affairs, they are. In fact, a "legitimate" IMO is is obtained through a specified procedure. What has to be the case is that some VARO's are definitely by the book. What some of us have been describing as an IMO and having rejected may be subject to the aforemention. At any rate, the following is what I discovered today and thought I would share it with you guys here, especially those of you who have the experience of having your "IMO" rejected or ignored.

§ 3.328 lndependent medical opinions.

(a) General. When warranted by the medical complexity or controversy involved in a pending claim, an advisory medical opinion may be obtained from one or more medical experts who are not employees of VA. Opinions shall be obtained from recognized medical schools, universities, clinics or medical institutions with which arrangements for such opinions have been made, and an appropriate official of the institution shall select the individual expert(s) to render an opinion.

(;) Requests. A request for an independent medical opinion in conjunction with a claim pending at the regional office level may be initiated by the office having jurisdiction over the claim, by the claimant, or by his or her duly appointed representative. The request must be submitted in writing and must set forth in detail the reasons why the opinion is necessary. All such requests shall be submitted through the Veterans Service Center Manager of the office having jurisdiction over the claim, and those requests which in the judgment of the Veterans Service Center Manager merit consideration shall be referred to the Compensation and Pension Service for approval.

© Approval. Approval shall be granted only upon a determination by the Compensation and Pension Service that the issue under consideration poses a medical problem of such obscurity or complexity, or has generated such controversy in the medical community at large, as to justify solicitation of an independent medical opinion. When approval has been granted, the Compensation and Pension Service shall obtain the opinion. A determination that an independent medical opinion is not warranted may be contested only as part of an appeal on the merits of the decision rendered on the primary issue by the agency of original jurisdiction.

(d) Notification. The Compensation and Pension Service shall notify the claimant when the request for an independent medical opinion has been approved with regard to his or her claim and shall furnish the claimant with a copy of the opinion when it is received. If, in the judgment of the Secretary, disclosure of the independent medical opinion would be harmful to the physical or mental health of the claimant, disclosure shall be subject to the special procedures set forth in §1.577 of this chapter.

(Authority: 38 U.S.C. 5109, 5701(B)(1); 5 U.S.C. 552a(f)(3))

[55 FR 18602, May 3, 1990]

[Josephine]

Jay,

You are an extremely kind person. I do admire you for helping your wife so much.

If I could go back in time to 1978, when I filed my first claim for " Nervouness" with the Veterans Administration. This would have put me at age 34. I told the VA specifically to get those " Psychiatric Records from the Review Board thus allowing me my early discharge from service. I thought that they did, but they didn't.

I have no ideal, other than something that I read on the internet, for women that had filed an earlier claim to re-file, I never would have tried this.

It was in 2002, and I filed the claim again and was denied. I told them again about those records, and again, I thought that they had them. I was given the non- service connected pension 100% umemployable to 1983 due to " Anxiety with Depression".

I received this notice in 2003 and immediately had a fit for I had told the VA again to get those " Psychiatric Records leading to my early discharge.

The lady at the VA was kind enough to call me and to alert me of the non-service connection.

That is when I set down and hand wrote a letter to the St. Louis Archives and secured all the " Psychiatric Records myself.

I presented them first to the Rating Board, but was told that they needed to be in Appeals.

One of the Counselors filed out the NOD and here I stayed. I was within the time frame for the same claim.

June of 2004, I arrived in Appeals and was sent a Statement of the Case by the DRO, October 7, 2004.

I am sending you a preliminary to let you see that it appears that your claim for " Anxiety with Depression will be denied. THIS IS NOT THE DRO'S FINAL DECISION. I am sending you a form - 9 to return within 60 days. You will be going for a C&P for an " Acquired Psychiatric Disorder due to " New and Material Evidence.

The DRO had this " New and Material Evidence", when he denied my claim for " Anxiety with Depression".

C&P October 18, 2004. Generalized Anxiety with Depression

More likely than not due to two Psychiatric consulations before discharge that this veterans anxieity began in service.

5 months later, no word from the first C&P, I received a notice from the VAMC - Notice of your Clinic Appointment.

Bingo - C&P with the two Psychiatrist.

BVA remanded to AMC.

Now, you see, this thing has been going on for 5 years, and I am just so tired of it.

I contacted Dr. Bash and I contacted his associate. I wasn't too confident in Med-Opinions.

I have the letter from Dr. C dated May 10. 2004, from the doctor that treated me in service, only to clarify his meds of me in service, what they were for and what his role was in my early discharge.

He in no way wrote a letter to try to determine Nexus for me. He only wanted to clarify what he meant in the SMR's - Vascular v Tension Headaches. Cafergot ineffective. Librium T. I D.

No more than that. He added the Librium for Nervousness to the headache medication.

I will be most happy to pay anyone $ 100.00 by Paypal if they can find a Board Certified Psychiatrist to do an IMO for me.

I do mean this, as they will have to go back to 1964 and move forward. I have all of my medical records from 1964 to date.

Josephine

[Guest jangrin]

Vike is absolutely right here. In fact, SS won't even take the opinion of a psychologist unless a psychiatrist signs off on said opinion. The same goes for the military.....my wife had been seeing a AF psychologist (captain) for about a year before she initially broke down, but he was not allowed to do the eval for her medical boarding; instead, she had to be pawned off to an AF psychiatrist at a neighboring base that knew nothing of her case.

In terms of education, psychologists and psychiatrists are light years apart even though both may hold doctorates. This is why the average psychologist earns around 50K in the US and the average psychiatrist earns about 175K+. A PsyD is nothing more than a LOT of schooling based on outdated psychological data from 40+ years ago and a ton of writing/clinical observation of behavior. A psychiatrist, on the other hand, has a MD and knows EVERYTHING a psychologist knows plus has far more knowledge of the physiological effects of various psychological "issues" on the brain.

As far as most government agencies are concerned, a psychologist cannot even diagnose you, let alone write a formal eval...they simply are not qualified to do so. A psychologist is for therapy, not diagnosis. The only reason the VA gives them any weight is because they cannot afford to send every vet to a psychiatrist for a C&P (would cost 5x more), so they have cheated and used people unqualified to do C&Ps and, therefore, are forced to accept IMO from those under-qualified individuals.

A psychologist/NP/PA should be used only in conjunction with a qualified medical professional (IE - an MD).

I think this is somewhat incorrect. As less than one year ago the SSA sent my husband out to thier SSA exam mental health provider and it was a Psychologist. Not only was the report of findings accepted and used in the consideration/determination for SSDI but it was their choice for examinig physician. Maybe times are changing and they are starting to value the Psychologist opinion more than in the past. However, I still feel anyone who has been discredited by a C+p EXAM doctor has a battle on thier hands and needs to find a doc or two on their side to help balance the findings.

Jangrin

Jangrin

[john999]

Josephine

I know a doctor Gary Arthur and a Dr. Jill Karatinos who will do an IMO for you in Tampa Florida. It is not free but would probably cost around 300 bucks. You would need to call them and talk to the shrinks and set something up to see them. You would need to bring your records or send copies to review. You don't have to pay me any fee for this. Getting these docs to do IMO's for you is not that hard as long as you have the money. Where do you live that it is so hard? I don't say you will get the result you want but I believe they would examine you and write it up for a not so large fee.

John

[Jay Johnson]

I think this is somewhat incorrect. As less than one year ago the SSA sent my husband out to thier SSA exam mental health provider and it was a Psychologist. Not only was the report of findings accepted and used in the consideration/determination for SSDI but it was their choice for examinig physician. Maybe times are changing and they are starting to value the Psychologist opinion more than in the past. However, I still feel anyone who has been discredited by a C+p EXAM doctor has a battle on thier hands and needs to find a doc or two on their side to help balance the findings.

Jangrin

Jangrin

Many psychologists/NPs/PAs work under the direct supervision of an MD (be it general practice MD or a psychiatrist). SS did accept my wife's NP's eval for SSD, but the NP had to have her residing psychiatrist sign off on the eval in order for SS to accept it. This was about 5 years ago and it was for her initial award (not a continuance), so maybe things have changed or you are refering to maintaining SS rather than being awarded SS. I know my wife's last eval for SSD consisted of a self-reporting statement saying she hasn't improved....nothing more.

[Jay Johnson]

Josephine,

Thanks for the kind words:-) Where do you live by the way? The best way to find a good psychiatrist is to use your yellow pages and start making some phone calls....be sure to say you are a cash customer and that you are shopping around for a med doctor and an eval. I know some areas have far more psychs than others (rural areas are extremely limited), so you may have to drive a bit to a major city to find a good one. Perhaps you should write something up (formally) and send it to the prospective psychiatrist so the psych knows what you're looking for, so you don't have to waste time/money on one who will not be favorable to your case.

As far as getting them to review your records for a nexus: Time = money, so understand that every hour they spend on reviewing your records and writing an opinion = an hour's worth of billing you must pay them. Considering most psychiatrists charge upwards of $200/hr+, it will likely cost you somewhere in the neighborhood of $400 - $1000 or more. If they know you are willing to pay them for their time, they will pretty much review anything you want.....it's easier on them to review paperwork then to schedule appointments, because they can do the review on their spare time and still charge you the full rate.

However, you need to keep things short and sweet or they can get lost in the paperwork and not be concise enough for the VA to sound educated on the matter. So, hammer home the nexus issue with documentation showing your anxiety while in service and leave out all of the VA mumbo-jumbo. On top of that, get a good eval that strongly discredits the personality disorder thing and that shows your disability in a manner that you feel is correct.

You may even need to do this with more than one doctor to get a favorable decision, but I think the key is to establish an ongoing relationship with a civilian doctor in order to build a strong case down the road. If you just get some IMOs without any long term care the VA will likely discredit it as "buying an opinion".

[Guest jangrin]

Many psychologists/NPs/PAs work under the direct supervision of an MD (be it general practice MD or a psychiatrist). SS did accept my wife's NP's eval for SSD, but the NP had to have her residing psychiatrist sign off on the eval in order for SS to accept it. This was about 5 years ago and it was for her initial award (not a continuance), so maybe things have changed or you are refering to maintaining SS rather than being awarded SS. I know my wife's last eval for SSD consisted of a self-reporting statement saying she hasn't improved....nothing more.

This is my take on this topic.

The difference between NP, PA's , and psychologist are....Nurses have to work under an MD's supervision and they are not doctors. They may work in clinics by themselves but they have protocols that are written by the advising MD and they still have some restrictions that they must have supervised. Physician assistants are under the same type regulations, they are not licensed as doctors and as such they are not able to work without MD protocols and MD review of activities.

Psychologists, are doctors. They are not required to work under the license of an MD. They have thier own licensing authority and it is not the AMA. They are considered a specialist the same as a pediatrist, opthomologist, chiropractor. They are expected to diagnosed and treat patients within thier expertise, but certainly not under the license of an MD. If they choose they can work in conjunction with an MD to aid their patient's in recieving meds, etc.that a psychologist cannot dispense. They can work in clinics with MD's but they still have their own doctorate, PHD.

Jangrin