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]

[free_spirit_etc]

Josephine,

I can't find it at the moment - but you made a remark that the doctor said you DENIED being a cutter.

Sometimes with psych diagnosis that can be interpreted as "they are - but they deny it."

However, I am amazed in looking at my husband's medical records how often doctors report that such and such was denied - though the doctor never asked.

Patient denies headaches. Patient denies fatigue. Patient denies pain.

Denied??

The doctor didn't ask.

So "denies" can mean - the patient did not walk in here screaming in pain and insisting that I did something about it.

If the patient didn't mention it - or if the patient mentions it and the doctor doesn't listen -I think they write patient DENIES -so they have covered themselves where it looks like they assessed it.

I recently looked at my husband's hospital records from his alst illness.

He was FULL CODE. He insisted on remaining full code until almost the end (meaning they would so EVERYTHING to try to save his life).

Everyone kept trying to talk him out of being "code"

Everyone kept trying to tell him he was delaying the inevitable.

But still - he insisted on actively FIGHTING FOR HIS LIFE!!

The psych report states 'Patient denies any suicidal tendencis...."

Duh.....

Free

[Jay Johnson]

I think one of the problems that can occur in diagnosing psychiatric disorders is that they are much more subjective and easier for someone to see what they are looking for. The "evidence" is different. And the lines are more "fuzzy."

My husband had cancer. No one could see the cancer unless it was there. But with psychiatric you can have PTSD and the clinician can SEE personality disorder and give "solid" reasoning for it - if that is what they WANT to see.

Because a lot of the psychiatric disorders have the same types of manifestations -- so the objective evidence is the way it manifests. The subjective part is what they decide to attribute the manifestations to.

That can create a problem.

Actually, as with my husband - he claimed fatigue -- under the dessert storm. The doctor tested him and decided his fatigue was "caused" by his mild depression. My husband never complained of being depressed. He complained of being fatigued. He was never treated for depression. He was never refered to get checked for his depression by any of his treating physicians. His doctors repeatedly documented how he was always in "good spirits," "cheerful" etc.

But yet the VA examiner - when doing the workup for fatigue - took the fact that he checked a certain number of boxes on the dperession inventory and that meant he was depressed.

Guess what boxes he checked that "triggered" the depression diagnosis?

I don't have much energy.

I have trouble getting things done.

I don't feel like going out much.

ALL the "triggers" on the depression inventory where about how TIRED he was. But yet, he was given a "depression" diagnosis because the diagnosis was triggered by the number of boxes checked.

What kind of circular reasoning is that?

What is your problem?

I am tired.

Okay - take this test.

On the test - mark that you are tired.

Oh.. you aren't tired. You are depressed. Because you checked the boxes on this form that said you are tired. And this measures depression. Therefore if you are tired on THIS test - you are depressed - and your fatigue is CAUSED by depression.

I can't see how a valid diagnosis could be made that depression is CAUSING your fatigue without OTHER indicators of depression BESIDES fatigue.

I don't think this is just the VA. I think it happens all the time in psychological / psychiatric diagnosis. They can see what they are looking for - and confirm it with their testing.

And I don't think the VA doc was "out to get" my husband. I think he actually thought he had "accurately" diagnosed him.

We have asked the VA to go back and reconsider this diagnosis - as ONE part of my husband's claim -- to reconsider the evidence in the light of new knowledge for diseases diagnosed after the presumptive period - to see if they were earlier manifestations of the disease that "gain new understanding in light of the new evidence"

In other words - fatigue is one of the first SYMPTOMS of many types of cancer. My husband consistently reported he was fatigued. Though the VA gave him a diagnosis of "depression" as the "cause" of his fatigue - the ONLY symptoms that triggered the depression diagnosis were the symptoms of his FATIGUE (no other indicators were triggered)

So we have asked them to reconsider that it as likely as not that his reported fatigue could be just as easily attributed to the cancer that was subsequently found - as it could to "depression."

I am not expecting the RO to do much with the info. But we still included it.

However, I have seen quite a few BVA cases where they have made similar decisions in cancer cases -- where cancer was detected shortly after the presumptive period - and the evidence shows that due to growth rates of that kind of cancer - it was probably incurred while in the service.

But often, instead of stretching all the way back to prior to discharge - the BVA will take some of the symptomology that the vet reported during their presumptive period - and decide that it is as likely as not that the symptomology reported in that time frame could be related to the cancer - and grant SC on that.

Free

This is the major problem with psychology....it relies WAY too much on self reporting statements that can easily be taken out of context or the person giving the statements can simply be lying. Personally, I think self reporting statements are as accurate as a blind monkey trying to shoot a humming bird with a sling shot.

[Josephine]

Josephine,


I can't find it at the moment - but you made a remark that the doctor said you DENIED being a cutter.


Sometimes with psych diagnosis that can be interpreted as "they are - but they deny it."

As I told the BVA and the AMC the examination is such a Blur in my Mind, I can only remember bits of pieces of what did and what did not happen in that room.

It is a good thing that I saw where they were sitting the first 10 minutes of the examination, for after that it took me three days to remember their names.

Dr. B the male was sitting at a desk at the far left to me and Dr. L was sitting corner for corner facing me.

He did all the talking. She did absolutely none. I could never see the male Doctor as he spoke and yet I remember directing all of my answers to her.

I can hear them asking me questions in no more than 5 sentences long. " Tell me about the Pool"? "What about your dad"?, " Where is Doris?" " Show me how to kick a wall"?

The one thing that is so clear to me in my mind. I was sitting under a window with the venetian blinds closed and I can hear myself saying to them. " You may think that I don't know who you are but you are doctors for the Veterans Administration.

Where all this other stuff came from , I have no ideal. If I had a breakdown, which I might have, I would have told the truth.

Dr. L is calling me a liar thoughout this whole examinaiton with her quotes everywhere.

There is no way, that I would have a statement from the nurse on duty, that I couldn't remember most of my clinic appointment and that she called me the next day to see if I could remember any better, if something didn't happen in that room.

Regarding her history of treatment, she stated that she has a standing order for Valium at the pharmacy and now takes 5 mg every 4 hours as needed , and frequently talkes more than six a day. In one of her emails reports, she stated " I chew Valium pills like there will be no tomorrow." She denies taking any other psychiatric medications. When asked what happens when she runs out of Valium, she replied, " I don't run out".

Common sense would tell you that if the medication is prescribed for you and you have been taking it for 29 years, you know better than to let your RX. run out.

She did approach the VA in 1994 for sinusitis and received antibiotics, but allegedly was told that " they did not have facility for women", so she never returned.

That is exactly what the doctor at the VAMC told me.

She denied any self-inflicted injury and any history of earing disorder symptoms "according to her. "

The last three years have been particularly " terrible". This seems to be related to her pursuit of disabilityand various letters and phone calls that she had to make to plead her case. At one point, she wanted to " end it all" as " a way out" and considered an overdose of Valium. She still occasionally has thoughts of taking an overdose but would not do it because of her children and grandchildren. She reported crying spells, sleeping problems and decreased concentration. There is no family history of suicide or mental illness.

One medical record said that she was a gravida 3 Para 3, but the patient claimed only two children.

She took an overdose of Aspirin in 1965 when she was pregnant with her first child. She stated that her anger causes difficulty for her. such that she struck her oldest daughter when she was two weeks old after the infant soiled her blouse.

She frequently threw food in anger. She recounted a history of violence towards her husband but stated now she has a close relationship with her children.

She said that she never " wanted to talk about it", iin terms of discussing the Navy with her private physicians.

She still breaks dishes and throws objects, Crying and Screaming and also kicks holes in her walls of her house.

She has broken furniture in her fits of anger. She acknowledges that this is a long- standing pattern.

Mrs xxxxx symptoms are primary consistent with a personality disorder. Furthermore, it does not APPEAR that Mrs. XXX developed a chronic psychiatric disability while on active duty.

She was separated from the navy because of " unsuitability" related to her dissatisfaction with the service and several incidents , which she considered indicative of abuse.

Where did this crap come from?

The last sentence is the only truth that I see in the complete write up.

Who can say that she is not telling the truth but a doctor who has treated me every 4 months for the last 30 years? This would be for complete physicial the works!

My husband with a Notarized Letter and my two Daughters.

5 days later, I pick up a copy of this C&P - dated April 12, 2005.

I immediately contact the Patient Advocate and the Regional Office.

I ask to have this removed from my records. I ask for another C&P.

30 days later Dr. L goes into the C&P and places a PRIVACY ACT AMENDMENT NOTE -YOU MAY NOT VIEW THIS COMPLETED PRIVACY ACT NOTE. DATE MAY 16, 2005

SSOC- We know that you feel that this C&P was erroneous, but it was good enough for rating.

Now the BVA states the issue in question is " What was the reason for her early discharge?"

My answer is:

Abuse , Abuse Abuse and More Abuse.

Josephine

Edited July 28, 2007 by Josephine

[free_spirit_etc]

Soft tissue injuries used to be this way also, until they developed technology that was able to objectively detect them. People complained of back problems -- the x-rays were "fine" - so presto! No back problem! The person was "faking it." Or the doctor who believed the patient had no objective "proof."

Problems that medical science has no way to objectively detect are prone to these problems. However, I think for every person that WAS faking it - there were MANY more people that actually DID have the pain that was not accepted or acknowledged by the doctors.

I think the same is true for psychological problems. Some people fake it. But many more are not given appropriate diagnosis or treatment because they are not listened to - or the doctor fits the self reports into the picture he / she has already created of the person.

Or people don't respect psychological pain as REAL pain, though it is very real and can often be equally (if not more) devestating than physical pain.

I think self reports ARE valid and should be taken as such. How many times do you hear of someone who kept explaining their symptoms to a doctor - and the doctor finds nothing wrong - later the illness is detected --which validates the person's self report.

Unfortunately - with mental pain - the person often never does recieve the medical finding that verifies and validates the very real pain that they feel but no one can see.

Free

This is the major problem with psychology....it relies WAY too much on self reporting statements that can easily be taken out of context or the person giving the statements can simply be lying. Personally, I think self reporting statements are as accurate as a blind monkey trying to shoot a humming bird with a sling shot.

[free_spirit_etc]

Josephine,

The doctors report should differentiate between observable facts and reports from others. To state that was you say was your report - and to state other things as if they were a fact - could be called into question..unless they actualy saw you kick the wall, throw food, etc. then they should note who reported it rather than state it as a fact.

However, consider this as a fight against a spider. There are two kinds of webs in a spider web. The ones that go straight to the center are the non sticky webs - - The ones that go around are the sticky webs. THe spider runds up and down the straight webs --the non sticky ones. That is why the spider never gets caught in its own web. It knows which ones to stay on. But the spider counts on others getting off onto the side webs - the sticky ones - and getting caught.

Kind of how Hoppy talks about how they often don't give you the real resons on the SOC. They can pull you into the sticky webs getting you to argue about points that even if you prove your point have nothing to do with proving your case.

So the best thing to do is to pay attention to which webs are the nonsticky ones and which ones are the sticky ones.

Which ones are the side arguments that if you go over to the side you get caught in the sticky web.

Try to focus on the nonticky ones. The ones that go straight to the heart of the issue.

One thing to keep in mind is that their evaluation can actually help you - if you play your cards right.

Many vets have so much problem proving that they actually suffer from a psychological illness. That can be SO hard to prove if one doctor says you do suffer from one and one docotr says you don't.

However, even THEIR doctors say you have the psych problems -- and they even date it all the way back to the military.

The issue is that they are calling it something different.They are calling it a personality disorder instead of an aquired psychological illness.

So the record clearly shows there IS a problem. The record clearly shows that it dates back to your military service. You have got that one covered.

The issue is what to call it.

So getting opinions from doctors that focus on what to CALL it is the most important part of the battle.

You already have some reports from the VA from the other C&Ps that support your claim. The VA is considering the report that is against your claim as more probative.

But if you add more opinions that SUPPORT your claim, especially if someone will actually point out why the one agaisnt your claim is mistaken -- the weight will have to shift - unless they get more evals that are agaisnt your claim.

If all the reports support your claim but one - it gets harder and harder to deny your claim based on that one report.

They can keep your arguing forever about exactly what the doctor said in his report and why that was wrong -- but that just keeps you stuck in the sticky webs.

Get back on the nonsticky web. Ask - what do I need to prove my claim - and go after it. It is probably more opinions that support your claim - and if you can get one that where a doctor specifically addresses the unfavorable report - and shows how that is not a valid conclusion...it would be hard for them to keep denying you.

I am not saying that the doctor who wrote the unfavorable report was not wrong for what he did / said. I am saying that if they can keep you focused on that -- they can keep you caught in the sticky webs.

Free

Josephine,


I can't find it at the moment - but you made a remark that the doctor said you DENIED being a cutter.


Sometimes with psych diagnosis that can be interpreted as "they are - but they deny it."

As I told the BVA and the AMC the examination is such a Blur in my Mind, I can only remember bits of pieces of what did and what did not happen in that room.

It is a good thing that I saw where they were sitting the first 10 minutes of the examination, for after that it took me three days to remember their names.

Dr. B the male was sitting at a desk at the far left to me and Dr. L was sitting corner for corner facing me.

He did all the talking. She did absolutely none. I could never see the male Doctor as he spoke and yet I remember directing all of my answers to her.

I can hear them asking me questions in no more than 5 sentences long. " Tell me about the Pool"? "What about your dad"?, " Where is Doris?" " Show me how to kick a wall"?

The one thing that is so clear to me in my mind. I was sitting under a window with the venetian blinds closed and I can hear myself saying to them. " You may think that I don't know who you are but you are doctors for the Veterans Administration.

Where all this other stuff came from , I have no ideal. If I had a breakdown, which I might have, I would have told the truth.

Dr. L is calling me a liar thoughout this whole examinaiton with her quotes everywhere.

There is no way, that I would have a statement from the nurse on duty, that I couldn't remember most of my clinic appointment and that she called me the next day to see if I could remember any better, if something didn't happen in that room.

Regarding her history of treatment, she stated that she has a standing order for Valium at the pharmacy and now takes 5 mg every 4 hours as needed , and frequently talkes more than six a day. In one of her emails reports, she stated " I chew Valium pills like there will be no tomorrow." She denies taking any other psychiatric medications. When asked what happens when she runs out of Valium, she replied, " I don't run out".

Common sense would tell you that if the medication is prescribed for you and you have been taking it for 29 years, you know better than to let your RX. run out.

She did approach the VA in 1994 for sinusitis and received antibiotics, but allegedly was told that " they did not have facility for women", so she never returned.

That is exactly what the doctor at the VAMC told me.

She denied any self-inflicted injury and any history of earing disorder symptoms "according to her. "

The last three years have been particularly " terrible". This seems to be related to her pursuit of disabilityand various letters and phone calls that she had to make to plead her case. At one point, she wanted to " end it all" as " a way out" and considered an overdose of Valium. She still occasionally has thoughts of taking an overdose but would not do it because of her children and grandchildren. She reported crying spells, sleeping problems and decreased concentration. There is no family history of suicide or mental illness.

One medical record said that she was a gravida 3 Para 3, but the patient claimed only two children.

She took an overdose of Aspirin in 1965 when she was pregnant with her first child. She stated that her anger causes difficulty for her. such that she struck her oldest daughter when she was two weeks old after the infant soiled her blouse.

She frequently threw food in anger. She recounted a history of violence towards her husband but stated now she has a close relationship with her children.

She said that she never " wanted to talk about it", iin terms of discussing the Navy with her private physicians.

She still breaks dishes and throws objects, Crying and Screaming and also kicks holes in her walls of her house.

She has broken furniture in her fits of anger. She acknowledges that this is a long- standing pattern.

Mrs xxxxx symptoms are primary consistent with a personality disorder. Furthermore, it does not APPEAR that Mrs. XXX developed a chronic psychiatric disability while on active duty.

She was separated from the navy because of " unsuitability" related to her dissatisfaction with the service and several incidents , which she considered indicative of abuse.

Where did this crap come from?

The last sentence is the only truth that I see in the complete write up.

Who can say that she is not telling the truth but a doctor who has treated me every 4 months for the last 30 years? This would be for complete physicial the works!

My husband with a Notarized Letter and my two Daughters.

5 days later, I pick up a copy of this C&P - dated April 12, 2005.

I immediately contact the Patient Advocate and the Regional Office.

I ask to have this removed from my records. I ask for another C&P.

30 days later Dr. L goes into the C&P and places a PRIVACY ACT AMENDMENT NOTE -YOU MAY NOT VIEW THIS COMPLETED PRIVACY ACT NOTE. DATE MAY 16, 2005

SSOC- We know that you feel that this C&P was erroneous, but it was good enough for rating.

Now the BVA states the issue in question is " What was the reason for her early discharge?"

My answer is:

Abuse , Abuse Abuse and More Abuse.

Josephine

[Josephine]

I think self reports ARE valid and should be taken as such. How many times do you hear of someone who kept explaining their symptoms to a doctor - and the doctor finds nothing wrong - later the illness is detected --which validates the person's self report.

Free,

You are correct. Your husband only complainted of fatigue and we both know that is not always a sign of depression.

I would think that since his service medical records never mentioned placing your husband on antidepressants would say and go a long way in your husbands claim.

Had the doctor really thought his constant complaint of fatigue was depression, would this have not been the normal mode of treatment. Anti- depressants and see why he was so depressed and perhaps send him to a service psychiatrist or psychologist.

Just my thought,

Josephine