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]

[Guest jangrin]

Oh yea, I almost forgot:

In the State of California- a provider must be a QME (qualified medical examiner) to be eligible in workers compensation to render an opinion about and injured worker. So there is some special training and yearly certification for a medical professional to be able to even give and IME or IMO and have it be acceptable in a legal setting (at least in California).Which makes me assume that this owuld be true in most legal or official settings.

Many proffesional medical specialists are "court certified" as experts in certain fileds. I believe the regulation here is intended to cover the legal rights of both the claimant (veteran) and the VA in establishing medical opinion about a certain disease or illness. Thus they established regulation to resolve disputes by using IMO "experts" in a particular situation when it can't be resolved another way or the previous experts on record can not agree on a specific issue. This breaks the "tie".

JMO- Jangrin

[Josephine]

Jan,

I see my claim as a VAMC Phd Psychologist v two Board Certified Psychiatrist at the VAMC. I am told that the Psychologist counts as one and the Board as one.

I also see that the Psychologist went by the book with complete rationale for his decision.

You already know what I think of the other two.

If the Battery of Test are important to determine " Personality Disorder". Why hasn't or why didn't those two administer them to me?

I do not see why I should have to pay for them and then take a chance that they will not be acceptable.

I know what you are speaking of. The VA can send my entire claims file to someone at Duke University for their opinion of all.

Is this correct?

Thanks,

Josephine

[Pete53]

Regarding C&P's in Dallas Texas the VA hires Doc's who have retired and usually elderly to do many of the C&P's. By the way most of these Docs although MD's are not familiar with what the VA wants or needs. I also get the impression that they feel that they work for the VA more than they fell that they are Independent.

[Guest jangrin]

Jan,

I see my claim as a VAMC Phd Psychologist v two Board Certified Psychiatrist at the VAMC. I am told that the Psychologist counts as one and the Board as one.

I also see that the Psychologist went by the book with complete rationale for his decision.

You already know what I think of the other two.

If the Battery of Test are important to determine " Personality Disorder". Why hasn't or why didn't those two administer them to me?

I do not see why I should have to pay for them and then take a chance that they will not be acceptable.

I know what you are speaking of. The VA can send my entire claims file to someone at Duke University for their opinion of all.

Is this correct?

Thanks,

Josephine

Josephine,

I will say that in general a psychiatrist's opinion will usually carry more weight than the opinion of a psychologist. Primarily because a psychiatrist

MD has generally more education and is trained in the pharmacopoeia and can write prescriptions for medications. Also, I beleive I read in the CFR's that a panel of two doctors for a C+P exam were to be counted as one. However, if you were a Rater with the VA, would you give more credit to the lone psychologist PHD. or to the TWO psychiatrists MD's?

Also, a primary care physician is suppost to carry weight as they know the patient the best and have actually treated the patient...However, if the primary care provider is a GP or is providing care "outside" his specialty, he will most likely NOT be regarded as the Most knowlegable when they look at opinions and who has what credentials.

Thats why Dr. Bash is so well regarded. He has the credentials and is a board certified specialist in radiology. He really shines when your talking about conditions and illnesses that use radiological tests to establish the condition or incapacities.

It's the credentials of the person that give their opinion credence and preference. My general take is, veterans should seek out and find board certified physicians that will review the c-file and give an expert opinion for the veteran when there is a dispute over findings with the VA C+P exams.If at all possible they should also be physically examined by the doctor if it can be arranged not just a review of records. The examination will also give weight to the doctor's opinion.

Josephine, in your case I would be getting at least one maybe two expert opinions by psychiatrists MD's (maybe One of which is a FEMALE doctor) to counter the two VA doc's C+P that you are up against. Whether it is the principle involved or need for income (or both), usually the cost up front is worth the end result if a vet wins their claim.

Possibly an attorney could advise you as to your eventual success if they reviewed your case. They may be able to help you decide if it is "worth" the expense to pay for an opinion by a doctor you may hire on your behalf. This is something that you will need to evaluate as to cost effectiveness in relationship to winning your case. It never hurts to get as much information as possible to make the best decision for yourself. But, yes I also think you need another expert on your side to link the nexus and support the SC.

JMO- Jangrin

Edited July 22, 2007 by jangrin

[Jay Johnson]

Josephine,

"VA Regulation does not allow the R. O to state: We place out weight with a " Psychiatrist" as they are a " Psychiatrist". VA Regulations - C&P by a Psychologist, Nurse, etc are equal. Credentials do not come into play only the rationale of the decision. Am I not correct?"

Actually, no, that's not correct. The decision maker's job within the VA is to deteremine the weight to be afforded to certain evidence as it applies to disability compensation claims.

I have seen claims where the RVSR or DRO has gone against a C&P examiners opinion in which they stated some medical issue wasn't related to a veteran's service and placed more weight on an IMO provided by an outside doctor and subsequently award the claim based on that outside IMO.

Actually credentials by doctors play a large role in the weight that their IMO's/statments are afforded by the decision maker. Granted, the rational also plays a large role, but for example, if there are two doctors wrangling over how an MRI is read and one of those doctors is a radiologist and the other is say just a general practioner, then the VA will most certainly place more weight with that radiologist's opinion.

Vike 17

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).

[Josephine]

Jan,

I am sure that you are correct and yet there is the point of finding a doctor that will state not just my condition today.

I went for the one IME and gave the Psychiartrist all of my SMR"s. He stated that in his opinion, he could not say with any certainty whether my anxiety began in service. He agreed that Dr. P was treating me with the correct medication and dosage.

He did state that the fear of death in the swimming pool in the military could have been the beginning of PTSD.

Axis 1 was Generalized Anxiety

Axis II No Personality Disorder

Axis III

Axis 1V - The veteran is too familiar with names and places and I am certain that this is having an effect on her present conditon.

Axis V - Gaf - 65

This is where is get good. He refused to put into his write up that he had possession of my SMR's or any of my medical records.

I called him and we had a huge discussion on that one, but he would not change his write-up. I ask him to place Board Certified Psychiatrist after his name and not just M.D. He refused. He stated that he did his internship at the VA hospital and he knew exactly what I needed.

This one was no worth sending to anyone.

Always,

Josephine

Edited July 22, 2007 by Josephine