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]

[Jay Johnson]

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 did state that the fear of death in the swimming pool 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.

This one was no worth sending to anyone.

Always,

Josephine

Be more up front with your psychiatrists. Tell them what you expect of them in their eval and how to format it. Don't make it sound as if you're paying for a favorable diagnosis either, because that's not what you're seeking; rather, you should tell him/her to be honest in their assessment, but to include items XYZ in their eval and use verbage like "more likely than not". It is best to write up a formal paper on what you're looking for and to include a sample eval that the VA would find acceptable, because you'll never get all your points across in a single eval, nor will the MD remember the finer points of the conversation (time = money).

So, shop around for a good psychiatrist (one psych can vary greatly from another...this field is far from an exact science; in my opinion, it's closer to voodoo medicine) and be prepared with what you're looking for out of them. Also, pay in cash because psychs LOVE cash customers......use insurance and you'll find they're booked for 2 months; say you're paying in cash and you'll be seen this tuesday:-)

[luvHIM]

Getting a doctor's medical opinion, VA or otherwise, is not my problem.

In fact, I went to my files and pulled all of the "Duty to Assist Letters" received by the PHX VARO. None of them were in accordance with the Court of Appeals case Dingess/Hartman v Nicholson March 2006. In fact, ironically, this particular case was RAMANDED back to the RO in Phx, who is also adjudicating my claim. Phoenix RO is notorious for denying veteran claims and having them remanded.

My point: Hoppy and Vike is that I have a copy of every single shred of paper sent and or received by the VA. My SOC states the evidence I provided that they claimed to have used in making their decision included the medical statements provided by my VA physicians (primary, ortho, rheumatologist and physicist, as well as the rating examiner); medical statement provided by private rheumatologist Dr. I, and of course, my SMR's.

Every one of the "Duty to Assist letters" state they are working on my claim for increase of service connected back injury. At no point in time, even on my HINQ report, does it state that they are working on my claim for increase of lumbosacral strain. My SMR's (througout) state chronic low back pain.

My claim was adjudicated using the residual criteria for Ankylosing Spondylitis but the decision letter stated I was denied because there was no relation between AS and lumbosacral strain. Where the heck did the lumbosacral strain come from, especially if they in fact weighed the statements from the doctors listed above?

I have copies of all of the statements provided and the rating examinations. NO WHERE does anyone say anything about lumbosacral strain.

So, I went to the regulation to look at what an IMO is, per VA. I know that some have had their claims adjudicated on the basis of the medical evidence and statements provided. But I also know that every VARO is hugely different in what they consider from a medical professional and definitely how they adjudicate a claim.

I was just merely pointing out that what is being interpreted by us (veterans) as an IMO is not necessarily what the VA is regarding as an IMO; but, instead, a medical opinion obtained by the veteran. I stated in my initial post that I searched the information because Vike caused me to see them as two different things. I was just sharing what I discovered to point out a possible discrepancy in terminology usage.

Hey, if it's not applicable...just disregard.

Edited July 22, 2007 by luvHIM

[Josephine]

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).

Jay,

When a Psychiatrist has to change your medical records to give you a personality disorder, then somewhere there is a RAT.

I am not saying that a Psychiatrist is not more qualified under normal circumstances, but when one has to lie to get what they want, then I haven't anything good to say about them.

At least the Phd Psychologist had the gumption to state the truth and go by the medical records. I can't say that for the other two.

The Psychologist didn't have too much trouble with his diagnosis when a veteran is sitting there with 43 years of treatment records for " Anxiety". Some of these treatment records were from Board Certified Psychiatrist.

How hard can it be to write down what 4 other doctors have written down over a period of 43 years.

I am not counting the two Board Certified Psychiatrist from the United States Navy.

I am only saying, " If a doctor has something to say, for God's sake, at least let it be the truth.

I did not have an abortion in service.

They changed my medical records to make me have three children alive. I do not, I have one dead son and two live daughters age 37 and 41.

At any time, I am ready to contact the AMC and withdraw my claim, for it just isn't worth going to the hospital for.

Josephine

Edited July 22, 2007 by Josephine

[Jay Johnson]

Jay,

When a Psychiatrist has to change your medical records to give you a personality disorder, then somewhere there is a RAT.

I am not saying that a Psychiatrist is not more qualified under normal circumstances, but when one has to lie to get what they want, then I haven't anything good to say about them.

At least the Phd Psychologist had the gumption to state the truth and go by the medical records. I can't say that for the other two.

The Psychologist didn't have too much trouble with his diagnosis when a veteran is sitting there with 43 years of treatment records for " Anxiety". Some of these treatment records were from Board Certified Psychiatrist.

How hard can it be to write down what 4 other doctors have written down over a period of 43 years.

I am not counting the two Board Certified Psychiatrist from the United States Navy.

I am only saying, " If a doctor has something to say, for God's sake, at least let it be the truth.

I did not have an abortion in service.

They changed my medical records to make me have three children alive. I do not, I have one dead son and two live daughters age 37 and 41.

At any time, I am ready to contact the AMC and withdraw my claim, for it just isn't worth going to the hospital for.

Josephine

Mental issues are subjective in the eyes of most people in this country and the VA uses that subjective nature to put wholes in every mental disorder they see. This is why I always strongly suggest using civilian care when one has a psychiatric disorder and staying as far away from the VA as possible....mental disorders have highs and lows by nature and although the VA is "supposed" to rate someone based on the lows and how often those lows occur, they do not; rather, they will focus on any shred of evidence that can be used to deny/low-ball a veteran.

So, if you want to fix your claim (and you can) you have to be vigilant and get some very hard evidence to win your case. This means spending some $ for *good* IMOs from highly qualified psychiatrists (IE - if you have PTSD see a psychiatrist that specializes in PTSD/anxiety disorders). The VA is like any civil law suite, you must prove your case by a preponderance of the evidence and shoot holes in their case against you wherever applicable. For you, this means getting more evidence stating that you do not have a personality disorder and having more evidence then they do showing that you have a well-founded nexus.

It may take a year, or more, but you CAN win your case. Perhaps finding a *good* psychiatrist and sticking with him/her for several months+ would be the evidence you need....the VA would be hard pressed to ignore your treating psychiatrist's eval even if there are dissenting opinions because your IMO opinion would be over a lengthy period and the VA opinions would likely be very short interviews with little medical background on your disorder.

It's sad that the VA uses these tactics, but you can beat them at their game if you go about it in the right way and take your time.

[Josephine]

Jay,

Spending money, I am not afraid of, but doctors yes.

Thanks,

Josephine

[Jay Johnson]

Jay,

Spending money, I am not afraid of, but doctors yes.

Thanks,

Josephine

That's the beauty of an IMO; you are in charge and you can fire them if they say something you disagree with:-) The wife has been seeing the same civilian psychiatrist for about 1.5 years now and we're about to fire him when we find someone better. During a recent episode of her's the psych completely missed that she was in a psychotic/dissassociative state and completely bought into her "coping mode" as if she had made some miraculous recovery. His utter failure at his own profession means he can find a new patient in my opinion!

Again, psychiatry is voodoo medicine, so find someone you feel best fits your needs/wants....most of them are over-educated idiots anyway.