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]

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

John,

Is there any chance they would do this without seeing me? Here is where the inner problem comes in at. I would never make the drive to Florida. John, I am only asking for the truth. As Dr. M. the VA Psychologist stated, " I am not telling the VA anything that they don't already know. Those two Board Certified Psychiatrist did not give me a diagnosis of Personality Disorder. They state nervousness, headaches and irrability. I do not have a P.D on my DD 214 either. The commanding Officer states clearly that I received a discharge by means of unsuitability. She is not able to perform the most menial task. Rendered no futher use to the service. I live in Virginia.

Thanks,

Josephine

[Josephine]

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".

Yes, it is the " buying an opinion" that I was speaking of earlier. I know that if I receive a denial, which I do expect from the AMC, I have been told to be ready to have an IMO in order.

I will be honest with you, I would have never made it this far had it not been for a couple of lawyers at the BVA and the help from those on this site.

I need a good Psychiatrist in an area that I am familiar with which would be Knoxville, Tenn. Anyone from that area? I could make it there, as I have no mountains to travel down. North Carolina is out and so is West Virginia. Of course I haven't been to Knoxville since this inner ear, but I could make it.

If I could find one, I bet it wouldn't take them 2 seconds to diagnose chronic anxiety.

Thanks,

Josephine

Edited July 23, 2007 by Josephine

[Jay Johnson]

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

This is incorrect. First, psychologists are not "doctors" in the traditional sense; they merely have an 8 year degree which does not qualify them to dispense medicine any more than someone with an 8 year degree in basket weaving. NPs do not have to fall under an MD to give therapy, nor do therapists or PAs, but they must be under an MD to dispense medicine. Actually, NP's and PAs and more qualified then psychologists because a psychologist cannot dispense medicine even under an MD.

In fact, many psychologists have a PhD, which is a general 8 year degree with an emphasis on psychology. A PsyD is an 8 year degree that is only in the field of psychology and focuses on therapy.

If anything a NP and a PA has far more education on human physiology and the biology of mental disorders. Also, many nurses have doctorates as do many PAs, but they do not have medical doctorates (MDs).

P.S. - A therapist (6 year, master's degree) has the same "license" to provide therapy that a psycologist has and both of them could have quit going to school after their associates, because one learns next to nothing in the field of psychology beyond a few classes....most of their education consists of regurgitating past theories that are completely unfounded and unproven. In that sense, psychology is more faith than science.

BTW, I am pursuing a masters in psychology right now and I stopped learning anything new in this field after my first general psychology course....therapy is a joke, period.

Edited July 23, 2007 by Jay Johnson

[Hoppy]

Josephine & Jangrin

Josephine,

There are ways to get an opinion from a doctor and still deal with the problems addressed by your niece. If you submit the reports reviewed by the independent doctor and those reports can be acquired by the VA through a direct request to the doctors then the possibility of fraud is eliminated. I will bet that your niece could site some case law that backs her up. However, there are ways to make a independent opinion stand.

It is probably so rare that a veteran gets an independent opinion in a manner that the VA has to accept it that your niece has never seen one submitted properly. The problem is that when these hard core DRO's write their decision they just blow smoke and don't tell the veterans why the denied the claim.

Jangrin and Josephine

The VA will allow a psychological diagnosis from A PHD in clinical psychology. The VA requires that both PhD's in clinical and a Psychiatrist are bound by the diagnostic standards set forth in the DSM IV. When I went to the VAMC and told my primary care doctor that I wanted to service connect a psychiatric condition. I was referred to a VA psychiatrist. The VA psychiatrist sent to see a PHD in clinical psychology. The PHD in clinical oversaw the testing and conducted about seven personal interviews. The PHD made all diagnoses. I saw the psychiatrist on two occasions and all we talked about was medication. All diagnoses were signed by the PHD not the psychiatrist. I eventually was sent to a C&P exam, not because the DRO did not think that a diagnosis signed by a PHD was not adequate. I was sent to the C&P with a Psychiatrist because the DRO did not think the psychologist addressed the issue of entwined symptoms.

The psychiatrist had read all of the reports written by the PHD before I walked into his office. The first words out of the psychiatrist mouth were how impressed he was with the quality of the workup the PHD did. He said he did not really need to see any evidence I brought with me and that he already made his decision. The psychiatrist wrote a report that basically repeated what the PHD had already said and I won my claim. You seem to be of the opinion that psychiatrists have a monopoly on quality psychiatric evaluations. I respectfully disagree. So does my Psychiatrist.

There is no such thing as a opinion that is free from bias when the VA is paying the bill of the IMO. Independent consultants could easily write reports favorable to the party paying for the report. The independent practitioner could be of the opinion that if they write reports favorable to the party paying for the report then they will receive additional business from the party who paid for the opinion. Any private practice attorney or doctor will tell you they have to be a good business man first. If they can't pay the office rent then they go out of business.

The reason I point out the money motive is because it is assumed by many in the CA comp system that a plaintiffs attorney will find doctors who write reports favorable to the plaintiff and the employers attorney will find doctors who write reports favorable to the employer. This is such a standard that doctors and attorneys who work both plaintiff and employer claims are not held in high regard by employee unions. Unions refer employees to attorneys and doctors who do plaintiff work only.

Your comparison to Ca. comp really does not work with the VA. Believe it or not there are claims adjuster schools for people who want to be a claims adjuster under CA. comp. There are also schools that that teach investigative techniques to find fraud on all levels of workers comp. Doctors fraud, lawyers fraud, insurance company fraud, employer fraud and claimant fraud. I have graduated from both claims adjuster school and investigator school.

A qualified medical examiner in the state of CA is used to resolve issues and the possibility that the doctors are writing reports favorable to the party paying the bill. A list of qualified QME doctors is developed and the attorneys must get together and agree which doctor from the list they want to write the QME report. The QME report is the last word on the subject matter and the judge makes the award It is not rare that QME's are both Md's and JD's. The doctors who my union referred injured workers to for initial treatment of work injuries were MD/JD's.

The VA can drag out the claims process for decades. They drug my slam dunk claim out for 8.5 years. I really wished that I could have used a system similar to CA. for my VA claim. Finally, when I got to a DRO on my claim he told me he wanted to get an opinion from a doctor of his choice. All my training told me that this was not good because this report was the final step and the VA was paying the bill. I was afraid that the doctor would be biased for the VA because they were paying the bill. Hoping to get return business this doctor might think he has to write a report favorable to the VA.

I immediately asked the DRO who he planned to get the report from. He said it was a private medical group in the community. I immediately asked why he could not get such a report from a VA doctor. He told me he could. I told him I wanted to go with a VA doctor. He said Ok and the appointment was scheduled with a VA doctor. I chose the VA doctor because I had found several VA doctors who wrote favorable reports for me in the past. Also, VA doctor's are hard to fire and they get their paycheck no matter what type of report they write. The doctor who the DRO sent me to see at the VA wrote another slam dunk report in my favor.

[Guest jangrin]

Josephine & Jangrin

Josephine,

There are ways to get an opinion from a doctor and still deal with the problems addressed by your niece. If you submit the reports reviewed by the independent doctor and those reports can be acquired by the VA through a direct request to the doctors then the possibility of fraud is eliminated. I will bet that your niece could site some case law that backs her up. However, there are ways to make a independent opinion stand.

It is probably so rare that a veteran gets an independent opinion in a manner that the VA has to accept it that your niece has never seen one submitted properly. The problem is that when these hard core DRO's write their decision they just blow smoke and don't tell the veterans why the denied the claim.

Jangrin and Josephine

The VA will allow a psychological diagnosis from A PHD in clinical psychology. The VA requires that both PhD's in clinical and a Psychiatrist are bound by the diagnostic standards set forth in the DSM IV. When I went to the VAMC and told my primary care doctor that I wanted to service connect a psychiatric condition. I was referred to a VA psychiatrist. The VA psychiatrist sent to see a PHD in clinical psychology. The PHD in clinical oversaw the testing and conducted about seven personal interviews. The PHD made all diagnoses. I saw the psychiatrist on two occasions and all we talked about was medication. All diagnoses were signed by the PHD not the psychiatrist. I eventually was sent to a C&P exam, not because the DRO did not think that a diagnosis signed by a PHD was not adequate. I was sent to the C&P with a Psychiatrist because the DRO did not think the psychologist addressed the issue of entwined symptoms.

The psychiatrist had read all of the reports written by the PHD before I walked into his office. The first words out of the psychiatrist mouth were how impressed he was with the quality of the workup the PHD did. He said he did not really need to see any evidence I brought with me and that he already made his decision. The psychiatrist wrote a report that basically repeated what the PHD had already said and I won my claim. You seem to be of the opinion that psychiatrists have a monopoly on quality psychiatric evaluations. I respectfully disagree. So does my Psychiatrist.

There is no such thing as a opinion that is free from bias when the VA is paying the bill of the IMO. Independent consultants could easily write reports favorable to the party paying for the report. The independent practitioner could be of the opinion that if they write reports favorable to the party paying for the report then they will receive additional business from the party who paid for the opinion. Any private practice attorney or doctor will tell you they have to be a good business man first. If they can't pay the office rent then they go out of business.

The reason I point out the money motive is because it is assumed by many in the CA comp system that a plaintiffs attorney will find doctors who write reports favorable to the plaintiff and the employers attorney will find doctors who write reports favorable to the employer. This is such a standard that doctors and attorneys who work both plaintiff and employer claims are not held in high regard by employee unions. Unions refer employees to attorneys and doctors who do plaintiff work only.

Your comparison to Ca. comp really does not work with the VA. Believe it or not there are claims adjuster schools for people who want to be a claims adjuster under CA. comp. There are also schools that that teach investigative techniques to find fraud on all levels of workers comp. Doctors fraud, lawyers fraud, insurance company fraud, employer fraud and claimant fraud. I have graduated from both claims adjuster school and investigator school.

A qualified medical examiner in the state of CA is used to resolve issues and the possibility that the doctors are writing reports favorable to the party paying the bill. A list of qualified QME doctors is developed and the attorneys must get together and agree which doctor from the list they want to write the QME report. The QME report is the last word on the subject matter and the judge makes the award It is not rare that QME's are both Md's and JD's. The doctors who my union referred injured workers to for initial treatment of work injuries were MD/JD's.

The VA can drag out the claims process for decades. They drug my slam dunk claim out for 8.5 years. I really wished that I could have used a system similar to CA. for my VA claim. Finally, when I got to a DRO on my claim he told me he wanted to get an opinion from a doctor of his choice. All my training told me that this was not good because this report was the final step and the VA was paying the bill. I was afraid that the doctor would be biased for the VA because they were paying the bill. Hoping to get return business this doctor might think he has to write a report favorable to the VA.

I immediately asked the DRO who he planned to get the report from. He said it was a private medical group in the community. I immediately asked why he could not get such a report from a VA doctor. He told me he could. I told him I wanted to go with a VA doctor. He said Ok and the appointment was scheduled with a VA doctor. I chose the VA doctor because I had found several VA doctors who wrote favorable reports for me in the past. Also, VA doctor's are hard to fire and they get their paycheck no matter what type of report they write. The doctor who the DRO sent me to see at the VA wrote another slam dunk report in my favor.

Hoppy,

It seems you miss read my posts. Please read the ones from Jangrin. I am the person who believes that psychologists work under their own license and are not obligated or controled by the MD's. I am also the one who stated that my husband won his SSDI based on the psychologist opinion, contrary to others who have posted on this thread that think menatal health treatment is the practice of VOODOO medicine.

I respect your opinions and have always felt you were informed. But please don't think that I believe psychiatrists are better than psychologists. That is not a statement that I would ever say. I did say however, that when given a choice the average VA rater would choose the opinion of a VA psychiatrist over that of a private psychologist. I stand behind that statement. Thanks for taking the time to review "my postings" ;) -Jangrin

Oh..P.S.- I was not comparing the VA with the California Compensation System. What I was trying to say, (maybe not so good) was that there are differences in QME, IMO, AME, IME, exams. It is my opinion that the CFR in this instance could be interpreted as, a veteran's right to legally request an examination independent of the VA, not just the VA's right. Other's seem to believe that this CFR section only apllies to the VA being able to request the exam. (maybe with atty's more involved we will get some clarification on this).

Qualified Medical Examiners reports in the State of California are paid for by the State not the insurance or atty's. Also I do not know of any Attorney's(JD's), that give Medical Exam's unless they hold a dual degree as a doctor. QME's are of many diciplines, even chiropractors and psychologist can be requested by the patient to do the evaluation if they are licensed by the state to perform such exams. So if a patient is treated by a psychologist then an independent psychologist would/could be selected from a list to do the QME exam. The patient chooses who gets to do the exam. It is a good system but expensive. That's why CA work comp is/was in trouble. My original post was not meant to compare, it was meant to provide information so people understand terminology. I may have done a poor job of doing that. When someone says IMO to me, I think in my mind legal opinion/examination ordered by insurance. WHen I hear IME I think legal exam /opinion ordered or contracted by patient or patient's advacate. QME I think legal exam order by the court.

Edited July 23, 2007 by jangrin

[Jay Johnson]

"The VA will allow a psychological diagnosis from A PHD in clinical psychology."

Hoppy,

I don't mean to be rude here, but I have a fair amount of education in this field and I think there are some misconceptions as to what a psychologist is and what education is required. A "PhD" is a doctorate in philosophy. If a psychologist has a PhD they can actually spend very little, to no, time in clinical psychology. A doctorate that emphasizes clinical psychology would be a PsyD, which many psychs have.

For ratings purposes there is a HUGE difference between a psychiatrist and a psychologist because a psychiatrist is taught the physiological basis for mental disorders and how to treat said physiological problems with pharmaceuticals. A psychologist can only make an observation of symptomology and diagnosis accordingly.

Let's put it this way - If I gave you several books on the theories of freud, erickson, piaget, etc and you spent 3 years studying them, would you really know any more about why and how something like PTSD works? Now what if I taught you how recent research in brain lateralization (how one side of the brain communicates with the other...IE - hemispheres) has shown that some forms of hallucinations and fears/anxiety could be due to one side of the brain perceiving the other as a foreign body? What if I taught you the physiological reasoning behind most disorders like elevated dopamine due to reuptake disorders between neural transmitters and how to prescribe medicine that alleviates that problem?

In other words, psychology, in general, is nothing more than "theory" that is unproven and relies heavily on subjective observations; whereas, psychiatry follows the medical model and assumes that there is a physiological basis for "mental disorders". Psychiatry is far from always being correct either, but they have FAR more education about human anatomy and how the brain works than ANY psychologist....a psychologist is nothing more than a therapist/social worker who had the time/money to go to school for 1-2 more years.