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]

Post grad work in clinical psychology is a PsyD, not a PHD. Also, your issue sounds far less subjective then something like PTSD, depression, etc. Either way, I have not said that the VA would *not* accept a psychologist's opinion...they even accept opinions from NPs and PAs, but only because they are cheap and cannot afford to get *good*, educated opinions from qualified personnel. In terms of IMOs, though, one would be a fool to try to overturn a VA decision based on the word of a NP, PsyD or PA.....even an IMO from a pscyhiatrist can be shaky if it's a one time appointment and the psychiatrist doesn't specialize in PTSD (or whatever disorder you're going for).

Try winning a SS case that is contested with only an opinion from a PsyD......

Again, a psycholigist and a psychiatrist are light years apart in terms of education and qualifications....if the VA doesn't see that, then they are dumber then even I thought:-)

BTW, as per the norm, the VA will weight things against you more than those FOR you. The reason they tried to bust down my wife's A&A rating a couple of years ago was based on a letter from a NP that stated ONLY that she was able to handle her finances for fiduciary purposes....the letter made one mention of her PTSD and said, "her PTSD does not seem to affect her ability to understand her finances". They used this to reopen her P&T A&A claim and lower her all the way to 50% on that alone, yet when I had the same PA write a letter saying that he made no diagnosis of her PTSD and that upon evaluating it he found it to be completely disabling the RO said, "a PA is not qualified to make that decision".

[Josephine]

Thanks,

Josephine

Edited July 25, 2007 by Josephine

[Hoppy]

Jay,

That is something about the PA and your wife. It goes to show how twisted the VA syatem can get. I have a brother who is a combat PTSD veteran. He is very disabled. If he forgets to put his keys in his pocket he will start walking with his keys in his hand and drop them and he does not even know he dropped the keys. He gets into thought trenches while walking and forgets what is going on. He has been in 5 car accidents in 15 years. He gets to spacing out and drives off the road. He cannot operate a boat with duel controls because he gets confused. Between his PTSD comp and an inheritence he has rec'd 50 thousand a year for the last twenty years after taxes. He has not saved a penny and will go without eating for several days each month because he spends all the money as fast as he gets it. I sent him another email today telling him to go to treatment. I do not know if he will or even if treatment will help.

I agree that the training for PsyD's and pcychiatrists is very different. Also, that you did not say that PsyD's were not in the loop. I responded to your original statement about the training becuase I thought it should be balanced by showing variances in the quality of reporting and biases that occur no matter what level of training. It is obvious by your comments about your wife and other statement that we are in agrement on these variances. I do think that these types of variance would likely occur no matter how much training is currently available to psychiatrists. I have read hundereds of BVA cases when preparing my claims with the VA. These biases can work both for and against the veteran. I have read PTSD claims that were awarded based of a statement from the veterans wife. I will admit it was a very old claim. The VA is trying to improve the process. However, I know of one veteran who made the same statements and submitted the same history of documentation to to different evaluators. One evaluator assigned a GAF of 50. The other evaluator said the veteran had no psychiatric disability. I think this type of subjective variance could occur whether the evaluators were both psychiatrists or both PsyD's.

During the process I was represented by an SO who had been a rating specialist for the VA for 20 years. He jumped sides when he thought the VA was not properly training adjudication personnel and to many claims were getting screwed up. It never was a problem to him that a PsyD was making my diagnoses. So I guess the VA is dumber than you think. It appeared to me what was being done in my case was standard operating proceedure during the entire 20 year experience of my SO.

It was obvious to me that the VA really did not care who made the diagnosis. Like you said PA's are in the loop. The DRO who made my award gave weight beacuse the PsyD went to great lengths to exlain the inadaquacies of the reports written by the psychiatrists. The entire system had changed between the time the PsyD got involved. The problem was that the psychiatrists were allowed to make diagnoses with very little work up. The psychiatrist, PsyD team that was assigned to treat me in 2002 refused to even make a diagnosis unless I participated in treatment for a minimum of 6 months.

I guess I am a lucky fool. I guess I did not mention that not only where the psychiatrists reports trashed by the DRO. The DRO's decision over turned 2 previous RO denials based on the psychiatrists reports. Also, I was awarded SS by an administrative law judge in 1996. When I went to court there was an individual sitting in the lobby. We got to talking and it turns out he was a "doctor" hired by the court to make an assesment for the judge. I asked him if he was an MD. He said he was a psychologist. I told him I had some reports that were not previously in the record. He immediately asked to see them and read them before we went into court.

The judge comes in and I start talking. I did not have an attorney. The story why I did not have an attorney is a mind blower and would take to much time to type up. Anyway I had to do all the talking. In the process I knock over a picture of water they set there in case I needed a drink. The judge interupts me and askes the "doctor" if he has anything to say at this point. The guy says. "Yes, I have reviewed the record, some additional evidence he gave me before the hearing and his verbal testimony just now and I have determined that he can not work due to a psychiatric disability. The Judge looks at me and says "you win lets go home". I said hold on I have two other qualifying disabilities that need to be addressed. The Judge said "You won". I said "what if you change your mind I want all the evidence heard and ruled on". He said he did not have to do that and to go home.

What was weird about this is that when I was in workers comp court and a civil suit. Nobody would allow evidence to be submitted the day of court. Also, judges would delay their decisions and send them out in writing. They would not give a verbal assesment at the time of the hearing.

I also agree that in my VA case I had a pile of verifiable and strong evidence in support of my claim. My SO was of the opinion that I had more significant evidence of record than anybody he had heard of with a similar case. The evidence was given to the PsyD when I walked into the first appointment. It included a type written, 7 page, single spaced position paper with 25 pages of supporting documents.

Edited July 27, 2007 by Hoppy

[Jay Johnson]

One of the problems with ALL of our law systems in this country (civil, legal, SS, VA, etc) is that there is always someone that has entirely too much power in the process. A jerk rating's officer can ruin someone's life for years.....A jerk SS judge can make your life a nightmare, just as a rater at SS can before him. The same goes for criminal law.....one Ahole judge having a bad day and your speeding ticket turns into 5 days in prison. Conversely, a good judge/rater can make life a wonderful thing......

But, I guess our systems have some checks and balances which is better than most other countries......

[free_spirit_etc]

I have a Bachelor's in Psychology. Can I write an opinion? lol

To me Psychiatrists focus more on "medical" treatment of the problem and prescribe medicine - Where Psychologists lean more toward other therapeutic approaches --talk therapy, behavioral etc. --and often work in tandem.

However, it has been my experience that Psychologist do most of the psychological testing. When my son was being evaluated in the hospital - the psychiatrist ordered psychological testing - and then went by thier reports.

And a lot of the Community Counseling centers have a Psychiatrist that prescribes meds and sign off on everything.

As far as the IMO's go - they do not have to include an actual exam but can be based on a review of the records.

I have seen quite a few times the BVA requested an IMO - if they needed a medical opinion -- or if there was a lot of conflicting evidence in the file.

Free

[Berta]

Free- that is a good qeustion- actually the VA will accept evidence and testimony on a claim from anyone who has some knowledge or expertise in the subject of the claim.

"Lay" statements can be bolstered by adding any particular background someone has that could show some ability to opine.

It isnt the same as a doctor's opinion at all-but still can be valid support.

My ex husband is a nurse with a long background that includes awards from the State he lives in-as to his skills.

He mentioned he would gladly write an IMO on Rods medical records as he too totally agrees with my AO claim-and send it to the VA.

I would tell VA he is the ex husband mentioned on my 21-534 app etc- so they know of his relationship to me-if he does that- but the truth is I dont want him to-

even if this would help my claim-I feel the 3 IMos I have now would be better-

because he is a former relative-

yet nothing in VA case law prohibits this type of statement if a relative has professional expertise-

They would still have to support the opinion with full medical rationale based on the clinical record.

Then again- I was former vet center volunteer in the PTSD combat group.

I wrote some lay statements to help a few vets over the years as to PTSD claims and copied my VA FBI card to the statement- (I call it that because of the FBI check- it is some sort of valid VA volunteer ID card) and told VA of the vet center where I worked and my team leader they could contact etc etc-

these were vets I personally knew and was well aware of their Vietnam experience.

these vets all got PTSD awards but I feel my statements only supported their claims that already had significant evidence.yet were more evidence to help corroborate their stressors or define the extent of their PTSD problems.

One vet would not reveal to VA his main stressor. He told me and this was one way of providing a statement to VA- his stressor also was consistent with the manuver and was documented in his unit's history.

Although no claim should rely just on lay statements, still lay statements can be very helpful- A vet's wife was a nurse and the BVA accepted her opinions as to the extent and degree of the veteran's problems. She had even kept a diary of his problems and that too was evidence they considered in that award from the BVA.

Of course it depends on whether the VA will even read lay statements.

They certainly did years ago.

Edited July 28, 2007 by Berta