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]

[Berta]

need to add-someone asked about who can administer an MMPI - a monkey could do it--

I did that myself-

the friend I was filling in for his secretary- a psychologist was just ready to administer the MMPI to a patient and got an emergency call to the hospital ward (State mental hospital)

I had to "administer" the MMPI test-

meaning I had to make sure the patient filled it all out, and did not ask me any questions about it other then the mechanics as to filling it out-then the PT had to put it into an envelope and seal it, and I had to put it into a safe,and lock up the office, until the doctor returned.

I think I did this on another occasion too--

It is the medical Assessment of these tests that matters.The MMPI is a multiple choice test I think.

This doctor is psychologist.

Every MMPI or other type of testing he handled involved the results being discussed with a team that included both psychiatrists and psychologists.

This was for mental patients who were primarily in a state hospital environment.

The 6-7 tests VA gave Rod were administered by a MSW I think- but the assessment was done by a psychiatrist-one of VA's best-

Combat vets get a Combat MMPI.

These tests could separate Rods 100% PTSD from physical brain injuries due to Section 1151 strokes.

[Josephine]

Free,

If a Monkey can administer the MMPI test- being that there are so many " quacks" in service, is one of them qualifed to give me the test?

I am ready when they are.

If I am understanding you two correctly, then we can assess that my "Board Certified Internist" is qualified to state from his own observation and medical examinations from the last 30 years that I am not a " Cutter", and " I do not have an Eating Disorder".

How a Psychiatrist that never ask me to take my clothes off could state that " I denied any self- inflicted injuries, " According to her" and all that hoop la in that record is one of the biggest liars in the VA system.

Dr. P is also qualifed to look at the medical records of Dr. S and read just how many live children I really do have.

Is this a sore spot with me yes, it is.

How the VA Regional Office bought into her terminology the word " Appears".

As far as him having probative value, he has written an excellent IMO according to the VA regulations and I think that when all is said and done, being that he has 43 years of medical records to read from Board Certified Psychiatrist, I do believe that the AMC will consider him to have as much expertise as the two quacks.

Here is a " Statement that you wrote for me and I have pasted it from one of " Statement in Support of Claim".

Others may benefit from Your Expertise

The Navy discharged Mrs.xxxxx, after she served for over one year for what they state” Emotional Immaturity".

Each of us has a different way of handling stress, anxiety and pressure.

The fact that, the veterans' inability to handle these in service stressors (because of immaturity) is proof that there were indeed stressors.

The Navy would have never recognized that she had a problem if she hadn't been under some form of stress that brought out the immaturity, to activate the discharge.

When Mrs. xxxxx went into service, The United States Navy, felt she was mature enough. She served for over a year and reached a point where she was unable to cope with portions of her duties and situations in the military.

Mrs. xxxxxxx inability to cope was considered by her commanding officer as "Emotional Immaturity".

This fact proves she had an inability to cope” normally" and it "started in the military" and became a chronic worsening condition"

Just wanted to share with others your expertise of my claim.

Always,

Josephine

Edited July 28, 2007 by Josephine

[Berta]

I meant I was the "monkey"-

it is just a matter of supplying an MMPI testing form ,under auspices of a shrink-to someone and making sure they have pen pencil etc, a quite place where no one can interrupt them and that the test and their privacy is secured for the next step- assessment of the test results by professionals-

I would think that any current treating doctor- giving treatment and therapy for any claimed psychological disability could administer this test and assess it if they have expertise in the field.

Or they could corroborate the results with another physician-

Or they could just send VA the test results in support of the claim.

I think if an IMO doctor will not be able to opine on a claim- they could at least- for a lessor fee- administer and then assess an MMPI test.

There are many IMO docs on the net these days- many shrinks- I don't know if they could do that but why wouldn't they be able to-

the testing would have to be done in their office or at an office of a professional closer to the patient.

Testing- I have to take an LOA test for my diploma- this has nothing to do with my grades or anything-just a requirement of the university-I could get it done at the school itself-but

I mention it here because AMU gave me a list of the places I could go to in order to have the test proctored-by a professional-in my area.

it is basically the same thing here-

Any professional can refer someone to another professional closer to the person who needs the MMPI test when their presense is required for something like this-

[Josephine]

Berta,

I considered you too intelligent and not to be a " Monkey". You sure have those VAMC Quacks beat all to pieces.

I called a Board Certified Psychiatrist and his charge was $700.00 and I ask him about the testing for a " Personality Disorder". He said, " I don't give the test".

I ask him about the self- inflicted inuries. He said, " I don't do examinations".

He said, I don't think that I would be interested.

Since we keep saying the word " Psychiatrist". My question would the BVA accept the testing by a Psychologist?

Comments welcome,

Josephine

Edited July 28, 2007 by Josephine

[free_spirit_etc]

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

Berta,

I considered you too intelligent and not to be a " Monkey". You sure have those VAMC Quacks beat all to pieces.

I called a Board Certified Psychiatrist and his charge was $700.00 and I ask him about the testing for a " Personality Disorder". He said, " I don't give the test".

I ask him about the self- inflicted inuries. He said, " I don't do examinations".

He said, I don't think that I would be interested.

Since we keep saying the word " Psychiatrist". My question would the BVA accept the testing by a Psychologist?

Comments welcome,

Josephine

[free_spirit_etc]

Good point. I don't think a Bachelor's would carry much weight for diagnosis.

But with the Bachelor's - if I was actually working with the vet in some way - it could carry SOME weight if I reported objective observations. Or if it was within my job speciality.

For instance, I worked at a shelter for battered women for several years. In that case - though I have a BAchelor's - a report that Client Z consitently distributed ___ behaviors in my presence and / or Client Z reported that the behavior of her husband reminded her of how ___ treated her while she was in the service - that might carry some weight.

I was reading an article recently about the number of women in the military that are subject to abuse by fellow soldiers - and how they have to travel in pairs for their own safety - and how they are afraid to report it because THEY will be the one who is treated like an outcast. Really sad.

Free

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.