Imos

[free_spirit_etc]

I know that if the VA seeks an IMO in regard to a claim, they have to send you a copy of the IMO and give you an opportunity to respond PRIOR to issuing a ruling on the claim.

Does anyone know if this is also true for the RO?

i.e.If the RO decides to seek a medical opinion in regard to my husband's cancer claim - do they have to send me a copy of that opinion and give me the opportunity to respond (and have a doctor respond) to that opinion before they decided the claim?

Or can they just get the opinion, decide the claim, and then I only have the opportunity to address the opinion through the appeal process?

Thanks,

Free

[Berta]

They can get the IMO and then deny the claim and refer to it in the Statement of the Case.

They often deny widow's claims without getting a VA opinion.

The only way to get a copy of the actual opinion is to write to the Records Access Officer where it was done and ask for a copy of it.

Often a VA doc will only opine on anything negative and then overlook the good stuff-

I have knocked down 4 so far or more VA opinions as a widow-in my personal claims because they were completely lacking in medical rationale- among other things-

I think they feel that widows will buy whatever they are selling-

They also give widows the same 60 days response time in order to conbat the VA opinion - and when I succeeded in my other claims ---they actually read my responses-

I never went to the BVA -the RO awarded DIC at the RO level.

These days unless the widow gets a legal VCAA letter and election notice, the responses and even additional medical evidence from the widow will be ignored.

In that case you have to do what I did- and raise hell-

Put lots of pressure on your reps too-

Especially if you have sent them IMOs that have been ignored.

My Imos were so strong my rep thought I would win in 2005.

The VA committed another legal error in processing my claim (one of many)

With significant medical evidence (regardless of where it comes from-the VA is supposed to award the claim)

The DRO told my vet rep she could not read my IMOs -so he said(the rep)

He claimed he was the one who ordered the VA expert opinion

All of this is against established VA case law-

That is the day my IMos disappeared from the VA- and disappeared many more times when I re -sent them-

Now as far as I know they are back in the c file and will finally be fully considered.

Most widows need IMos these days to succeed on DIC.

And then they have to make sure the IMOs are properly assessed.

The legal VCAA letter-as the BVA has stated in some BVA cases- remanded due to VCAA violation- should advise the widow in many cases to obtain an IMO.

Unless a vet dies of a presumptive condition contributing or causing death or due to a documented service connected condition contributing or causing death-

most widows must get IMOs to associate the veteran's death to their service (unless the veteran received 100% P & T for SC for ten years or more

or unless the VA killed the vet with pisspoor medical care and this is a documented medical fact.

[Berta]

forgot to add- in the late 1990s a VA doctor wrote 2 horrible opinions that caused my claim to be denied.They were other VA doc reports too that denied both DIC and 100% SC-but I won them -

I not only called him up at the time in anger but I did succeed in knocking down his faulty medical rationale twice.1998 ???

About 3 years ago ,prior to getting my IMos from Dr. BAsh (I had one from a VA neuro ) for my new claim I called up this doc and asked him if he remembered me- well he sure did-

and he pulled out his records and we discussed what happened-

he had realised-when I knocked down his opinions (dont know how he found that out)

he did not have the complete med recs when he opined- he didnt even know there had been an autopsy (VA lost the autopsy 12 times)

we sure werent mad at each other anymore and I knew the prior opinions had given him stress-

then he totally agreed with my new claim.

I asked if he could opine on it for VA but he send since I already knocked down his last two they would definitely not accept an opinion from him FOR the new claim.

I laughed and promised I would not knock down his new opinion but I also knew he could not do what I asked-

Long story but when I actually obtained his reports-the actual IMOS- (Duh-I didnt know I could get the actual reports and he sent me copies of them)

they supported one of my other present pending claims anyhow!

Also a prior claim that was denied long ago-

I had filed a CUE on this and just never pursued it beyond a BVA denial-1999?

In AUg 2006 the VARO itself filed a Motion for Reconsideration of this old CUE claim.

I guess they too saw that this doctor had supported the older SC death claim as he went against the 1151 claim-

But the VA pulls out the negative and does not always (sometimes they do) focus on the good stuff.

It pays to get the actual VA doctor's report.

I never did get the more recent one- what the SOC said was so awful I had plenty to work with and so did Dr. Bash.

In order to prove wrongful death I studied cardiology-

to prove my more recent claim I had to study endocrinology and then associate the medical facts with my husbands type of CAD and brain trauma due to strokes-

That all involves a lot of reading and thinking-

I was not taking any chances that VA would reject my medical opinions-

although they accepted them in the past-

I got 3 IMOs.

Now all I can hope for is that the VA will finally read them .

I can get another IMO-already spoke to the doc about that- a pathologist-

if I get more medical VA crapola I can deal with that-and get another IMO- but no one -no vet or widow should ever put up with having bonafide IMOs from real doctors ignored.My IMOs cost 4000 and the pathologist will write one in support of my claim for 1750- he needs only a few pieces of med evidence- one more reaosn that the VA should never ignore real IMOs.

Vets and widows often have to pay a lot for them if the clinical record is extensive.

Edited August 16, 2007 by Berta

[68mustang]

forgot to add- in the late 1990s a VA doctor wrote 2 horrible opinions that caused my claim to be denied.They were other VA doc reports too that denied both DIC and 100% SC-but I won them -

I not only called him up at the time in anger but I did succeed in knocking down his faulty medical rationale twice.1998 ???

About 3 years ago ,prior to getting my IMos from Dr. BAsh (I had one from a VA neuro ) for my new claim I called up this doc and asked him if he remembered me- well he sure did-

and he pulled out his records and we discussed what happened-

he had realised-when I knocked down his opinions (dont know how he found that out)

he did not have the complete med recs when he opined- he didnt even know there had been an autopsy (VA lost the autopsy 12 times)

we sure werent mad at each other anymore and I knew the prior opinions had given him stress-

then he totally agreed with my new claim.

I asked if he could opine on it for VA but he send since I already knocked down his last two they would definitely not accept an opinion from him FOR the new claim.

I laughed and promised I would not knock down his new opinion but I also knew he could not do what I asked-

Long story but when I actually obtained his reports-the actual IMOS- (Duh-I didnt know I could get the actual reports and he sent me copies of them)

they supported one of my other present pending claims anyhow!

Also a prior claim that was denied long ago-

I had filed a CUE on this and just never pursued it beyond a BVA denial-1999?

In AUg 2006 the VARO itself filed a Motion for Reconsideration of this old CUE claim.

I guess they too saw that this doctor had supported the older SC death claim as he went against the 1151 claim-

But the VA pulls out the negative and does not always (sometimes they do) focus on the good stuff.

It pays to get the actual VA doctor's report.

I never did get the more recent one- what the SOC said was so awful I had plenty to work with and so did Dr. Bash.

In order to prove wrongful death I studied cardiology-

to prove my more recent claim I had to study endocrinology and then associate the medical facts with my husbands type of CAD and brain trauma due to strokes-

That all involves a lot of reading and thinking-

I was not taking any chances that VA would reject my medical opinions-

although they accepted them in the past-

I got 3 IMOs.

Now all I can hope for is that the VA will finally read them .

I can get another IMO-already spoke to the doc about that- a pathologist-

if I get more medical VA crapola I can deal with that-and get another IMO- but no one -no vet or widow should ever put up with having bonafide IMOs from real doctors ignored.My IMOs cost 4000 and the pathologist will write one in support of my claim for 1750- he needs only a few pieces of med evidence- one more reaosn that the VA should never ignore real IMOs.

Vets and widows often have to pay a lot for them if the clinical record is extensive.

This has to do with another topic, which you provided some input. It has to do with asbestos exposure. Correct me if I misunderstood, but can I request a copy of the report the VA doctor turn in when I was denied my asbestos exposure claim? How can I request it? Thanks 68mustang

[free_spirit_etc]

Thanks Berta. Thank for your response on my Social Security question also.

On the asbestos portion of the cancer claim, they already have the pseudo C&P report that states my husband's cancer couldn't be caused by asbestos because there is no evidence he was exposed to asbestos.

But on the whether the cancer started in the service claim - the Va did not pursue that - nor did they obtain a medical opinion as to that issue.

So if I submit an IMO on the issue of as to when the cancer started - do they have to approve the claim or obtain a medical opinion that refutes it?

We already have documentation from his treating doctor that shows the doubling times and growth rates of cancer - and how long it should take to reach the size it was when diagnosed. And we have a brief statement from the oncologist stating the standard doubling time of that type of cancer is 180 days. And medical journal / treatesies evidence which shows that the information the doctors provided (though the didn't provide their medical rationale) is supported by sound medical principles.

This is a case that the argument is pretty much FULLY supported by medical principles. It is standard medical practice that it takes a tumor about 35 doublings to reach 3cm. (This is for ALL kinds of cancer). It is standard medical practice that the typical growth rate for pulmonary adenocarcinoma is approximately 180 days (6 months). This is not just a case where you can find this growth rate in a couple of articles. This is the typical growth rate reported by the National Cancer Institute, SEERS training program, taught in medical schools (it is the ACCEPTED growth rate of this type of cancer).

Based on not only sound medical principles - but ESTABLISHED medical principles - 35 doublings x 180 days = 17.2 years.

Though growth rates CAN vary - it is MORE LIKELY THAN NOT that my husband's cancer did NOT reach the same size in 2 years (retirement to diagnosis) that the typical cancer of that type would take 17 years to reach.

It is all there - between the doctors notes and our submission of medical articles to support the doctors notes.

I don't think I have to have any medical expertise to be able to say "See where the doctor says 35 doublings = 3 cm> Here is an excerpt from the National Cancer Institute, Mayo Clinic, and the American Cancer Society that show his opinion is based on sound medical reasoning. See the place in the doctors notes that says Doubling times = 180 days, which is supported by the letter by the oncologist stating the same thing? Here is an articles from the National Cancer Institute, and from Case Western Reserve School of Medicine, etc. that show this is the medically established standard...

However, you know how the VA is.

So if all the info in the file supports the other info in the file - and I get an IMO that pulls it all together - does the VA pretty much have to grant the claim unless they seek a medical opinion that refutes the opinion and all the evidence in the file?

Free

They can get the IMO and then deny the claim and refer to it in the Statement of the Case.

They often deny widow's claims without getting a VA opinion.

The only way to get a copy of the actual opinion is to write to the Records Access Officer where it was done and ask for a copy of it.

Often a VA doc will only opine on anything negative and then overlook the good stuff-

I have knocked down 4 so far or more VA opinions as a widow-in my personal claims because they were completely lacking in medical rationale- among other things-

I think they feel that widows will buy whatever they are selling-

They also give widows the same 60 days response time in order to conbat the VA opinion - and when I succeeded in my other claims ---they actually read my responses-

I never went to the BVA -the RO awarded DIC at the RO level.

These days unless the widow gets a legal VCAA letter and election notice, the responses and even additional medical evidence from the widow will be ignored.

In that case you have to do what I did- and raise hell-

Put lots of pressure on your reps too-

Especially if you have sent them IMOs that have been ignored.

My Imos were so strong my rep thought I would win in 2005.

The VA committed another legal error in processing my claim (one of many)

With significant medical evidence (regardless of where it comes from-the VA is supposed to award the claim)

The DRO told my vet rep she could not read my IMOs -so he said(the rep)

He claimed he was the one who ordered the VA expert opinion

All of this is against established VA case law-

That is the day my IMos disappeared from the VA- and disappeared many more times when I re -sent them-

Now as far as I know they are back in the c file and will finally be fully considered.

Most widows need IMos these days to succeed on DIC.

And then they have to make sure the IMOs are properly assessed.

The legal VCAA letter-as the BVA has stated in some BVA cases- remanded due to VCAA violation- should advise the widow in many cases to obtain an IMO.

Unless a vet dies of a presumptive condition contributing or causing death or due to a documented service connected condition contributing or causing death-

most widows must get IMOs to associate the veteran's death to their service (unless the veteran received 100% P & T for SC for ten years or more

or unless the VA killed the vet with pisspoor medical care and this is a documented medical fact.

[Berta]

"This has to do with another topic, which you provided some input. It has to do with asbestos exposure. Correct me if I misunderstood, but can I request a copy of the report the VA doctor turn in when I was denied my asbestos exposure claim? How can I request it? Thanks 68mustang "

You can send a letter to the Records Access Officer at the VA where the C & P was done- or even to the VARO- as they too get a copy of this report.

Put your C file number on the request.

Dont use the FOIA for this request-Freedom of info Act requests take too long and a vet has right to their records and does not have to invoke FOIA.

Free-

"So if I submit an IMO on the issue of as to when the cancer started - do they have to approve the claim or obtain a medical opinion that refutes it?"

The VA will either accept the IMO as probative medical evidence to award- or they will obtain a VA doctor's opinion to go against it-

not that all VA opinions go against all claims- but -that is most often the case-

However the VA must provide clear medical rationale to attempt to refute an IMO.

In my case -with 3 supportive IMos and considerable other medical information (plus the fact that I reminded VA I opined on my husband's death and proved it in 1998 so I do have some obvious expertise as a lay person) as long as they VA refused to acknowledge or read my IMos they can continue to deny the claim.

A claimant whose medical evidence is consistently lost or ignored by VA must take -at some point- strong action.

I did and now fully expect my evidence to be finally considered in the next decision.

I have an additional plan of action prepared if it isnt-

this is why I asked- if you have received a VCAA letter yet-

the VA is supposed to send them to every claimant PRIOR to any denial-

the VCAA letter will tell you exactly what the VA needs as evidence.

In many BVA remands of widows claims due to VCAA violation-the BVA stated that the remand is for a legal VCAA letter to be sent to the widow -advising her to get an IMO.

(I say widow and "her" -last night another Female Iraq servicewoman was announced as dead in Iraq. I dont mean to ever overlook that women are dying in service these days leaving widowers and children)

It seems to me (and I spend much time off the board on this issue) that

ONLY when the VCAA letter suggests an IMO- does the VA actually read and consider the IMO-

If the claimant never gets a legal VCAA the claim is in limbo for years-

Also Only if the claimant gets an election Notice- will the VA actually then begin working on the claim-it doesnt matter how much evidence the claimant has-

they dont get the election notice and therefore cannot respond to it- and then VARO turns around and says the veterans has failed to respond to them- and the claim is denied.

VCAA is perfect but- with the way VAROs have manipulated this prime DTA law- it has become the biggest scam since Nehmer retro.

You have made good points as to the growth rate but the VA-when a widow gives medical info and opinion-is quick to say the widow has no medical expertise

The issues you raised as to inservice etiology or beginning of this cancer-

would have to be stated by a medical doctor with full medical rationale and the expertise needed to opine on a cancer claim.

If the cancer can be proven as starting in service- it would not matter if asbestos exposure was a factor - and you are correct to approach this claim from two different positions-

any medical treatises can be given to the IMO doctor and he/she could use them in their opinion-a good IMO doc usuaully will have, however, their own medical references to support thier poinion but it does not hurt to send them what you have.

An IMO doctor-and there are plenty IMO docs on the web for all types of disabilities-mental and physical-will need all SMRs and all treatment records.

IMOs docs for claims that already received VA doc opinion- need the SOC and the opinion itself in order to combat it with their IMO.

An Independent Doctor cannot opine on anything they cannot fully support.It is often hard to determine what an independent medical opinion will actually be.

The good part -for IMOs- is that these doctors take the time to study every single piece of medical information they have.15 minute C & P doctors dont have the time to do that at all.

"So if all the info in the file supports the other info in the file - and I get an IMO that pulls it all together - does the VA pretty much have to grant the claim unless they seek a medical opinion that refutes the opinion and all the evidence in the file?

Technically- if the IMO and all evidence supports your claim- they have to grant the claim.

So that means the VA actually has to read the IMO and weigh it's value as evidence.

The VA cannot ignore an IMO but they can get a VA doctor to attempt to go against it.

Still -these opinions both have to be weighed as to probative value.

If they are in equal merit- both for (your IMO) and against (VA opinion)

the laws that are called Relative Equipoise kick in.

an opinion for that is equal in quality to an opinion against equals Relative Equipoise and the veteran or widow succeeds on the claim and is awarded benefits.

It is also called Benefit of DOubt.

The only problem with this is that VA owns the scale.

Quantity of medical evidence means nothing- Quality of medical evidence and opinions mean everything.

A supportive IMO that meets the criteria that I posted here under "Getting an IMO" is in many many situations the only way a widow or veterans can succeed on their claim.

If there is no way to prove asbestos exposure in your case, then the best thing to do is focus on the SMRs and how they revealed symptoms and manifestation of cancer beginning in service.

A good IMO doctor will look for those symptoms and be able to opine as to whether they indicated the beginnings of this type of cancer in service.

Edited August 17, 2007 by Berta

[Pete53]

If you are a Widow or a Widower don't forget if the spouse is entitled to a larger check than you are that you can elect to get the larger check from Social Security.