hypertension Individual Medical Opinion (imo)

[blueteak]

Has anyone ever requested when submitting evidence on their claim that the VBA attain an IMO for a service connection in their medical record? I am claiming for sleep apnea and there is no diagnosis in my service record for same. However there are incidences of MVP, Hypertension, Dyspnea (none currently SC or have been requested SC). Everything that I have read suggests these elements are related to Sleep Apnea but my opinion would not count as I am not a MD. Apnea was first diagnosed approx 9 yrs after discharge. Period of service was '70-'93. I'm considering asking them to obtain an IMO since I can't afford to pay a private MD for one. I have 16 days left to submit my evidence before the 60 day expiration for submission of evidence to the VBA. Thanks in advance for any input.

[blueteak]

Philip, you are right on the IMO. Also I typed in the link wrong. It should be: http://www.warms.vba.gov/regs/38CFR/BOOKB/PART3/S3_328.DOC

Hope I got it right this time.

[john999]

Blue

The VA is never going to pay for an IMO or IME. This is something you have to arrange. This is part of the burden you have to prove that your disabilities are service connected. They might arrange for a C&P exam, but that may hurt you just as well as help you. Of all the things you can do to help yourself getting a good IMO is probably the best. If you have any evidence in your SMR's a good IMO doctor can possibly related this to your current disability. The IMO doctor should provide the nexus between what is in your SMR's and your current conditions. You need all your medical records for him/her to review. Unless congress changes the very nature of the VA disability system we are going to have to scrape up the money to get our own doctors to help us.

[blueteak]

Sorry, still could not get the link to work so everyone could see the regulation I was talking about. This regulation is listed in M21-1MR, Part III, Subpart IV, Chap3, Sec A, Pg 3-A-24. It states:

G. Initiating a request for an independent medical opinion;

A request for an independent medical opinion under 38CFR 3.328 in conjunction with a pending claim, may be initiated by the

-RO

-Claiment, or

-Claiment's Representative

I read that as they are saying that the VBA will obtain the IMO for me if they determine it is warranted.

[tssnave]

My guess is the only possible way the VA is going to send you out for an IMO is if your problem is so esoteric that they do not believe they can give you a valid C&P exam without getting an outside opinion and sleep apnea is not going to fall out in that category.

If you have a regular doctor ask him/her to write something up for you. Better yet, write it yourself and ask them to sign it. Recently someone posted a very good nexus letter that a VA doc could just sign saying your sleep apnea is at least as likely as not caused by your other sc disabilities. Something along those lines would work and be inexpensive (no more cost than an office visit, just take it in w/ you and ask the doc to sign it).

As for not being able to afford it, I understand. I spent several thousand dollars on a psych IMO that I could ill afford. However, something in the VBM hit me - basically, it said to run the numbers. IOW, in my case, with the difference between 100% and 50% (my current rating) it doesn't take too long for the IMO to "pay" for itself. Plus, in my case, the VA was ignoring their own examiner's report because she said I was 100% total occupation and social disabled - yet the VA ignored their own examiner's opinion and rated me 50% despite the reg saying the rater can't place their opinion over the evidence. So, given the game we are in with the rules in our favor but the umpires often against us, it seemed like a good idea and I asked the shrink if he would take payments, which he did.

Keep us posted on how things turn out.

[blueteak]

tssnave. I think we are talking about two different things. I would not be asking for an IME, just an IMO to prove Nexus to sleep apnea. In the same chapter, sec a, it shows the form that would be sent out with the request for the IMO that would require the MD to determine if by reviewing the records of the claimant, whether or not there is a nexus for the claimed disability. I plan to go ahead and request this when I send my package of evidence in. All they can do is deny the request. I will still have till Dec this year to send any additional evidence on the disability if needed. Between now and Dec, I will have the funds necessary to obtain my own private MD IMO if needed.

Thanks to all for their inputs. As soon as I hear word one way or another on this, I will post on board for others under this topic.

[donews]

Blueteak,

Your correct all they can do is say no, so why not ask.

I personally have been told by various people that if I request it, the VA must provide an IMO for nexus. In one of my claims I stated that if they found my evidence lacking I request that they get an IMO as to the cause of my condition.

They did send the case off to an outside doctor and he just so happened to opine that my condition was aggrivated by other service connected conditions. So it turned out in my favor thankfully. I do not know if they did this because of my request or if they got the IMO because of another reason.

But the only reg I can come up with at the moment is this one:

§ 20.901 Rule 901. Medical opinions and opinions of the General Counsel.

(a) Opinion from the Veterans Health Administration.

The Board may obtain a medical opinion from an appropriate health care professional in the Veterans Health Administration of the Department of Veterans Affairs on medical questions involved in the consideration of an appeal when, in its judgment, such medical expertise is needed for equitable disposition of an appeal.(Authority: 38 U.S.C. 5107(a))

(B) Armed Forces Institute of Pathology opinions.

The Board may refer pathologic material to the Armed Forces Institute of Pathology and request an opinion based on that material. (Authority: 38 U.S.C. 7109(a))

© Opinion of the General Counsel.

The Board may obtain an opinion from the General Counsel of the Department of Veterans Affairs on legal questions involved in the consideration of an appeal. (Authority: 38 U.S.C. 7104©)

(d) Independent medical expert opinions.

When, in the judgment of the Board, additional medical opinion is warranted by the medical complexity or controversy involved in an appeal, the Board may obtain an advisory medical opinion from one or more medical experts who are not employees of the Department of Veterans Affairs. Opinions will be secured, as requested by the Chairman of the Board, from recognized medical schools, universities, clinics, or medical institutions with which arrangements for such opinions have been made by the Secretary of Veterans Affairs. An appropriate official of the institution will select the individual expert, or experts, to give an opinion. (Authority: 38 U.S.C. 7109)

(e) For purposes of this section, the term ''the Board'' includes the Chairman, the Vice Chairman, any Deputy Vice Chairman, and any Member of the Board before whom a case is pending. (Authority: 38 U.S.C. 5107(a), 7104©, 7109) [57 FR 4109, Feb. 3, 1992, as amended at 61 FR 20453, May 7, 1996; 66 FR 38159, July 23, 2001]

§ 20.902 Rule 902. Filing of requests for the procurement of opinions.

The appellant or representative may request that the Board obtain an opinion under Rule 901 (§ 20.901 of this part). The request must be in writing. It will be granted upon a showing of goodcause, such as the identification of a complex or controversial medical or legal issue involved in the appeal which warrants such an opinion.

(Authority: 38 U.S.C. 5107(a), 7102©, 7104©,7109)

Edited February 28, 2008 by Pete53