Getting An Independent Medical

[Berta]

My past posts seem to vanish on this important info on an IMO criteria-

I added something to my original post-

"Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim.

Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability and can be very costly.

However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO.

A Valid IMO must contain the following:

The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs.

Also the doc needs to have all prior SOC decisions from VA particularly those referencing any VA medical opinions or a copy of the actual C & P results.

The doctor should define their medical expertise as to how their background makes their opinion valid.

In other words a psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.

The doctor must have some valid medical expertise that makes his/her IMO valid.

The doctor should state their opinion in terms of “as least as likely as not”, or “More than likely” as to the present disability and the nexus to the veteran’s service medical records or other SC disabilities, if the medical evidence warrants them to agree with the claim.

They should then refer to specific medical evidence to support their conclusion.

They should rule out any other potential etiology if they can-but for service as causing the disability.

They should briefly quote from and cite any established medical principles or treatises that support their opinion.

They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record.

They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion.

They should attach a full Curriculum Vitae if possible or list their expertise within the opinion and tell VA of any special medical background they have that also makes their opinion valid. (For example, how long they have treated patients with the same disability, any articles they have written, or symposiums attended etc,)

It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion.

A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records.

Send the VA and your vet rep copies of the signed IMO.

And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence.

added:

PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes time to find and have the VA approve of a payee."

[Pete53]

Berta is correct. Until I got an outside medical opinion I was not Service Connected except for flat feet which I did not ask for

[scottC]

Berta?

You answerd my question on another post about diabetes and sleep apnea. The neurologist says that I was diagnosed with metabolic syndrome x in the service. He states x causes both DM and sleep apnea. I read some of your other posts thats why I decided to go to a specialist. Also i did have high blood sugar levels in SMR. Service connected for hypertension and asthma currently. Thanks I hope it will work he is saying more likely than not. cost me 20 dollar blue cross co-pay

[Berta]

You seem to have great evidence for everything.

The ADA diabetes criteria changed in 1997.

The newer criteria might be even more favorable-in your case-to those inservice glucose readings.

"In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus named 3 ways to diagnose diabetes:

1. Symptoms of diabetes (such as polyuria, polydipsia, and unexplained weight loss) plus casual plasma glucose greater than 200 mg/dL (11.1 mmol/L). Casual means any time of day, without regard to meals.

2. Fasting plasma glucose (FPG) greater than 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.

3. Glucose greater than 200 mg/dL (11.1 mmol/L) after a 75-g glucose load. This is not recommended for routine clinical use.

V Any of these is sufficient for diagnosis but should be confirmed by repeat testing on a separate day.

Impaired glucose tolerance (IGT) is a category that refers to those with fasting plasma glucose greater than 110 but less than 126. This group is at increased risk for diabetes."

from VA training letter Diabetes 2000

[scottC]

You seem to have great evidence for everything.

The ADA diabetes criteria changed in 1997.

The newer criteria might be even more favorable-in your case-to those inservice glucose readings.

"In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus named 3 ways to diagnose diabetes:

1. Symptoms of diabetes (such as polyuria, polydipsia, and unexplained weight loss) plus casual plasma glucose greater than 200 mg/dL (11.1 mmol/L). Casual means any time of day, without regard to meals.

2. Fasting plasma glucose (FPG) greater than 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.

3. Glucose greater than 200 mg/dL (11.1 mmol/L) after a 75-g glucose load. This is not recommended for routine clinical use.

V Any of these is sufficient for diagnosis but should be confirmed by repeat testing on a separate day.

Impaired glucose tolerance (IGT) is a category that refers to those with fasting plasma glucose greater than 110 but less than 126. This group is at increased risk for diabetes."

from VA training letter Diabetes 2000

I got a copy of the VA Compensation doctors opinion today. she stated most likely sleep apnea started in 2002. Diabetes at least as likely as not due to military service.

So far so good

[Berta]

Jim- of a vet can get a "more than likely" or "as likely as not" documented statement from their VA doctor-(this question is always asked on the C & P forms)-the vet obviously has very good chance of succeeding in their claim and would not need an IMO.

An IMO- it doesn't depend on how professionally written it is- it just has to cover the IMO criteria- and the IMO doctor has to state his/her medical background or area of expertise that makes the opinion valid.

And then state how they medically came to the conclusion of "more then likely" or " as likely as not".

VA doctors sometimes can say just about anything in order for a claim to be denied-

I found this in my Section 1151 claims issues-

statements with no rationale or basis at all-

but if the medical evidence is there- faulty VA med opinions can be challenged.

One Med opinion for the claim and one of equal weight against the claim- equals the Benefit of Doubt.

But the VA owns the scale they weigh these opinions on.

One thing is for sure -the BVA decisions reveal that the BVA puts much more weight on any detailed and probative medical opinion- for which an IMO doctor fully assessed all medical records,referenced the SMRs if needed, referred to specific records, and then supported their opinion with references to medical treatises or abstracts.

If a C file was not present or -in my case- only a few records were faxed from the local VA to the VA doctor in Buffalo-while the rest of the entire clinical record of my husband as well as the FTCA Sec 1151 information -and the C file -remained here in Bath (documented)for no good reason whatsoever,is a point I vigorously rebutted in my response to the SSOC-

one single page in the C file of my initial rebuttal also was used by the VA doctor- who questioned my definitions of symbols in the med recs and I rebutted that I use Medilexicon and Merck medical symbiology-the same references for medical abbreviations and symbols that VA uses.

DVD- which appeared in Rod's records with inversion mark- (meaning past History of DVD)

means diabetic vascular disease.

The VA doctor tried to say DVD meant patient "denies venereal disease"

Ha Ha I laughed at that one -

Rod told the VA in 1984 that he had VD in Nam and clearly -even on his last award letter the VA clearly listed he had mentioned this in the past to VA many times.

They rated it as NSC "0"%-no residuals on all of his rating sheets.

That was easy to knock down of course-

Also Dr. Bash, in his second IMO (the first one was ignored) also specifically stated that, per the SSOC it was obvious that the VA doctor did not have benefit of his IMO when she opined- and his IMOs covered the whooe 9 yards (except he did not need the SMRs because the exposure to AO had already been presumed)

Dr. Bash did not use or cover all of the extensive additional rebuttal-with medical evidence- I also had sent to the VA.

Even with the IMos and the brief freeby I got-I made sure they had plenty of additional evidence.

A vet or widow has to read the VA Medical opinions from these VA doctors VERY clearly if they go against a claim-because some of these opinions are absolutely ridiculous and others appear rational but also can be definitely knocked down.

[Berta]

Jim- of a vet can get a "more than likely" or "as likely as not" documented statement from their VA doctor-(this question is always asked on the C & P forms)-the vet obviously has very good chance of succeeding in their claim and would not need an IMO.

An IMO- it doesn't depend on how professionally written it is- it just has to cover the IMO criteria- and the IMO doctor has to state his/her medical background or area of expertise that makes the opinion valid.

And then state how they medically came to the conclusion of "more then likely" or " as likely as not".

VA doctors sometimes can say just about anything in order for a claim to be denied-

I found this in my Section 1151 claims issues-

statements with no rationale or basis at all-

but if the medical evidence is there- faulty VA med opinions can be challenged.

One Med opinion for the claim and one of equal weight against the claim- equals the Benefit of Doubt.

But the VA owns the scale they weigh these opinions on.

One thing is for sure -the BVA decisions reveal that the BVA puts much more weight on any detailed and probative medical opinion- for which an IMO doctor fully assessed all medical records,referenced the SMRs if needed, referred to specific records, and then supported their opinion with references to medical treatises or abstracts.

If a C file was not present or -in my case- only a few records were faxed from the local VA to the VA doctor in Buffalo-while the rest of the entire clinical record of my husband as well as the FTCA Sec 1151 information -and the C file -remained here in Bath (documented)for no good reason whatsoever,is a point I vigorously rebutted in my response to the SSOC-for my present AO death claim-

one single page in the C file of my initial rebuttal also was used by the VA doctor- who questioned my definitions of symbols in the med recs and I rebutted that I use Medilexicon and Merck medical symbiology-the same references for medical abbreviations and symbols that VA uses.

DVD- which appeared in Rod's records with inversion mark- (meaning past History of DVD)

means diabetic vascular disease.

The VA doctor tried to say DVD meant patient "denies venereal disease"

Ha Ha I laughed at that one -

Rod told the VA in 1984 that he had VD in Nam and clearly -even on his last award letter the VA clearly listed he had mentioned this in the past to VA many times.

They rated it as NSC "0"%-no residuals on all of his rating sheets.

That was easy to knock down of course-

Also Dr. Bash, in his second IMO (the first one was ignored) also specifically stated that, per the SSOC it was obvious that the VA doctor did not have benefit of his IMO when she opined- and his IMOs covered the whooe 9 yards (except he did not need the SMRs because the exposure to AO had already been presumed)

Dr. Bash did not use or cover all of the extensive additional rebuttal-with medical evidence- I also had sent to the VA.

Even with the IMos and the brief freeby I got-I made sure they had plenty of additional evidence.

A vet or widow has to read the VA Medical opinions from these VA doctors VERY carefully if they go against a claim-because some of these opinions are absolutely ridiculous and others appear rational but also often can be definitely knocked down.

I rebutted every single statement the VA examiner said with medical evidence.

Only one statement I didnt rebutt-the single statement she made that actually supported the claim-

I highlighted her words with inserts from a medical and legal dictionary on that statement and her statement reflected the latest information from the ADA and the CDC.It supported my claim.

We have to manipulate the evidence they use against us to use it against them-

That is what they do-they often manipulate the evidence or parse the C & P report.

If this was not so, why would so many vets -with denials based on VA doctors-in the long run-eventually succeed anyhow on their claims.

I didnt have IMOs for my last 3 claims.

I had medical rationale and the medical evidence in the clinical record.

And a rep who offered nothing but very negative remarks as to my evidence (DAV)

and he was stunned when he found out I won my claims when we were in the DAVs lawyers office.

Edited September 17, 2008 by Berta (see edit history)