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admiral7

Bva Remand

Question

Just recieved the brown envelope from BVA and it was a remand.I have heard that some vets wait for years for the RO to comply and at age 70 I don't have a bunch of those left.So I need some real advice on what to do next since the letter states a remand cannot be appealed to the court of appeals.It appears to me according to the wording of the remand that they are doctor shopping since they asked the RO to get a VA doctor opinion to rebutt the IMO from Dr. B.So I need some good solid advice as to how to approach and what is the next step.Should I try to find a lawyer at this stage or wait it out?

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Mariano V Principi stops 'doctor shopping'.

However- did the VA have any opportunity to opine already on your claim?

If so does your IMO fully rebutt what the VA said?

Can you give us the exact way they worded the remand part or can you scan it and post it here as an attachment?

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Yes Berta the VA dr. did opine negatively and Dr.B. also added a rebuttal to the supplemental statement of claim thereby giving two opinions.I was given two c&p exams for the same diagnosis,one was in 2000 but dr. did not have my records and the other in 2005 with the records.I also gave dr.B a copy of my smrs to use in his opinion.The wording in the remand states "On the claim for RA with Felty's syndrome,arrange to have the veterans file reviewed by a VA rheumatologist to determine whether it is as loeast as likely as not that the RA had onset during service,considering accepted medical principles,pertaining to the history,manifestations,clinical course,and character of RA.The examiner is asked to comment on the opinion of dr.B.that predicated the diagnosis of RA on the recollections of the veterans spouse that in july 1955 the veteran had a problem with swelling of his hands and had difficulty removing a ring.

In formulating the medical opinion the rheumatologist is asked to consider that the term at least as likely as not does not mean within the realm of possibility.

After the above has been completed,adjudicate the claim.If the determination remains adverse,furnish the veteran a supplemental statement of the case and return the case to the board."

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The examiner is asked to comment on the opinion of dr.B.that predicated the diagnosis of RA on the recollections of the veterans spouse that in july 1955 the veteran had a problem with swelling of his hands and had difficulty removing a ring.

Admiral - I do not think they are doctor shopping. From your posts it appears that you had a couple of non-supporting C&P exams which you have rebutted with this IMO from Dr. B.

Although (from what you have posted) this IMO is kinda shaky because it is based solely on the history as provided by your spouse: The examiner is asked to comment on the opinion of dr.B.that predicated the diagnosis of RA on the recollections of the veterans spouse that in july 1955 the veteran had a problem with swelling of his hands and had difficulty removing a ring.

Laying aside all of the bad things about the VA they appear to have stepped out on a limb and used a Dr. statement based solely on reported history of a spouse and given you some benefit of the doubt at this time. Normally a Dr. opinion based upon history as reported by the veteran does not and will not carry any weight in the claims process. In your case they have put the burden of proof back onto the VA and asked the VA doc to review the statement and then tell them why they should not afford any weight to the statement.

As I said my comments are being made solely on your posts which provides no information on medical evidence supporting your claim of RA other than the statement of Dr B. If this is all there is then, although it breaks my heart, I commend the board for indicating they are looking at the benefit of the doubt, and tasking the VA to support or not support DR B's theory and if they do not support it then to fully justify their reasoning.

I hope my comments do not upset you but from your post it appears that the board is looking outside the box and feel that Dr. B's reasoning in his opinion could be medically true. Kinda nice to see them act the way they are supposed to in all cases. Good luck.

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I agree with Ricky that since the IMO is not based on direct references to SMRs or other med recs-the BVA is giving the VA a chance to opine on it in more detail.

Meaning you too have a chance to send them any other evidence too that supports your IMO.

"considering accepted medical principles,pertaining to the history,manifestations,clinical course,and character of RA"

When a vet gets a rendition like this- I feel the vet should do all they can top provide some abstracts or treatises in support of the claim-

Ten years ago the BVA would have denied your claim- in my opinion- but the BVA saw good reason to request the VA IMO.

For example my husband had an unusual symptom that the VA doctors didnt diagnose for years and when they did they treated it-

I found 5-6 abstracts and medical treatises that showed there was a direct connection between this symptom and his undiagnosed diabetes.

Dr. Bash didnt appraoch his IMos on this facet or other issues I raised but did support his IMOs with medical text references.

That left me with the unusual symptoms as well as other aspects of undiagnosed diabetes that I supported ,from documentation in the med recs, with abstracts and treatises-

The VA said I had only sent them "internet printouts" and had made my own medical assessments of the claim.

I reminded VA that years ago I was awarded FTCA settlement solely on my own medical assessments that the VA could not rebutt. My medical texts and printouts enhanced the IMO that they didnt even read or consider as evidence.

So I had plenty there to rebutt.

CAVC has made it clear that medical literature, abstracts, and texts can be a crucial a part of the evidence a vet or wiodw supplies -

( a recent widows award was based solely

on a medical study)-

and since the VA wants their Docs to use texts to support their opinion-it is imperative that we claimants do too-and make sure that VA considers them if they are critical to the claim.

I dont see this as doctor shopping by VA at all- it is the normal SOP when there isnt enough there to properly weigh the scale.

If what your wife observed can be proven by medical abstract or studies as manifestations of this disability- that could help weigh the scale in your favor.

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Here is what I mean:

http://www.assh.org/Content/NavigationMenu...s_Rheumatoi.htm

That is supportive of what your wife observed-

had anyone else observed this symptom you had?

I would try the John Hopkins web site, Mayo Clinic and Merck (VA will surely use Merck) to find any abstract or study regarding this symptom and also tell VA if this affected you in asny other ways-on the job, etc.

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