Helping Doctor To Write A Nexus

[Capt.]

Hello All,

Ok,,,, I am going to get more IMO's from several doctors. I already have at least 3 . Most of the Hadit group know the importance of IMO's as well as myself. It is not illegal for a veteran to write an IMO for a doctor for him/her to sign as long as the doctor agrees with it and it is factual and supported by evidence/test. It is his or hers opinion. For the sake of helping me and others who will or are at some point going to get an IMO lets hear from some of you who have had success on the their SAMPLE type IMO that is PROVEN to work or has already succeeded in RO or BVA cases in the past. OR EVERYONE GET TOGETHER AND COME UP WITH A NEXUS THAT IS JUST GOING TO KNOCK THE VA OUT COLD WITH NO WIGGLE ROOM. Also the legal phraseology of the nexus with the ever important acceptable terms such as .....

1."is due to"= 100%

2."more likely than not"= greater than 50%

3."at least as likely as not"= equal or greater than 50%

WHICH ONE IS THE BEST to use for VA , RO, DRO, BVA, COVA, APPEALS.

I have used the bottom one but my IMO's have also said "AS least as likely as not" without the AT least as likely as not". Is this a legal problem and grounds for the VA to ignore IMO?

I believe this to be a great help to the Veterans and I am in the process of writing an Independent Medical Opinion (IMO) or in this case a Medical Opinion(MO) for my VA doctor and several more to sign , which they have agreed to...... I almost had heart failure when I asked and got a yes they would sign it , even when I said I would word it for them.......

OK HADIT family here it is ......plain and simple..... THE BIG GREEN LIGHT.....

SO Everyone can play this one ....what works and what is best? The Veteran writes the IMO/MO and the Doctor agrees to the wording and opinion and signs it.

Lets see what some sample letters that are indefenseable by the VA , should look like from some of the successful Vets here.

Any VA lawyers out there reading this..... PLEASE write a sample letter that will

win in the BVA / COVA Appeals process. Or for that matter even an initial decision.

Lets please try and keep this to the main points ....

Best legal phraseology of the 3 choices and why.

Sample IMOS from members here at Hadit that will propel the claim in a favorable ruling by the VA.

You can write one up that has not been submitted to the VA , so if everyone writes one we can glean and use bits and pieces and come up with one that will be great for Veterans wanting to get their IMO or even VA doctor to use.

This should be interesting and beneficial not just to me but to all Veterans.

Thanks again to our family here at Hadit.....

NEVER GIVE UP .....God Bless,,,,,,C.C.

[Berta]

Bill-for what I paid for 2 of my IMOs- 4,000 bucks- I made sure the doctor wrote them himself-

The full criteria of what an IMO should contain is posted here at hadit- and maybe there are some sample IMos there too-

Maybe some doctors would accept one a vet wrote themselves- if they can concur with it.

In my case I wrote to Dr. Bash of the way I had traced documented symptoms in the med recs to prove undiagnosed DMII.All supported by legitimate medical information known in the standard medical community and many of his symptoms were also in the VA's own DMII traing letter.This is exactly how I proved wrongful death claim in 1997.Without IMOs.

I sent in this additional evidence to the VA even though Dr. Bash didnt need it for his opinion.He focused mainly on the conditions found at autopsy and correlated them with DMII.He did however mention conversation with me in which the 1988 records were pertinent-and he determined that date as first manifestations of DMII.The BVA picked up on that date because this regarded the extensive evidence I too had sent to the VA- ignored for over 5 years-and the 1988 med recs were to be addressed in the remand.I was thrilled with that.An audiologist and a dentist had documented initial DMII symptoms-all found in VA Training letter.

In cases of exposures to toxins, chemicals, AO outside of Nam etc-

the doctor must make the nexus statement- as to the etiology of the disability but a vet needs to remember this is not confirming exposure at all.

Know one knows this better than Kurt Priessman as you know-

he had the presumptives but had to prove exposure to AO in Thailand.(which he did after much research)

This is the same for PTSD claims- if the vet didnt have combat awards they could get an IMO from the Surgeon General of the USA-saying more than likely or as likely as not- but unless the SG witnessed their stressor-and served in their same unit- that does not confirm their stressor.

I sent Dr. Bash many internet abstracts that supported the IMO I needed from him-he read them all used instead some abstracts from very costly medical texts that I cannot access on line.Brauwald and something else-prime medical literature.

A good IMO not only with have a full medical rationale behind any as likely as not or more than likely statement- but also the opining doctor will add excerpts from medical texts, abstracts or treatises to support the opinion.

Edited October 22, 2008 by Berta

[john999]

If I am paying for the IMO then I want the doctor to say "It is my medical opinion that the vet's condition is due to an injury or illness that is directly due to his service". If you are asking for a secondary condition to be SC'ed the the doc should say something like " It is my medical opinion that Mr. Jone's condition (X) is secondary to his service connected condition (X)". Why leave room for doubt?

Also, have your IMO deal directly with the reasons the VA used to deny or low ball your claim. You want the IMO to rebut the VA's decision in detail. Plus, a specialist is better since the VA often uses PA's and Residents to do your C&P exam.

[Berta]

Right John-you added some good points-

the BVA totally disregarded the VA IMO they got to deny my AO claim-because,in Dr. Bash's second IMO

he wrote at the beginning of it"the statements in this recent Statement of the Case are medically inaccurate."

I loved that and he proceeded to state exactly why.

In the response I had made to VA on this deficient opinion, I raised also pointed out that the opining doctor could not even tell military time on the records- critical to the 3 or 4 records she used.

And of course 3 or 4 med recs arent enough to opine on a death claim-Dr. Bash had the whole 9 yards-

I highlighted the support for my claim that the opinion contained with a medical and legal definition of the Risk factor-

Basically as deficient as the VA opinion was in numerous respects- the VA doctor admitted Rod had been a risk for DMII_ all the more reason in lieu of the documented symptoms he had and the findings on the autopsy (which she never even referred to)that VA failed to rule in or out DMII.

The opining doctor didnt even know the VA had malpracticed on Rod causing his death-she had her secretary call the local VA for 3 or 4 med recs-and never even saw the C file or complete medical records.

Veterans are making a mistake if they think a IMO doctor doesnt need the complete clinical record and in most cases the complete SMRS.

The opinion doctor should state in the opinion what records they used to support their opinion.

If they didnt have all of the records- how can their opinion be valid?

I tabbed the critical medical stuff and documents in the whole clinical record for Dr. Bash.

He didnt need the SMRs due to proven AO exposure.

I did send Dr. Bash copy of the District Court Judges letter to Rod that showed the AO Settlement fund (the first AO lawsuit) had confirmed his exposure to Agent Orange In Vietnam.

[cowgirl]

Good thread CC!

When I request IMO from doctors, I copy the rating criteria CFR and CP exam worksheets. Then add them to an outline of my specific condition, VA phrases for support and other specific *medical record pages (SMR and/or VA) that I'll submit for the claim. Usually about 8-10 pg.

So far so good, One doc refused to write a IMO. That doc showed me a valid IMO in my *medical record pages. Pretty good eh?

Best to y'all,

Cg

[Capt.]

Hello and thanks Berta , John , and Cowgirl....

Each one of you posted some pertinent stuff...each having different dealings with the VA and their own battle with them. Kinda of makes you think that each case is viewed differently even when the VA is suppose to use the CFR and MI but we know better. Ok so John I see your answer did not use the important legal terms I listed. Do you think that your answer would satisfy the VA or BVA without the proper wording??? Berta or Cowgirl which legal phrase , of the three I listed, is best then? Yes , I agree that an IMO or MO, if done by VA doctor, should be be written by the Doctor but it is not necessary. The reason I asked for any sample IMO/MO is to help the Vet write one specifically for their disease/injury which the doctor may not be familiar with all of the details or that it is to be used for court rulings and after all this is really what it all boils down to, is court and the CFR's. Where accuracy and wording can mean the difference. Anybody else have thoughts on the wording of the phrases of which one is best or has a sample of an IMO/MO for evidence. Once again thank you Berta, John, Cowgirl. God Bless, Bill

[Berta]

This is the post I put here long ago- I developed it directly from Dr. Bash's IMOs I got-I used the exact format he used.

The only thing I added was the competency part when I noticed that the VA was holding up large retros due to incompetency crap.

"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 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.

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."

Added-the Schedule of ratings for the claimed disability in a claim for higher rating should be attached for the IMO doctor to read.

This way the doctor can shape the medical evidence to support the higher rating.

This is good to do for SMC claims too- let the doctor see the VA criteria for SMC .

I would attach my IMOs but they really would not help you at all-

The VA denied your claim for a specific reason.This is the reason the IMO doctor has to overcome with medical rationale.

The IMO does not have to be full of legal beagle VA stuff-

I have one opinion accepted as a IMO that was only a paragraph or two.

It said it all.

Dr. Bash used this opinion within his IMOs and he thought it was great.

ALL of the medical evidence expanded on this short concise opinion.

It was a freeby and it took me about 8 months to find this doctor- well worth the search.A former VA doctor who had treated my husband and told us he had DMII.The tests he ordered were never done.

John is right on the expertise part-I used Dr. Bash , a Neuro radiologist-because he could interpret my husband's MRI of brain.He correlated the multiple areas and types of brain damage as consistent with "thousands" of MRIs he had read for diabetics with similiar brain trauma due to diabetes.

I also supported this fact with considerable abstracts -very detailed medically and also correlated Rod's heart disease by studying the ECHos EKGs and autopsy with findings that are totally consistent with left ventricular hypertrophy as found in diabetics.

Any vet or widow can provide the VA with competent lay evidence and I reminded VA this is how I proved my past claims.I studied cardiology to win those claims.

Edited October 22, 2008 by Berta