Ro's Response To Imo....

[vetwife]

Hi all,

We got a IMO from Dr Bash for my husbands claim. Please read the attachment on the response from the RO in their decision (denial) letter. bash.bmp

This claim is a 1151 - the RO never ever sent him for a C&P , never got their own opinion, just swept this under the rug. Then they knock the IMO that we sent - the only medical opinion there is on this claim - it's not even disputed - because they never sent my husband in for one..... This came a while back...I'm am still REALLY upset.... please read & give me opinions on what to do ( I have just filed form 9).

I have his records! They x-rayed the wrong ankle & then reported that he only had a sprain - when he actually had a fractured ankle bone. They had him walking on it for over 4 months in excruciating pain before finally doing an MRI & seeing it was still fractured.

The decisions also reads "there is no evidence the VA caused additional damage" Could they truly believe walking on a fracture for months wouldn't cause additional damage?

If I am wrong - please set me straight here.... he ended up with sever nerve damage & having to have his whole ankle fused together. But they think they didn't cause additional damage? Is that possible?

[rdawg]

poolguy hit the nail on the head, no examination by Dr. Bash. The VA docs may render "persuasive" opinions without an examination but the vet may not. Another example of the cards being stacked against you.

with that said, I don't think flying to MD for an examination would n=make any difference. They've made uo thier minds and are not budging. time to move to the next level.

[Berta]

Did Dr. Bash have his complete set of medical records?I assume that he did.

Have you contacted Dr. Bash since getting this decision?

This part concerns me however:

"The decisions also reads "there is no evidence the VA caused additional damage" Could they truly believe walking on a fracture for months wouldn't cause additional damage?"

Was Dr. Bash able to determine what the additional damage was?

Section 1151 are not easy.

I had to prove the malpractice occurred from the actual medical records,step by step, then prove a cover up at another VA hospital and then prove this malpractice directly caused my husband's death (it caused 100% additional disability in his lifetime and then led to his death.)

The evidence was in his medical records-difficult to see at first but it then became quite evident.

You have to prove that doctors 'in the standard medical community' oputside of the VA would have taken different approach to his situation.

Has he seen any private orthopedic specialist?

"I have his records! They x-rayed the wrong ankle & then reported that he only had a sprain - when he actually had a fractured ankle bone. They had him walking on it for over 4 months in excruciating pain before finally doing an MRI & seeing it was still fractured"

Did Dr. Bash have these specific records and did you highlight them for the VA to consider?

[Pete53]

I have thought about this and I have seen another example of a VARO trying to discredit Craig Bash and I think that you need to send him a copy of this VARO crap Statement concerning his qualifications.

I know that Dr Bash does not take every case and is not a hired gun Doctor. His IMO's although expensive are professional and well documented. I believe that he even worked for the VA at one time doing C&P's. I know that he has helped a lot of Veterans get Service Connected on very difficult claims. However he is brutal when he deals with VA incompetence and I figure that some have a score to settle.

This is probably why you need a lawyer but I think it is important to let Dr Bash know what happened.

Good Luck

[spike]

I brought the regs into this because I am all about learning and helping teach. Hopefully my fellow vets here are wanting to learn to :( and teach as well.

First off, IMO is short for Independent Medical Opinion. It sounds to me that the VA is stating Md Bash never saw the Vet to confirm or deny that the VA is at fault. Secondly, it sounds as though the VA is stating that Md Bash is biased and is not making a Independent Medical Opinion or Evaluation. I am personally confused honestly because IMO is Independent Medical Opinion, while his page says Indepedent Medical "Evaluation". The way I understand an Evaluation is by actually seeing a patient.....maybe the confusion lays there....The difference between the two is Opinion is based on the evidence I have reviewed, evaluation is based on the tests I have conducted/evaluated (right??)

§ 4.2 Interpretation of examination reports.

Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes.

[41 FR 11292, Mar. 18, 1976]

Regs on Independent Medical Opinion With the CFR

§ 3.328 lndependent medical opinions.

(a) General. When warranted by the medical complexity or controversy involved in a pending claim, an advisory medical opinion may be obtained from one or more medical experts who are not employees of VA. Opinions shall be obtained from recognized medical schools, universities, clinics or medical institutions with which arrangements for such opinions have been made, and an appropriate official of the institution shall select the individual expert(s) to render an opinion.

(;) Requests. A request for an independent medical opinion in conjunction with a claim pending at the regional office level may be initiated by the office having jurisdiction over the claim, by the claimant, or by his or her duly appointed representative. The request must be submitted in writing and must set forth in detail the reasons why the opinion is necessary. All such requests shall be submitted through the Veterans Service Center Manager of the office having jurisdiction over the claim, and those requests which in the judgment of the Veterans Service Center Manager merit consideration shall be referred to the Compensation and Pension Service for approval.

© Approval. Approval shall be granted only upon a determination by the Compensation and Pension Service that the issue under consideration poses a medical problem of such obscurity or complexity, or has generated such controversy in the medical community at large, as to justify solicitation of an independent medical opinion. When approval has been granted, the Compensation and Pension Service shall obtain the opinion. A determination that an independent medical opinion is not warranted may be contested only as part of an appeal on the merits of the decision rendered on the primary issue by the agency of original jurisdiction.

(d) Notification. The Compensation and Pension Service shall notify the claimant when the request for an independent medical opinion has been approved with regard to his or her claim and shall furnish the claimant with a copy of the opinion when it is received. If, in the judgment of the Secretary, disclosure of the independent medical opinion would be harmful to the physical or mental health of the claimant, disclosure shall be subject to the special procedures set forth in §1.577 of this chapter.

(Authority: 38 U.S.C. 5109, 5701(:D(1); 5 U.S.C. 552a(f)(3))

[55 FR 18602, May 3, 1990]

[Tayo]

Very, very, very interesting.

I agree,,, a lawyer may be needed in this situation.

However,,, you have his medical records.

1. Find the original day you went in to see the doctor about the ankle.

2. Look for what is titled "Progress Note."

3. You will see something like c/c. That means the patients chief complaint. What is there?

4. Then look at what may be listed as HPI. That means "history of present illness. Does the Chief complaint match what is in the History?

5. Then look for Assessment and Plan. That should be at the bottom of the progress note. Here, it should talk about the doctors assessment of the injury. Is this the same as the initial complaint, etc.

6. Now,,, the doctor should have written information about X-Ray of the correct ankle. The doctor would have put in a consult to X-Ray the ankle. Was the consult for the correct ankle?

---

Now,,, locate the note containing the X-Ray. "Radiology Report"

1. What does the report say? They should have listed what ankle was X-Rayed.

2. Does that match what the consult was for?

Hope that helps. Still,,, you may need a lawyer to get all this settled. I also agree with the others about contacting Dr. Bash.

Still, after reading the VA's response. It sounds like Dr. Bash is a wonderful person but,,, I read that he is known by the VA. I'm not sure how to take that. I do understand what Dr. Bash is doing. To interpret medical records and form an opinion,,, well, the patient does not need to be present. That is an opinion of a physician.

So,,, yes,,, please, once more,,, contact Dr. Bash and try to find a lawyer.

Tayo

[jbasser]

I agree you do need an attorney but dont forget the fac that Dr Bash is a NeuroRadiologist.

He was a radiologist before he specialized in the Neurological modality.

His opinion cannot be discounted that easily. It may at a certain level but once it sets serious at the court level it will come into play.

Good luck.

J