Nexus/imo Question

[Vync]

Regarding my lower back claim, I understand that a nexus/IMO from a neurologist or sports/rehab medicine doc is really desired. However, would a well worded nexus/IMO statement from a doctor certified in internal medicine, with 25+ yrs experience, be a good idea or should I keep saving my hard earned cash for the neuro/rehab doc?

Thanks

[jerrbilly]

Either one is sufficient. The main thing is it's thorough and hits mark of what the VA needs to make a favorable decision.

Go for it and don't give up,

Jerr

Regarding my lower back claim, I understand that a nexus/IMO from a neurologist or sports/rehab medicine doc is really desired. However, would a well worded nexus/IMO statement from a doctor certified in internal medicine, with 25+ yrs experience, be a good idea or should I keep saving my hard earned cash for the neuro/rehab doc?

Thanks

[john999]

I think you should get the IMO from a neuro or orthopedist. This way the VA can't top your expert. If you use a internist and the VA uses a neuro or orthopod at the C&P exam that will top your doctor. You don't want to bring a knife to a gunfight.

[Vync]

John,

If they do try to screw me over at the C&P exam, then could I not use relative equipoise to counter it?

I would really be surprised if they even give me a C&P. My range of motion is in the toilet and the records show it recently.

[Berta]

Relative Equipoise only comes into play when the VA finds the evidence both for and against the claim is equal.

However the VA owns the scale that they weigh the evidence on.

I won my claim under Relative Equipoise.

I felt I should have won it due to absolutely overwhelming medical evidence which far outweighed what the VA came up with.

However the VA had 2 opinions against the claim (the last one contained speculation and BVA didnt use it)

and I had 2 extensive IMOs and then a brief 2 sentence statement from a former VA doc.

The BVA gave that statement a lot of weight as well as my IMOs.And all of my lay medical evidence was sound.

It goes to show that even by tipping the scales-which the decision narrative seems to suggest I certainly did- they still awarded under relative equipoise -I think because the 2 IMOs I had were from the same IMO doctor yet based on different aspects of the claim.

It is not the extent of an IMO that matters, it is the expertise the doctor has in order to make a fully rationale medical statement as to the nexus and extent of the disability.

The IMOs I paid for were 2 pages long with 10 or 12 page Curriculum Vitae.

I made sure VA knew the freeby I got was from a former VA doctor whose care my husband was in for weeks as his notes are in the clinical record.

He seemed to be the only VA doctor at that time who knew the true etiology of my husband's condition.His attempts to test for proper diagnosis were overruled or ignored.

I proved all the other docs during this hospitalized malpracticed on him to cover up malpractice from another VAMC.

I had to prove that all to the main IMO doc but that didnt take more than a few minutes and then with the full clinical records, he prepared 2 strong IMOs.

[Berta]

PS this is why I feel an SOC on a denial has to be responded to line by line as to any negative medical stuff.

A copy of the actual C & P is the only good way to do this as SOCs do not often contain all the actual copy does.

When I sent Dr. Bash my stuff I also sent him all past C & Ps and SSOCs.And legal -medical reports generated from a prior claim.

Often claims succeed when a vet can successfully combat a lousy C & P exam with documented facts from the clinical record.

Say the C & P doc guessed on a ROM measurement without using a goinometer.

Or the C & P doc manipulated something critical the vet said as to their condition.

Or the C & P doctor did not consider significant records -these are all ways a C & P can be combated.

I rebutted the endocrinologists opinion in many ways.

One point I made is that she didnt understand Military time on the clinical records.Those times were critical to one part of my claim.

ANother point is she offered no etiology whatsoever that medically ruled out diabetes nor gave any reason why my husband's death was due to ischemia of heart and brain.

She totally ignored the autopsy and all of my competent lay evidence as to how the autopsy revealed untreated diabetes -such as the heart slides and myocardial fibrosis etc etc

She said a notation of DVD in the record did not mean what I said it did-diabetic vascular disease-she said it meant the veteran "denied Venereal disease"

My rebutt -He never denied it- this was noted throughout his med recs that he had VD in Vietnam.

I also rebutted with a printout from 2 well known medical texts -DVD when noted in med recs by any doctor -means Diabetic VAscular Disease.I made the point that one print out came from Merck itself - a text that VA always uses.

My point is a rebuttal to a negative C & P exam depends opn using common sense as well as medical facts.

But this can continue the claim for years as VA rebutts the rebuttal or goes doctor shopping.Or argues that the veteran is not a medical professional therefore their rebuttal is not sound.

In many cases the cost of a strong IMO (if the medical evidence supports the claim) is absorbed with a few comp checks that-without the IMO- might never come.