Va Medical Opinions

[free_spirit_etc]

My husband's claim for lung cancer is on the basis that his lung cancer began while he was in the service. He had a 3.1 cm tumor of slow growing cancer removed 2 years after his retirement. He also claimed - as a secondary basis - that his exposure to asbestos - working as an electrician for 13 years (before safety equipment was used) contributed to the development of his cancer.

Though he was not able to get an actual written opinion from his base doctors (they said the attorneys won't let them write them) - he does have documentation within his post service medical records indicating probable exposure to asbestos - and the relative risk - and indicating the typical growth rate for his type of cancer - and the time it would take to grow to the size of my husband's.

Though these doctor's notes would most likely not stand alone (against written opinions of the VA doctors), they should add support to an IMO.

The VA initially acknowledged my husband's claim was that his cancer STARTED in the service. There are MANY BVA cases awarded for post service diagnosis of cancer on the theory that the cancer could not grown to the extent it did without starting in service. So this is not a "new" idea to the VA.

But the VA then obtained a medical opinion (without having him see the doctor) on the asbestos exposure alone. The doctor opined that asbestos could not have played a role in the development of my husband's cancer because the doctor stated there was no evidence my husband was exposed to asbestos. (The doctor indicated that he was an electrician but pointed out he wasn't part of any medical surveillance programs. Those programs were not even implemented until my husband no longer worked as an electrician.)**I will add that the doctor wrote it on a C&P form - so it looks like a C&P - but he never saw my husband. It was an opinion; not a C&P exam.

My husband once again stressed his major claim was that his cancer STARTED in service. The VA acknowledged this. My DIC claim stressed this again. And the VA once again acknowledged it.

However, I just received a copy of the medical opinion they obtained (which was used to deny my DIC claim) and it only addresses whether his SYMPTOMS in service were connected to the cancer. Once again, they ignored the major point of when the cancer most likely started.

The medical opinion is rather brief and handwritten on a Report of Contact form.

"This veteran retired from service 9-30-1998. Therefore, his presumptive terminated 9-30-1999. I have reviewed the SMR related to treatment for respiratory problems. The symptoms and treatments suggest manifestations of viral respiratory tract illness. None of the episodes can be reasonably linked to an early manifestation of lung cancer. (over)

After review of the c-file it is my opinion the veteran’s signs and symptoms listed in his SMR are less likely than not early manifestation of the adenocarcinoma of lung first diagnosed in September 2000."

XXXXXXX

10/19/07

My question is as the VA has already obtained two medical opinions on the claim, and ignored the major premise altogether, if I obtain an IMO that indicates it is more likely than not that his cancer started in the service - is the VA then allowed to obtain a third medical opinion from one of their providers - or would that be considered a "fishing expedition?"

I also looked up the name of the doctor who issued the last opinion - and the doctor is a thoracic surgeon. It seemed kind of odd that they would have a surgeon addressing early symptoms of cancer. (However, I would think a thoracic surgeon would know fairly well that type of cancer would not have grown to 3.1 cm in two years. - but he didn't say it did not - he just didn't bother to mention it.)

Lung cancer, by the way, most often has NO symptoms until the late stages. The doctor didn't even bother to mention that. He merely indicated that the symptoms my husband had were most likely not an early manifestation of lung cancer.

And really - if I turned in an IMO of the same quality as the VA opinion - the VA would give it no weight at all.

So again - that is my question - can they just keep on cranking out the shoddy medical opinions to deny the claim, and then when I submit an IMO, decide to get a "better" medical opinion to counter with?

Thanks!

Free

Edited January 29, 2010 by free_spirit_etc

[Berta]

"My question is as the VA has already obtained two medical opinions on the claim, and ignored the major premise altogether, if I obtain an IMO that indicates it is more likely than not that his cancer started in the service - is the VA then allowed to obtain a third medical opinion from one of their providers - or would that be considered a "fishing expedition?"

Hard to say- I thought they were attempting fishing expedition on me when they had 3 for the claim and one VA opinion against.But I like to fish- I sent for a fourth IMO - the remand called for a Cardiology opinion but they gave the VA opinion request to a PA.I knocked down his opinion.

Even before my IMO cardio doc had chance to write up the 4th IMO-the BVA awarded the claim.

It doesnt matter what they might do-a strong IMO can level the scales and they can make an award if all evidence is equal for and against the claim.(Doctrine of Relative Equipoise)

But VA owns the scale- an IMO has to be VERY strong and follow the IMO format carefully (criteria for IMO is in IMO forum here.

The clock is ticking.How long do you have to respond to their last letter?

My initial IMO took only a week after I contacted him by email and told him a little of my evidence.It took time to copy all of it and send him the whole thing-all med recs, and considerable other documents not in the med rec files but most of that had been done already.One week or so after he got all that I had the IMO.

The cardio IMO- I had to sign the contract and send the check first and then prepare a cover letter and exhibits geared to this different type of IMO then what I previously had and then sent the whole 9 yards of all Med recs, etc, SSOCs, etc, FTCA etc, to the Cardio doc.

The clock was ticking and the 4th IMO was not done in time for BVA to consider when they awarded.

I didnt need it but I wasn't going to take a chance on some bogus cardio opinion from a mere VA PA to outweigh my stuff.

If you fully feel that an IMO will help the claim and support the evidence for service connection-it has to be viewed as an investment-easily recovered with comp or DIC that might never come without it.

No one here can predict what an IMO will contain or whether a requested IMO will even help a claim.

Awards rest solely on medical evidence -which a strong IMO can put into the strongest light with a full medical rationale if the IMO doctor sees the medical rationale for that.

[free_spirit_etc]

Berta,

Thanks. I don't have any time frame to respond to their last letter. I already have all my appeals in. The last letter was the medical opinion I have been trying to get a copy of for a couple years. When I emailed the Survivor Unit that you gave me the info for, they forwarded the request and I got it in two days. Amazing.

[carlie]

free,

How about finding an Oncologist to go over your

husband's medical records for an IMO ?

Would that be possible ?

carlie