hypertension For Berta And Others...request For Increase And Iu And Imo

[joeserp]

Sorry this is so long..Wanted to try to give a complete picture.

Currently 60% combined. 30% for Colitis and six 10% for Tinnitus, scarring of face, hypertension, Laceration of right wrist, left and right carpal tunnel.

Have applied for increase and IU, reporting my Colitis has got worse, to include feelings of depression and fecal incontinence. Sent the VA copies of my Medical Records for the past year from the GI doctor.

Received a letter back from VA asking me to send them a signed VCAA document, signed VA forms allowing them to contact my doctor’s and supporting documents saying the fecal incontinence and depression are related to my service connected disability.

Spoke to my GI doctor (non VA), tried to explain the importance of using key words such as, “More likely than, or At least as Likely”. Was advised he does not like to do letters like this as he is there to treat and cure, or something like that.

Well, he did give me a letter that says, I have Ulcerative Colitis that is poorly controlled, That I am scheduled to begin treatment with biologic in hopes that my colitis can be brought under better control. He said, my fecal incontinence appears to be related to my diarrhea and specifically to my left-sided colitis disease. Adding, this patient has a Chronic Condition that will require ongoing treatment.

I also saw a VA Psychiatrist – First Visit. He said

Axis I: Major Depressive Disorder, single episode, mild to moderate, likely related to

his Ulcerated Colitis.

Axis II: Deferred

Axis III: Ulcerated Colitis, hypertension, hyperglycemia

Axis IV: Moderate to severe

Axis V: GAF 60

I have not worked for almost 5 years so no letters from previous employers.

I have three C&P’s scheduled. So far have found out 1 of them are for Psych, other is for Hearing, don’t know what the other one is for.

Now for the IMO

I am in the process of getting an IMO.

In the past when I submitted a claim, all or part was denied and when I submitted a NOD, I had better luck. I also hear this happens often.

QUESTION:

If the IMO is good, should I submit it now, or should I hold on to it and wait to see what the results are and if needed submit it with the NOD?

Thanks

Joe

[Berta]

“If the IMO is good, should I submit it now, or should I hold on to it and wait to see what the results are and if needed submit it with the NOD .”

If the IMO is good and conforms to the IMO criteria (in our IMO forum)I would send it in ASAP with a 21-4138 as a cover letter to support the claim.

But you haven't been denied yet-

“He said, my fecal incontinence appears to be related to my diarrhea and specifically to my left-sided colitis disease. Adding, this patient has a Chronic Condition that will require ongoing treatment.”

This isn't exactly what VA wants as an IMO but it certainly ties in the fecal problem with the SC

colitis.

“Axis I: Major Depressive Disorder, single episode, mild to moderate, likely related to

his Ulcerated Colitis. “

This too can help the claim but the single episode part concerns me.Then again it appears that you will be getting more treatment for this.

“I have not worked for almost 5 years so no letters from previous employers.” Does the form say you still have to list those employers?

Do you get Social Security disability?

If so is it for exactly the same SC conditions you have now?

And if so, does VA know of the SSA award?

“I have three C&P’s scheduled. So far have found out 1 of them are for Psych, other is for Hearing, don’t know what the other one is for.”

Try to get the results of those C & Ps as soon as they are prepared.

It is possible that they could render an award and if not- the C & P results should be something the IMO doctor has, in order to medically argue with what they say.

Then again regardless of what the C & Ps say, a strong IMO could potentially rebutt anything they use to deny.

If the IMO supports a finding of unemployability due to SC conditions, that will be excellent TDIU evidence.

In my opinion you have evidence already that does link the depressive disorder and the fecal problem to the SC colitis.Make sure you send the private doctor's opinion with proof of mailing and a 21-4138 brief cover letter telling them this is evidence for your claim.(I assume he put this on his formal letterhead)

I would hate to see you spend IMO money at this point if your claim doesn't require an IMO-

particularly since you are set for those C & P exams.

One of my IMOs was from a former VA neuro and it was a statement he made to me in email after I spent 8 months looking for him.A decade had passed since he had treated my husband and then went into private practice but he remembered my husband's hospitalization well.(He was the only VA doctor at this VAMC who didnt commit malpractice while treating my husband there and his suggestion for further treatment had been ignored)

Although his email statement was very brief, Dr. Bash, my other IMO doc called him and asked him to put the statement on his letterhead which he did and sent that to Dr. Bash who incorporated his statement into my initial formal IMO.

The BVA weighed the former VA neuro's statement with great weight as it corroborated the other medical evidence.

So while the opinion you have from the private doc isn't perfect-it still holds the key factors for secondary SC.

The C & P exams might well go OK here and VA might consider you unemployable due to the SC conditions.

I hope others chime in.

I spent 4,000 on IMOs and then had paid 1750 more for another one I didnt need.The award came before it was even prepared.

The VA neuro email IMO was a freeby.

I never regret these costs but hate to see any vet pay for an IMO that perhaps the medical evidence would award without the IMO.

“Axis III: Ulcerated Colitis, hypertension, hyperglycemia”

Is the hyperglycemia controlled?

Hyperglycemia s a symptom that VA doesnt SC. If it turns into full blown diabetes mellitus , that is different as DMII is presumptive to any incountry Vietnam vet.

[john999]

If your claim is pretty strong you might wait for your decision and then get a doctor to craft the IMO to rebutt exactly the VA decision. This is a step-by-step deal like any legal process. After all your C&P exams the ball is in the VA's court until you get a decision. I went from 10%, to 30%, to 70% to TDIU over a number of years. I was appealing all the time.

[joeserp]

For Berta and John999

Thanks for taking the time to respond.

Not sure if it matters, but the VA Psych put me on Paxil.

I am not on SSDI. I applied (thinking I was qualified) and was denied because I have not worked and do not have the necessary credits. I stupidly thought I was qualifed since I have been drawing a Navy Retirement for 20 years.

My three C&P's are scheduled for the end of the month.

I have already mailed out the Cashier's Check to the Doctor for the IMO.

I expect to get the IMO about a week before I go to the C&P's.

Not knowing what the IMO will say, I am thinking, I should hold on to it until I get copies of the C&P's.

Then I can compare both and decide.

Any opinions on this?

[Berta]

If the IMO is strong maybe you should bring it to the C & Ps.

Some C & P docs might not want to consider it but some of them might take into their consideration what your IMO says.

Does the IMO doc have a Curriculum Vitae they can attach to the IMO?

CVs from IMO doctors or at least a statement as to their credentials, any seminars they attended or spoke at, any abstracts they have written etc etc, all helps support that their credentials and expertise outweigh or can match that of any VA C & P examiner.

I ran a local well known endocrinologist through healthgrades for a few bucks and told the vet to send it with his IMO to VA as he was too proud to give any credentials for a local vet I helped.He thought the VA had heard of how brilliant he was.

I also ran a VA endocrinologist through healthgrades for my last claim.My IMO had an 11 page CV attached and the VA doctor had nothing in her background at healthgrades to come close to it.

Also the next C & P I had to combat was done by a PA.PAs can be very good but they do not have MD after their names.

I rebutted this exam and the BVA rejected it because,in spite of overwhelmng medical evidence , the examiner's opinion was to speculative and held no medical facts that would go against the claim.

Sorry about the SSDI- I think maybe one has to have worked within 5 years of applying for SSDI.

Have you checked into any possible CRDP eligibility?

Edited August 10, 2011 by Berta

[john999]

Filing claims with the VA is not an exact science. You just get all the evidence you can and file your claim. Persistence is what wins these things in the long run. Keep appealing and getting more evidence until you win. I read posts here all the time about how long this or that phase of the process should take and that is all bunk. You just fight it until the end however long it takes.

[jsmith6609]

My UC is rated at 10% with Anxiety/Depression as secondary to the UC. I just put it to get an increase for UC and Anxiety/Depression, I was originally rated at discharge from the Army @ 10% even though this was the primary condition used for discharge and my medical records stated unresponsive to treatment. Im lost on how the VA determines these things.