Good Question For Imo

[cooter]

Ok IMO experts, sharpen up your nails cause I need an answer that is no where to be found!!!

When writing up an IMO for an existing SC disability that has worsened in time, and your C&P examiner states that you can only do sedentary work, where/what is the starting point of the phase of the worsening when you begin explaining the Subjective & Objective scenario's.

Another words, since the disability has already been established SC, do you begin at the beginning when you injured yourself, or since the last surgery of the injury, or does it start with the C&P exam stating sedentary work only. I just don't want to add alot of history that isn't going to make any differences to the result of decision...Hope this is understandable what I'm trying to say.

Coot

[Berta]

I am confused here-

when an IMO doctor writes up an IMO report,they base their opinions on the entire medical record as to

'where/what is the starting point of the phase of the worsening.'

("when you begin explaining the Subjective & Objective scenario's" =I dont understand this part but others will know what you mean.)

In both IMOs I got from Dr. Bash, he made definitive statements from the medical evidence, as to when my husband's physical disabilities started and then , in essense , 'the phase' where they got worse.

This is why I suggest always preparing a cover letter with an IMO request to tell the IMO doctor exactly what type of award you are seeking and what you need them to clarify in the IMO with references to the medical records.

It helps too that they have copies of denials, SOCS, etc and copies of actual C & P reports.

Dates of treatment records, and medication changes also can show a SC disability has worsened.

Also by comparing the Schedule of Ratings that warranted the initial rating, then offering evidence that the disability has fallen into a higher rating criteria ,warranted by current medical evidence, I guess I don't see how important the dates of increased disability began, when the VA, if this is a re-opened claim, will use the date of the claim for retro anyhow.

On the other hand -I await a response from the VA, this is not an appeal, that sort of involves what I think you mean-

it involved a very old C & P exam and in those days claimants and their reps never even asked for C &P results.

24 years later, in Dec 2011, something the Nehmer examiner stated was a big red flag for me and NVLSP.

It involved the date the disability worsened which could be significant in your case as well as mine.This was also an FTCA case so that is why the big red flag.

BUT my long point here is,your subjective evidence could include lay statements from family/friends, but that should be supported by documented medical records that would show either maybe more appointments at VA to treat the disability as it worsened or, often better yet, prescriptions of higher dosages or additional meds to treat the condition, that could be tracked as to dates of the med changes, showing increased disability.

Maybe results of any older C & Ps you had would also help you compare the current level of disability to the past rating from the Schedule of ratings at time of the past rating. The past ratings sheets certainly might help too as they would contain the diagnostic codes VA used in the past.

I feel an IMO doctor will cover all bases in establishing when the disability worsened,and they should also have copies of any lay statements as well as all medical recs , to include medication records.

But I think I am missing a point here that others will comment on.

Unless this is a TDIU award and you get SSDI solely for the same SC, I assume VA will use the date of the claim

for any retro regardless of when the disability worsened, as they could do a staged rating, based on the evidence available.

What I mean is say the medical evidence doesn't really warrant a higher rating until 3 months after the date of claim.

VA could continue the current rating for the first three months after claim date, then stage a higher rating at some point, as they had medical evidence that the disability got worse during the claims process.

This is also why IMO doctors should have a good concept of the nuances of the VA rating schedule for all disabilities.

That is the criteria they need to focus on,in their IMOs, for claims for higher ratings.

I am no IMO expert.

But before I paid thousands for IMOs, I made sure my claim and medical evidence was as solid as it could be.

[carlie]

Ok IMO experts, sharpen up your nails cause I need an answer that is no where to be found!!!

When writing up an IMO for an existing SC disability that has worsened in time, and

your C&P examiner states that you can only do sedentary work,

where/what is the starting point of the phase of the worsening when you begin explaining the Subjective & Objective scenario's.

Coot

Coot,

Are you asking in relation to a claim for VA - IU or SSA - SSDI ?

[cooter]

Sorry Ladies! Somewhere between my brain and my writeing hand, there's a loose connection that's shorting out my thought process.

Berta>..Subjective=History......Objective=Finding's...When filling out an IMO

Carlie>..This is for a VA TDIU claim that was denied

Ok let me try a different approach with this.

First of all, I'm trying to write out an IMO for my private Dr as he has no idea when and where to use the "benefit of doubt rule", among other VA language. After trying to explain to him the Do's and Don'ts on the letter, that loose connection must of showed up again cause he was all confused. He said just write it up and he'll sign it. ha

Long story short; 2003 SC right knee>Reason>Parachute jump in 1976..2008 Total Knee Replacement, 30%...2009 awarded 60%...2009 filed claim for TDIU...2010 claim denied>Reason>sedentary work only...2010 filed Reconsideration...2011 1 year anniversary>filed NOD...2011 Dec. C&P Exam>Finding's>sedentary work only...2012 working on more evidence.

Now.. The VA has all my history of my SC knee, correct. Being the argument for TDIU SC, is going to be based on whether or not I'm capable of sedentary type work. Sooo, when I write about my IMO Dr's finding's (which is the part my Dr explain's his rational and bases to why I am not capable of sedentary work), do I begin his finding's from the very beginning in 2003 to the present time, or do I begin from the last C&P exam. Another words, use my last C&P exam as the bases of his rational.

I had to stop a couple of times to rattle my brain to get this understood a little better. I hope this works! Like I mentioned in an earlier post, I've searched for an answer for this but no dice. Thanks!!

Coot

[jbasser]

Cooter, an IMO if done correctly will establish a timeline for you.

Better off using a SSDI format for this because it as way more detailed than one for the VA.

A good examiner knows what to do.

I had a template that shows the timeline. Here is an example with a fictitious ailment.

1978 Veteran reported trouble with knee locking up.

1982 veteran underwent knee surgury

1996 Veteran had to quit job because of th e KNEE,. (Could no longer stand)

2000 Veteran can no longer use the knee.

The medical evidence establishes a time line with treatment and diagnosis dates.

Basser

[Berta]

"First of all, I'm trying to write out an IMO for my private Dr as he has no idea when and where to use the "benefit of doubt rule", among other VA language. After trying to explain to him the Do's and Don'ts on the letter, that loose connection must of showed up again cause he was all confused. He said just write it up and he'll sign it. ha"

He doesn't need to throw in Benefit of doubt rule.

The full IMO criteria is here in our IMO forum.

The language regarding " as likely as not" etc is there too.That covers BOD regs.

"He said just write it up and he'll sign it"

Who is going to give the complete medical rationale ?????

He needs to refer directly to the medical evidence.

I had local vet and went through a miserable ordeal getting his doc to write a valid IMO.

The doc got mad at me and at the veteran because the VA rejected his first IMO.

Finally the doctor calmed down and wrote a proper IMO in the IMO format VA is used to and the veteran won the claim.

(It took a lot of work on my part to even establish an inservice nexus and without that, his second IMO would have still been useless.The claim had been in the system for over a decade, until I found and established the nexus, which fortunately you dont have a problem with here.)

Maybe if you search 'sedentary work ' at the BVA ,there would be some idea of whether vets have overcome that statement with or without IMOs.

I searched there the other day and many sedentary work claims popped up as cause for denials but I didnt have time to read them.

Your doc has to give a strong medical rationale as to why you cannot do sedentary work if that was the reason they denied TDIU.

Do SC meds you take interfere with employment? Do the meds say do not take and drive? Do they say causes sleeplessness or drowsiness or confusion?

Were you ever turned down for Voc Rehab solely due to your SCs?

These are all important factors in TDIU claims.

Edited April 12, 2012 by Berta

[carlie]

cooter,

Check your PM's.