Seeking Feedback On Imo - Copy Attached

[free_spirit_etc]

Hi folks! I know it has been awhile! I am now scheduled for a Board Hearing and have the following IMO to support my claim. I am open to feedback to pass on to the doctor. Thanks.

Thanks for the replies. I deleted it. I didn't want to leave it up very long.

Edited August 30, 2013 by free_spirit_etc

[harleyman]

Free_spirit_etc- I am sorry for your loss.

With regard to your IMO...

This is probably one of the best IMOs I have read regarding lung cancer in support of direct service connection (as likely as not) opinion for that I have read in a very long time. The opinion is excellent and it is backed by scientific studies and data. Also, your doctor is a Board Certified Radiation Oncologist. As far a credibility goes this doctor's opinion "packs a punch."

When VA gets your application for DIC and your claim for your spouse claim for DIC due to lung cancer to be granted as directly related to his military service, the VA will review this IMO. Unfortunately, now days the RVSRs don't really make a decision on a claim without an opinion from a VA examiner concurring the IMO doctors report. Especially, if for some reason the RVSR doesn't understand the report or it is a "newer" RVSR, they may send the claim file with this report to the VAMC for an "opinion review" just becuase they are afraid of making a decision. This, in essense, is the claims processor asking the VA doctor to agree or disagree with your IMO Oncologist's report. (It would not be unusual for this to happen).

The VA does not have a whole lot of Radiation Oncologists running around serving as C&P exam doctors, who they will ask to review your IMO opinion and your husband c-file to determine it the lung cancer was or was not occuring during his military service. Quite frankly, I don't know of too many VA examiners who would have the credentials or TAKE THE TIME NEEDED, to rebutt or refute your oncologist's opinion. If someone once to refute your IMO,they will have to spend more than 20 minutes filling out a DBQ. Ha!

Personally, I belive this is a slam dunk for service connection, and if by some fluke you do not win your DIC claim for cancer directly related to service you need to APPEAL for sure.- IMO

Good wishes for a speedy decision, and again I am sorry for your loss.- Harleyman

edited for spelling and just to make sense of my typing, Sorry.

Edited August 30, 2013 by harleyman

[free_spirit_etc]

Thanks Harley! This doctor is TOPS for sure. I actually have my Board Hearing next week. I am going to Washington to the hearing - and I was going to give the opinion to the BVA. I also got another opinion from another doctor, It is not quite as strong - but it is still written in my favor.

I am so hopeful that with a strong, strong, strong opinion in support of my claim, another opinion in support of my claim, lots supportive information from journals, etc. that supports what both doctors said that the BVA would grant the claim. There isn't any doctor who has stated that the cancer did NOT start in service.

The VA examiner just wrote:

The veteran retired from service 9-30-1998. Therefore, his presumptive terminated 9-30-1999. I have reviewed the AMR 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. 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 manifestations of the adenocarcinoma of lung first diagnosed September 2000.

That is it. Handwritten on a Report of Contact Form.

I am hoping that the BVA will be convinced to grant the claim, and not remand it to give the VA examiners another try at defeating the claim.

[free_spirit_etc]

Berta,

No. He didn't get radiation from the VA. He was on Tri-Care. When we wrote our letter way back asking the VA to consider the the exam inadequate, we pointed out the examiner stated he didn't have any unique conditions that would suggest he would have been exposed to asbestos - but he failed to address his interstitial lung disease. Actually his post service records do document asbestos exposure. They are post service, but they are still in his chronological record of medical care because he got his medical care at the base.

[free_spirit_etc]

Berta - That was an interesting observation you made about the ILD --about how the smoking "may cause was weaker"

Mayo Clinic lists asbestos exposure as a cause and smoking as a risk.factor:

http://www.mayoclinic.com/health/interstitial-lung-disease/DS00592/METHOD=print

[Berta]

Yes it is interesting and important because I have seen VA deny many claims that they could attribute to smoking habits.

But also some vets have proven a nicotine addiction stemmed from their PTSD,causing other disabilitiy

Smoking is bad for sure, but not always a prime cause of some disabilities, even though VA might say it is.

"I also got another opinion from another doctor, It is not quite as strong - but it is still written in my favor."

GREAT

Free Spirit, one of my IMOs was a 2-3 sentence email from a former VA Neuro who had treated my husband at the VA before he went into private practice.

I sent his email to Dr. Bash who was preparing my 2 main IMOs. Dr. Bash called the neuro doc up
and had him put the same email response to me on his letterhead so VA would know who he was and incorporated the email response into his IMOs.

The BVA gave this 2-3 sentence statement as much weight as any other evidence I had because it corroborated the other IMos and other stuff.

It took me 8 months to even find this doc. I searched for him , because of one entry he had made in the med recs and I remembered that day and what my husband told me he had said (but the cf dm entry had been crossed out in the actual VA med recs) I blew up the record and could see what had been crossed out.

( cf dm ......confirm diabetes)

He was the only doc at VA Neuro team at the time, when my husband was treated for a major stroke, who knew what he was doing.

That other opinion is sure something that the BVA should see along with the main IMO..

[Berta]

Re: what I said about nicotine and VA claims.......

I hate to make statements here without bolstering what I say right away sometimes .........

because I start to wonder where I got the idea....and then I recheck it....

This case shows what I mean:

In part:

, “the veteran testified that he began smoking 
in service when cigarettes were provided in rations, and that 
when he was out of service he continued to smoke and was 
smoking two packs a day.  In addition, while a VA examiner in 
October 2003 stated that in the absence of objective data one 
would have to take the veteran's word regarding whether his 
smoking started during active service, on VA examination in 
July 2006, the examiner found that the veteran had nicotine 
addiction currently in remission, and that given his report, 
it is more likely than not that the he did become nicotine 
dependent during his active military service.” 

“The Board finds that the lay assertions that the veteran 
began smoking during service are corroborated by the medical 
evidence of record.  Therefore, the Board finds that element 
(2), above, to wit, in-service incurrence of nicotine 
dependence, which is a disease, has been established.”  

“ORDER

Service connection for nicotine dependence is granted.

Service connection for COPD as secondary to nicotine 
dependence is granted. “ 
http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp07/Files1/0700952.txt

Although this claim was granted in 2007 by the BVA, the case details how this provision regarding 
nicotine was changed in 1997,so it cant really help most vets claiming disability on this basis these days....
But still I wonder how many vets were denied by VA for nicotine related illnesses that,in fact, 
might have been service connectable ,if filed under the former regs and OG Pres Ops, 

but they didnt appeal to the BVA? The BVA can read.

This vet's PTSD claim was remanded....so it doesnt really show what I meant as to PTSD and nicotine but it was the first one I found to explain what I meant here.