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

[free_spirit_etc]

I agree so much about the nicotine dependence thing. Back in the day when I was researching lots and lots of claims and the VA was able to grant claims for smoking related illnesses based on tobacco dependence the veteran had to "prove" their illness was related to their smoking. You can see lots of claims where the VA doctors said the illnesses were NOT related to smoking. As soon as they changed that law, they related all that stuff to smoking again.

The pattern I see with the smoking, asbestos claims is the VA doctors say that smoking causes 90% of lung cancer, and even if the veteran was exposed to asbestos it would have contributed less than 50% to the veterans cancer, and therefore it is less likely than not. That is faulty math. There is too much research on the combined effect that I don't see how they can keep ruling it out as a contributing cause. I don't see how they can rule one part of a combined effect out just because it may have had less of an effect. The question is not did it contribute more to the cancer. The question is did it contribute. If it contributed 5%, it contributed.

Now if the doctor says they can't separate out the effects of smoking from the affects of cancer - then the claim is granted because if it is not possible to separate the effects of an SC cause from a non-SC cause, the entire effect is presumed to be from the SC cause.

And yes - Vets can still get secondary connection if their SC condition causes them to smoke.

[free_spirit_etc]

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

I was surprised my husband didn't pursue his claims more than he did. I think part of the reason is that even if you got an SC condition, they reduced your retirement pay at that time – so you had to fight and fight to get …. Pretty much nowhere.

And like many vets, he seemed to think the VA would do what it did – and there wasn’t much you could do about it. It is sad how many vets have VSOs representing them – but still don’t get the benefits they deserve.

I

He just had the SOCs, but didn't have copies of his C&Ps (I really think the VA should send those with the SOCs). And when we got the records and went through them - wow! He claimed for fatigue and headaches that he thought might be related to Desert Storm. But the VA said his headaches didn't count as an undiagnosed illness because they were "diagnosed as headaches."

What the heck kind of reasoning is that???

But when we looked at the C&P exam -- the examiner gave two reasons for his headaches. They frontal headaches were caused from chronic ethmoid sinusitis, which the examiner pointed out had been diagnosed path proven in the service. And the headaches that started in the back he opined were from a cervical cause. He showed the x-ray (made copies to put in his report) that showed a separation and space between C 4 and C 5 (I think that was the two). Anyway, my husband had claimed for cervical strain when he retired – and they found a slight abnormality at the exact same place – but said it wasn’t disabling. A few years later, a C&P doctor finds progression of damage in the same place – but the VA denied the claim for headaches because they were not an undiagnosed illness?? For gosh sakes! The examiners connected them to two service related causes. The doctor didn’t point out the neck one was service related though. But if my husband would have gotten his C&P exam reports, I am sure it wouldn’t have taken a doctor long to put 2 and 2 together.

As far as the fatigue – he claimed it when he retired. And they said he didn’t have chronic fatigue. He was just “tired all the time” but it didn’t rise to the level of chronic fatigue. He reopened the claim for fatigue a few years later. This time they decided he was depressed and the depression was causing his fatigue. Geez – the things he triggered on the Beck Depression Inventory were feeling no real satisfaction, loss of interest, difficulty making decisions, needing to push hard to accomplish things, and tiring easily. So you go to the doctor and say you are tired. They have you fill out a form and you tell them you are tired. So they decide you must be depressed because you are tired.

In that case, the VA examiner opined his chronic fatigue was most likely related to his “depression.” In all the years of medical records I have reviewed, the ONLY mention of depression is in the C&P exam who decided he was depressed because he was tired all the time. That was kind of interesting.

Now one thing is that even if it was depression causing his fatigue, he reported it when he retired, and reopened it a few years later, but no one went back and saw if it could be service connected. They just decided since he was depressed it was not a Desert Storm illness.

But something odd is that the VA examiner opined that he was fatigued due to depression, though he noted my husband was scheduled for a sleep study the following day. My husband had a sleep study done, and the VA gave him a CPAP machine. It seems like the doctor would have waited one day to offer an opinion on the fatigue, knowing my husband was scheduled for a sleep study.

My husband complained of difficulty sleeping and fatigue since retiring from the military – he reported it on his discharge physical (which is missing from his file) and claimed for it from the VA before he retired – so I think they should have seen if the sleep apnea was SC.

What is odd is that the VA gave him the CPAP machine, and that is where he went to get his supplies for it. Since he had Tri-Care, I thought the VA only provided treatment for SC conditions.

I think some of these could have been SCed, and I have kind of wondered if the sleep apnea could be a “pending” claim, (for accrued benefits) because they didn’t address it as a cause of his fatigue, even though they tested for it – because they were in too big of a hurry to issue an opinon before all the testing was done.

I guess it wouldn’t hurt to ask….

As far as the other claims, they are pretty much dead – and I couldn’t revive them – and even if I could, it wouldn’t make much of a difference money wise, because of the retiree pay offset at that time.

Edited August 30, 2013 by free_spirit_etc

[free_spirit_etc]

Berta - Thanks for your advise on the other IMO. (By the way, I sent the information in your post about what to include in the IMO to the doctors)

I was concerned that the other IMO wasn't quite strong enough. But it does support the strong one well. The other doctor also reported my husband had slow growing cancer, lived for a long time after diagnosis, briefly discussed growth rates and doubling times, etc. Where they differ is the stronger IMO said the cancer probably started 8 - 17 years before my husband retired and the other IMO said 5 to 10 years. They were using the same logic, but arrived at different conclusions -- but the one doctor didn't go into specific details about how he arrived at the conclusion. So they might consider it "flawed" because he spoke of a doubling time of 180 days, but said the cancer would have been in place 5 - 10 years. (With a doubling time of 180 days - it would be 17 years).

But I hope the BVA doesn't get bogged down in those details, because both doctors made the major point that the cancer didn't just suddenly pop up and grow to 3.1 cm in 2 years.

With two supportive IMOs - and NO medical opinion that states that my husband's cancer did not START in the service (they just said his viral illnesses were not related to his cancer) I am hoping the VA grants the claim without dragging it out and seeking other opinions.

But OMG Berta, you are SO right about IMOs!! I have read cases where the VA doctor will say something like it is impossible to speculate when the cancer started, or we in the field of oncology believe cancer starts when it is diagnosed. The second statement is BS BUT, the VA denied the claim because the widow did not provide an IMO to counter those flimsy VA opinions. And with NOTHING in the file for the BVA to work with, they had to deny the claim.

[free_spirit_etc]

This is my OTHER IMO to submit:

...don't want it out there very long before I submit it.

Edited August 30, 2013 by free_spirit_etc

[Berta]

That is an excellent IMO too Free spirit!

[free_spirit_etc]

That is an excellent IMO too Free spirit!

Thank you so much Berta! I learned about getting IMOs from the best!

We asked my husband's doctors and they said they "weren't allowed" to write them - that the VA would have their doctors decide. (ugh)

Then I emailed lots of doctors who either wanted to charge horrid amounts or said they couldn't help me because my husband smoked.

I got so tired of it all I contacted a Vet lawyer, and figured it would be worth giving them a chunk of my retro pay to not have to deal with finding a doctor.

And they said I didn't have a case. :(

So, I buckled down and got to work. I did contact medopinions, but they charge $2900 - and don't give any guarantees that the opinion will be supportive. Though I understand the non-guarantee part, I called to see if I could at least be referred to a smoker-friendly doctor. I did not want to pay $2900 for a doctor to refuse to support my claim for when the cancer started because my husband smoked.

So I went to SEAK expert witnesses, laid the basis on my case out briefly in an email, and emailed doctors to see if they could write an opinion as to whether it was more likely than not my husband's cancer started in the service. That way, they knew the basics of the claim before they agreed to write an opinion. Of course, they didn't guarantee anything either. And they had to see the records before they could commit to an opinion. But at least I felt they would be somewhat friendly toward my claim if they had already read the basis before they responded.

Actually, after the radiation oncologist read the records, he told me he couldn't believe that they are making a veteran's widow fight this battle. He said ANY doctor should know his cancer started in the service.