ptsd Read First If Getting An Imo

[Berta]

Tbird has very good info at the hadit Home page on IMOs.

I reworked a topic I posted here some time ago.and maybe it can be found better now:

Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim.

VA plays a war game called the War of the Words. The proper wording of an IMO is critical to VA's acceptance of it, as probative evidence.

Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability and can be very costly.


However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO.


A Valid IMO must contain the following:

The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs.

Also the doc needs to have all prior SOC decisions from VA ,particularly those referencing any VA medical opinions and a copy of the actual C & P results is even better. The SOC or SSOC could parse or manipulate critical statements in the actual C & P exam.

The IMO doctor should define their medical expertise as to how their background makes their opinion valid.

They should be willing to attach to the IMO their CV (Curriculum Vitae that contains their medical background and any other info pertinent ,such as any symposiums they attended, articles they had published etc etc,if possible, that show their expertise .)

A psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.

They need to have expertise in the field of the disability you have claimed to make their IMO valid.

They should rule out any other potential etiology if they can-but for service as causing the disability.

They should briefly quote from and cite any established medical principles or treatises that support their opinion.

They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record.

They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion.

They should then refer to specific medical evidence to support their conclusion.

They must use these terms: (VA is familiar with these terms)

"Is due to- 100%
More likely than not- Greater than 50%
At least as likely as not- 50% (Benefit of doubt goes to Vet)
Not at least as likely as not- Less than 50%
Is not due to- 0% from an post by carlie “

It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion.



A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records.

Send the VA and your vet rep copies of the signed IMO.



And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence.



PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes times to find and have the VA approve of a payee. (unfortunately many PTSD claims these days depend on a VA MH professionals diagnosis of PTSD and an IMO diagnosing PTSD will not be accepted by the VA. See our PTSD forum for the 2010 regs on that.

I need to add here that a secondary condition to an established SC condition wold not need the IMO doctor to read all of the SMRs.
They just have to state with medical rationale why the second claimed disabilty is due to (secondary to) the initial SC disability.

IMO docs must avoid words like 'maybe', 'possibly', 'could ' or 'might' be related to, or any other wording that VA could construe as speculative and then disregard the IMO for that reason.

On the other hand the IMO doc should look for any purely speculative statements in the C & P exam report or in the C & P and overcome those statements by stating they are mere speculation and have no medical basis.

DIC claims IMOs are different and the IMO doctor needs the death certificate and any autopsy findings and any past C & Ps as well as the entire clinical record (to include SMRs in some cases) and copies of any and all private records.

They need the rating info on the vet and what his or her SCs were for.

If the immediate cause of death is NSC but a service connected disability substantially contributes to death, the VA should award DIC.

Often this type of DIC claim definitely needs an IMO to clarify a substantial contribution to a NSC death.

1151 IMOs are different too.

The IMO doctor must identify the exact nature of the negligence with direct referrals to the med recs.

Then the IMO doctor must make a strong medical statement with a full medical rationale that the veteran has a documented disability that is directly due to the VA's negligence and give a full medical rational for that.

It is a good idea for a 1151 IMO doc to also add abstracts or citations from known medical practices in the 'standard medical community' to bolster a 1151 claim.

What I mean is showing the VA proof that non VA doctors (the standard medical community) would have taken different steps to diagnose and treat the veteran and the VA's “omission” of these proper medical steps caused the veteran's additional and documented disability.

Hope this all helps someone.

[free_spirit_etc]

"The SOC or SSOC could parse or manipulate critical statements in the actual C & P exam."

Yep....

[jbasser]

Berta, I have detected a pattern they are starting to use against IMO's. If you get an IMO the VA will likely defeat it by using the words Tele IMO.

It may be a good thought for the veteran to seek an IME instead because a vet should be examined by the doctor.

[Philip Rogers]

There's no doubt in my mind that an IME should take place for an IMO.

pr

[carlie]

Berta,

Great post.

I always suggest getting an IME that also contains an IMO when possible.

I say if you think you can't afford it - go collect aluminum cans for recycle money,

eat ramen noodles for months, stand on the corner with a need some help sign . . .

put together every penny you can and get the damned IME/IMO, and be sure it's done right the first time.

[Berta]

You are all Correct on the IME.....I didnt even think about that when I wrote this.

Sometime ago Dr. Bash mentioned ,maybe on a SVR show, that he does IMEs whenever required.

For many claims he doesn't need to (and IMO docs cant do IMEs for DIC claims), but you all made a great point.

An IME can also determine the exact level of disability for rating purposes,that might be a far greater level than the VA could determine.

And a good IMO doctor can also raise secondaries ,due to the disability claimed, and give a full medical rationale for them as well and then the claimant should claim the secondary conditions too.

I need to find the cover letter I sent to Dr. Bash for my IMOs.That might help someone out there to use as a template.

Or maybe just make one up as a generic template.

Thank you all for adding the points about the IME.!!!! (Independent Medical Exam)

[john999]

I know when I went to recommended doctor for an IME I did not really want an IME. I wanted a report that would support my claim for TDIU. I did not pay a chunk of money to get some joker to say "This vet might be unemployable". I paid for an opinion that would say "this vet can be poured into a bucket he is so messed up". Just kidding but if you live in a big city you should be able to find a doctor that will opine in your favor.

[Vync]

Words of wisdom

[iraqvet77]

John,

What doctor did your IME and how much was it?

Thanks

[NavyWife]

I wanted to add the link for the website that K9MAL found, which is a list of IME docs throughout the US.

http://www.imenet.com/

[Chuck75]

That website may be quite useful!

[ArNG11]

Personally I have made the decision to get an IMO. If this fails then and IME. My point though or rather concern is this. If they ignore evidence, whether, in service medical records or private like mine, 15 7/8" thick all records. Why would they even acknowledge an IMO/IME? It seems to me, from what I ve read in the forums you only have a slight chance of getting this corrected at BVA or CAVC level, at times even worse, when it goes to the mighty Supreme Court.

I am a little disturbed, but I can't help getting the image of seeing myself holding a 9mm to a rater's face and stating that you will adjudicate the claim by regulation, law and ALL the evidence. Im meaning this to be metaphorical but now and again I think about it.

I know I'm pushing the envelope here a bit and letting some of my monsters out, however, am I really that far off the mark? I know this is the game now, but does it really have to be like this.

Anyways, I believe that truth will prevail eventually. An IME/IMO is expensive. I am using one now and have sent records to a records review agency to consolidate my file. I decided to use Dr. Ellis. He is here local and more often than not has had positive results. I will say it is expensive. 15" or so of records. So I urge vets, that once they have a claim won and have a nice chunk of compensation to save the money for an IME/IMO. You will get lowballed and you will need the ammunition to counter the BS that the VA decision makers hand out. If there is such a thing as handout. I've given heart and soul to this country and I only ask that they take care of me in return for the service I provided. It is the only just thing to do. No amount of money will make me whole again, however, it can help the difficulties that I will face for the rest of my days.

[GatorNavy]

This is an excellent thread. As Berta has already stated, sometimes an IMO is the only way to get Service connected Compensation. I flailed around for about a year trying to figure out what my VSO was missing. Asknod told me that I needed a NEXUS opinion to pass go and collect the 200 dollars:

-------------------------------------------------------------------------------------------------------------

In order to establish service connection for the claimed 
disorder, there must be 
(1) medical evidence of a current disability;
(2) medical, or in certain circumstances, lay evidence of the
 incurrence or aggravation of a disease or injury in service
 or during the presumptive period; and 
(3) medical evidence of a nexus between the claimed in-service
disease or injury and the current disability.  Hickson v. West,
 12 Vet. App. 247, 253 (1999).  

The determination as to whether these requirements are met is 
based on an analysis of all the evidence of record and the 
evaluation of its credibility and probative value.  Baldwin 
v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a).  Once 
the evidence is assembled, the Board is responsible for 
determining whether the preponderance of the evidence is 
against the claim.  If so, the claim is denied; if the 
evidence is in support of the claim or is in equal balance, 
the claim is allowed.  38 U.S.C.A. § 5107 (West 2002); Ortiz 
v. Principi, No. 01-7006, slip op. at 7 (Fed. Cir. Dec. 17, 
2001); 38 C.F.R. § 3.102 (as amended by 66 Fed. Reg. 45,620 
(Aug. 29, 2001)).
 

----------------------------------------------------------------------------------------------

Of course the C&P exam (once I showed cause to have one) was a thumbs down, no surprise there as the benefit of the doubt at the RO is that no evidence equals negative evidence. . . I had an IMO/IME from the VA provider (An expert for 15 years in her field) that had been treating me for 2 years. The RO deep-sixed that one. I submitted a statement from my VA PCP who stated my service connected conditions and why I could not work and they deep-sixed that. Those opinions were never listed as evidence in the SOCs or SSOCs either so the VLJ would never even knew they existed to begin with. I guess I can say that this VARO is quite consistent about using POSITIVE evidence as toilet paper. Of course they lost my 10 years of active duty SMRs and then promptly rebuilt my C-file of over 25 years with nothing in it. My C-file is now as skinny as a toothless ferret. In two weeks I have my BVA hearing and it will be a trip down memory lane. All of the evidence will be re-submitted including a squeaky tight IMO that the VARO has never seen before.

[ArNG11]

It's amazing how that crap works isn't it. Deniability, it wasn't in the C-file. Yeah BS, when wasn't in the c-file, before of after you shredded it, or if you mr rater even looked at it. You must have since you didn't mention it explicitly . Look copy everything, keep a journal and keep multiple records. Buy a high speed scanner, opt to have a records review, keep all your mail you send these bozos. It is all a PAPER TRAIL. Just like this websites advocates. I will say in my case. I just sent my whole file to a records review agency. I didn't have the chance to copy it since it was 15 1/2" thick, I am running out of time, but I am getting ready to hire a lawyer as this is too much for me and they can request a copy via the law. I still have mounds and multiple copies of private records which is where most of my conditions are documented anyways so tit for tat of sorts. The VA doesn't know me and what I am capable of doing. I am committed now and there is nothing turning me back from the path that has been laid down before me, except death, and I don't plan on dying anytime soon, at least as far as I can help it.

Excuse the affirmations. A good IMO/ IME is worth the time and the cost. Better to have in service documentation, however, an IME/IMO can be a powerful weapon. Members here have won and it is possible. Just keep pressing.

Edited March 28, 2014 by arng11 (see edit history)

[john999]

I had an IME 40 years ago that declared I was 100% disabled. The VA just ignored it, and since they did not even have to list evidence in those days you never knew if they even looked at it. I can tell you that the NOD is the most important few lines of script you will ever file in your life. Due to my own ignorance and VA's mailing my decision to the wrong address I missed a chance to challenge the awful decision I got back in the day. I am sure many vets fail to appeal decisions even in this day and age. The VA can deep six an IME/IMO for any number of reasons. You have to consider that a vet who files a mental health claim is trying to prove they are mentally/emotionally ill. This, in itself, is a pretty humiliating experience. Before the concept of PTSD was accepted by the VA mental illness claims were really like a brand of shame. The VA assumes you are shaming to get money. The C&P doctor's assumed the same thing. You might have some VSO who would look at you and say "You look ok to me. Why are you asking for an increase?" Before the internet it was just you and your VSO against the VA with limited knowledge available. I remember my VA doctor telling me I would never be able to get more than 30% for bipolar because I was not psychotic as in seeing things and hearing voices. The army combed out numerous months of treatment records and army doctors failed to even DX conditions I had while at the same time telling me there was no treatment. They lie to a 20 year old kid to save a buck and these people say "Duty, Honor, Country". What honor I would say! Doctor's who lie and misrepresent conditions to make their commands happy so they don't get sent to a combat zone.

[GatorNavy]

The VARO will deep-six evidence only if it is positive toward the Veteran. If there is something wrong with an IMO/IME then they would gladly list it as evidence and flaunt it as the basis for a denial in a proverbial heartbeat. Notice how the timelines are always against the Veteran and the VA takes as long as they want too? IMHO if the VA doesn't start granting more claims sooner then they are finished as a Federal Agency. Non-adversarial means that we don't get a firing squad just for applying for benefits. The VA's "ex-parte" system amounts to a denial or low ball decision along with a take it or leave it attitude. Waiting 5-10 years for any semblance of justice on appeal is abominable, and has nothing to do with the US constitution. Their idea of justice is to let the appeals languish so long that many appeals will just fall to the wayside for one reason or another. Some Vets get just ratings sooner than later but most Vets don't win the VA lotto. In the mean time the VA continues their shell game.

[GatorNavy]

Living in the outback, IMEs are near impossible to get.

[Berta]

bumping it up

[63SIERRA]

The VARO will deep-six evidence only if it is positive toward the Veteran. If there is something wrong with an IMO/IME then they would gladly list it as evidence and flaunt it as the basis for a denial in a proverbial heartbeat. Notice how the timelines are always against the Veteran and the VA takes as long as they want too? IMHO if the VA doesn't start granting more claims sooner then they are finished as a Federal Agency. Non-adversarial means that we don't get a firing squad just for applying for benefits. The VA's "ex-parte" system amounts to a denial or low ball decision along with a take it or leave it attitude. Waiting 5-10 years for any semblance of justice on appeal is abominable, and has nothing to do with the US constitution. Their idea of justice is to let the appeals languish so long that many appeals will just fall to the wayside for one reason or another. Some Vets get just ratings sooner than later but most Vets don't win the VA lotto. In the mean time the VA continues their shell game.

my brother you speak the truth,and thats why I believe the whole system as it currently operates, is intentional. Time is on the Gvt side, not ours. The life of this country may be infinite, the life of its veterans is not.

[63SIERRA]

Insurance companies work the same way. The reason ... because they dont pay interest/. They will stall and delay claims, because there is NO INCENTIVE et all to settle in a timely matter. They rather hold onto the money as long as possible.

Like my buddy used to say .. " as long as I owe you you shall never be broke" ? ha

Edited May 23, 2014 by 63SIERRA (see edit history)

[Berta]

Bump