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.

[Berta]

Just to add here.......

I recently read an IMO,done by a doctor who certainly had expertise, but not in the field of most of the veteran's claimed disabilities.

This happens when multiple disabilities are claimed by only one IMO/IME is prepared ,to ostensibly cover all of them.

That  does not always work out well for the claimant....because the doctor might not have the background to support their medical rationale at all for all disabilities claimed and the opinion might hold more weight if it focused solely on anything is that is within the doctor's actual expertise.

A doc with expertise also has at their fingertips, the most current studies ,abstracts, and published medical

knowledge they would need to cite and then bolster their opinion and rationale.

We can all find stuff on the net that seems to support our claims medically.I used to use Merck, because VA does. But much on the net is outdated medically and a good IMO/IME doctor would be well aware of the best medical texts to quote or to cite in their opinions. 

A full strong medical rationale depends on documented medical facts, expertise, common sense, and the ability to rule out any other bogus etiology a VA doctor might come up with, in order to deny the claim.

In the long run, I feel one IMO/IME for many conditions, might appear to save a big fee cost,but if the IMO/IME doctor does not have the background for their opinion on some of the disabilities, the veteran might well need to spend more IMO $$$ on an additional expert medical opinion. 

 

 

 

 

 

[Buck52]

Thats a good Point Ms berta! I totally Agree.

[Berta]

bumping this up for local vet

[Berta]

Bumping it up for new member

[Berta]

Someone asked for a simplified version of the IMO/IME criteria-something that they can give to a private doctor,who might have never prepared an IMO/IME before,  that is not too involved-

You need to explain briefly to the doctor exactly what type of disability you are seeking the IMO/IME for.

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.

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.

_____________________________________________________________________________

For example, you have a private doctor willing to do an IME for you.

You have SC diabetes and want to sc your NSC heart condition to it ( a non AO claim)

You seek an Endocrinologist or a cardiologist to do the IMO/IME:

EXAMPLE IMO/IME

I have been asked to do an opinion regarding, _______________________name of veteran.

They seek service connection of their heart disease as a secondary disability ,to their established service connected  diabetes mellitus.

As a ( put cardiologist) or Endocrinologist here), with expertise in these two disabilities, I quote from the American Heart Association:

"The following statistics speak loud and clear that there is a strong correlation between cardiovascular disease (CVD) and diabetes.

At least 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16% die of stroke.

Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.

The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease."

http://www.heart.org/HEARTORG/Conditions/More/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp#.W1C2CdJKg5s

Also:

https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke

(The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH).

The veterans has also enclosed with my opinion a copy of VA TL 00-06, pointing out that diabetes can lead to heart disease. I t is a well known estabished fact ,in the medical community to include the VA , as wityhin this VA Traiing Letter, that DMII can cause heart disease.

I have examined this veteran and diagosed him with diabetic cardiomyopathy.

I have reviewed all of his VA medical records, and have determined his DMII diagnosis preceeded  his heart disease diagnosis and there is no other know etiology for his secondary cardiac situation, but for the diabetes mellitus.

It is at least as likely as not that the veteran, (__name ___________) has developed cardiomyopathy solely due  to his service connected Diabetes Mellitus.

I have enclosed a Curriculum Vitae of my expertise in diagnosing and treating diabetes and also the secondary disabilities ,such as heart disease, that  it can cause.

------------------------------------------------------signed by the IMO/IME Doctor.

Example # 2

I have been asked by ( name of veteran) to render an opinion on their bi polar disability.

The veteran is service connected for  High Blood pressure that was noted in his SMRs many times.Also I have  a copy of his USN 201 Personnel File.

While in the Navy,the veteran received a Captain 's Mast on  (date) and was put into the brig for a few days for unusual and bizarre behavor. The veteran was discharged a few months later with an Honorable Discharge.

He subsequently was awarded SSDI solely for his NSC bi polar disability.

I am a psychologist with expertise in Bi Polar disabilities. The VA treatment records show this veteran does gets VA treatment for his Bi Polar condition.

It is as likely as not that this veteran exhibited the very first manifestations of Bi Polar a few months aboard ship, prior to his discharge from the Navy, causing the bizarre behavor.

He also showed me a "buddy statement" from one of his shipmates who  also  witnessed another unusual manifestation of this disability , which is attached to my opinion.

He lost his first job, after discharge because one day he went to work and told everyone he was their new boss and started to give orders. When  he was fired his wife insisted he see a psychiatrist and at some point after getting a diagnosis of  Bi polar and continuous  treatment he applied for and received SSDI for this disability.

I have attached my Curriculum Vitae and have had numerous articles published on Bi Polar , and how it's early manifestations ( as in this veteran's case) are often mistaken for completely unrelated illnesses and/or anti social behavors. I have copied one of those articles to have the veteran attach to my opinion.

Signed_______________________

 

( This was supposed to be a condensation of what an IMO/IME doctor would need to cover but I found that we really cannot condense the IMO/IME criteria too much. Every bit of it is important depending on what the veteran is seeking from an independent medical review of his/her disability situation.)

If anyone here can condense the IMO/IME format to make it shorter-

or write another example letter-and someone asked that it be put onto just one page, please advise how that can be done.

 

 

 

 

 

 

 

Edited July 19, 2018 by Berta

[Berta]

To add there are templates for Experts to use for forensic IMO/IMEs just by googling expert medical opinion templates.....

BUT the VA is a whole different ball game-and I really dont see how the info here can be made briefer than it is.

It is imperative, to let an IMO/IME doctor see a copy of  whatever  C & P exam resulted in a denial of the claim

and also the decision as to exactly why the VA did not award the claim......was the C & P medically deficient

 or is there another reason for denial?