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.

[paulstrgn]

6 hours ago, blahsaysme2u said:

do they have to say they "reviewed all records" or can they say they reviewed relevant auiditory records?

Mine just said they reviewed my medical records and gave examples of relevant medical records looked at. The IMO he used had several check boxes for evidence looked at and the first one was "military service treatment records" which he checked. Now he did not look at all the records, I gave him all the relevant ones that pertained to my SA (I did the leg work to make sure he looked at what I wanted him too). They were BMI and blood pressure readings. His rational was that I was already obese and that the military failed to diagniosed my high blood pressure. He also marked "VA treatment records" and "civilian records". I had given him a copy of the medical opinion done by the VA (the NP had stated I had gained weight since leaving the service and became obese indicating it was not service releated), and the civilian records were the sleep studies.

I believe if the IMO is well written and indicates that all relevant SMR were reviewed and any other medical records you should be okay. After all they don't need to review your medical records when you went to sick call for an unrelated illness.

[blahsaysme2u]

2 hours ago, paulstrgn said:

Now he did not look at all the records, I gave him all the relevant ones that pertained to my SA (I did the leg work to make sure he looked at what I wanted him too).

aaaaaaaaaaah. ok good deal. i dont have my c-file yet so they cant review the VA findings, but agin the VA was not actually looking or testing me for what i was saying was wrong(and what i now know as CAPD). 

like if you file for brain tumor bc of the symptoms you exhibited. but didnt know it was PTSD  then you went to C&P and they only examined you for brain tumor even after you described the symptom.all the test come back normal and mri shows nothing, ..and they dont examine you for depression or PTSD bc you didnt put in claim for that. of course they deny the claim bc you dont have a brain tumor(i dont have hearing loss) and years later you find out about this disorder called PTSD that explains everything. does your new dr really need to review the denial for your brain tumor claim?

my new audiologist gave me a hearing test just like the VA did and i passed it bc my actual hearing is fine, its the processing that sound into speech or determinable information thats the problem.

 

[JKWilliamsSr]

Nieves-Rodriguez v. Peake  is the precedent setting case that states that a medical opinion cannot be discounted because the physician did not review the claims file.  This decision was handed down in 2008.

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014711/Nieves-Rodriguez-v.-Peake,-Dec-1,-2008,-22-Vet.App.-295

 

[GBArmy]

blah Really good input from JK. However, old habits sometimes die hard. The VA sometimes doesn't flow down to the people who should know rulings and training info that changes their methods. We shouldn't lie, ever, but here is how I view the "review of records" by your doc. Give them copies of what you can from ebennies; the stuff that pertains. If you don't have a cfile, no sweat. They probably don't have the time and inclination to read it anyway. But, give them SOME records. Then, tell them that when they write up your opinion they say "they have reviewed the veterans files and medical records."  Notice, I didn't say "ALL" the records. Big difference, and it is the truth. No problem.

[blahsaysme2u]

yeah that was my main concern....thanks GB and JK and everyone here

[Berta]

If a claim was denied due to no inservice nexus, an IM0/IME doctor would need a copy of the SMRs.

Also they need copies of any negative C & P exams.

And it is a good idea to highlight with tabs, anything in your Medical record stack ,that supports the claim. and refer to them in a cover letter to the doctor.

Someone here said IMO/IMEs are a personal decision and they are correct!

It depends on how much confidence you have ,in your medical evidence , that an IMO/IME will actually  grant the claim.

Sometimes even an IMO/IME expert cannot provide the information you need.

It can be a major expense, so try to be sure that it will help your claim.

Neither IMO doctors or vet lawyers can perform miracles.

This veteran had a 1151 claim and also an IMO but was denied, under 1151:

https://www.va.gov/vetapp19/files8/19161291.txt

This vet had 2 IMEs but was denied:

https://www.va.gov/vetapp15/files6/1553025.txt

However in this claim the veteran had re opened his back disability  claim with an IMO/IME and BVA granted that claim, as the IMO doctor had referred to the veteran’s SMRs.

https://www.va.gov/vetapp19/files7/19157427.txt

 

In this case a widow proved her husband’s death to be service connected. She had two very strong IMOs.

https://www.va.gov/vetapp19/files2/19109224.txt

A point about SMRs-I believe the VA just skims over them most of the time.

It is something a veteran, needing a nexus, should do themselves.

And,if they get an IMO /IME, they should try to point out to the IMO doctor whatever they find in them that would help establish the inservice nexus.

 

 

 

 

 

Edited December 18, 2019 by Berta