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Read First If Getting An Imo

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Berta

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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.

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I think Berta has given the best advise.   While the VA cannot deny a claim based on the fact a doctor did not review records it is best to get them to do it anyway.  In the decision I cited there is also a note in there where the courts mention that there are ways for a veteran to get copies of their records so the doctor doing the IMO/IME can see them. 

Also,  on a personal note I think IME's go a lot further than IMO's because for an IME it is an actual examination.  IMO's are opinions based on the view of records. 

This does not mean the VA will not deny the claim even if you do everything correct.  I personally think raters cannot properly read the english language and they are lazy.  I have been denied service connection because someone they claimed records that were not in there actually were.  I submitted an IME report that covers all the recommended points and still was denied.  I submitted an IME that had a separate diagnose and report for each diagnosis I claimed.  I submitted a separate lay statement for every disability claimed.   The rater only cited the IME in 3 of the 12 decisions and did not make a single reference to any of my lay evidence. 

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Bumping  it up-the criteria is on page 6.

Also we have Buddy statement info under a hadit search as well as how VA defines a Stressor -under a search.

And also the 2010 new PTSD regulations are here as well.

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This is an old thread but very helpful to anyone needing an IMO/IME.

I am bumping it up for a local veteran-who said none the local vet reps can help him in person- due to Stay at Home restrictions here. 

And just to add:

It might be necessary to get, along with your  your SMRs, on a SF 180 at National Archives on line, , a copy of your Military Personnel file.

I had a good friend who kept forgetting to get his NAV201 Personnel file.

He finally did and I found in it evidence of his first manifestation of a MH issue.

I wrote up a brief statement for his VA doctor. who I also knew well, and the doctor prepared an excellent but very brief IMO for him. 

This doctor, a VA psychologist, had been treating him for over a decade for the MH issue he claimed, and somehow the veteran had kept this MH claim in the system long enough to get to the BVA on appeal.

Unfortunately this doctor ( my husband's PTSD psycholoigist as well)never  documented any extensive treatment records on  VA employees such as my husband ( because -this doctor shared with me he did not want to have anything documented , that the VA could use against their employment)but I do not know if maybe he did have some documentation of this other MH veteran.

The veteran based on the VA doctor's brief IMO which was also really an IME, as his prime MH doctor, succeeded at the BVA and the retro was almost 1/4 million.

This is why a military personnel record can be very viable for some specific disability claims.

I am sure I also mentioned this in this thread somewhere-

that it helps the IMO/IME doctor to have a copy of the actual C & P exam and the SOC that denied the claim.

If the VA fails to read and comment on a valid IMO/IME- even if they list it as evidence, that is a CUE under 38 CFR 4.6.

If the VA has a valid IMO/IME and does not even list it as Evidence and ignores it completely. that also is a CUE under 38 CFR.4.6.

You can and should CUE them immediately.

 

 

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Thanks, that is good to know Hamslice-if VA had already gotten the 201 file.

Many vets still need to  get them at NARA, as far as I know, if the VA doesn't get them.

 

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