Md Statements: Opinions

[Guest jstacy]

I have been reading the board and have come across the following.

You have a MD statement that says it is at least as likely as not, is most likely, was due to.

I received a SC for a least as likely as not ( 50 percent sure)

I have 2 C@P opinion from MD not NP that state most likely. (75 percent)

I have 1 from same doctor that says was due to. (100 percent)

I have no decision because this has been going from the rating team to the development team back and forth. I feel confident I am going to win, But they are really messing with these claims.

Has anyone ever been denied and had a MD statement at the least as likely and and over opinion?

Edited August 30, 2006 by jstacy

[Guest jstacy]

Those statements of degree of certainty are used by the VA in the Adjudication process. I have seen an instance where a Nures Paractitioner issued an opinion , but a MD over ruled it. They are supposed to follow the advice of a good opinion but they always try to find a negative opinion to shoot down a claim.

Edited September 7, 2006 by jstacy

[Dorothy Kansas]

You mean that you can be DENIED a claim with an IMO of #2, "more likely than not" ?

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1. "is due to" (100% sure)

2. "more likely than not" (greater than 50%)

3. "at least as likely as not" (equal to or greater than 50%)

4. "not at least as likely as not" (less than 50%)

5. "is not due to" (0%)

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What are the essential items of a good IMO?

* PERSONAL DATA

* MEDICAL DIAGNOSIS (specific by title of disease/condition)

* MEDICAL PROGNOSIS (future outlook, permanent, no chance of improvement)

* RATIONALE FOR OPINION (nexus)

On Dr. Bash's web site, he has a sample Letter of Disagreement with VA Medical Evaluations (C&P). Dr. Bash used, "it is my opinion that this patient does have XXX". Also, he says, "it is my opinion that this patient’s XXXXXs are all likely XXXXXX."

Must the IMO state "it is my opinion that Mr. YYYYY's XXXX is due to ZZZZZ ?"

Comments, please?

Yes! I was denied for more likely than not. They chose to give the other opinion more credibility. The opinion for more likely than not was from the specialist who treats this condition,

[Ricky]

VIKE In my example below, the IMO was two pages. It included the doctor's creds, my hospital trip, the symptoms recorded by the hospital, statements about my treatment under him (to rule out doctor shopping) a couple of entries about current medical acceptance that the symptoms were indicative of stroke, the association between dmii, hypertension and stroke then what his opinion was based upon - his personal review of the MRI films, my verified symptoms -

What else could they want- they had his experience as a neuro guy, association between stroke, dmii and hypertension, established treatment between patient and doctor and his opinion based upon his experience, personal review of related medical records and current treatment of my symptoms.