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Question For Patrick428 Or Anyone Else

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John's Primary (IMO) DR. has written a lettr of all of his medical problems.

Took it to our VA Rep and she said it sounded good but negative and there where no phrases in like " more likely tha not" or "Least as likely as not" in it, so she said we should not sumit it.

I suggested to John to ask the DR. to rewrite this letter with these phrases it it, He of course thinks it would be an insult to ask him to redo it. It would be like saying it isn't good enough do it my way.

Question to all: Is John's thinking right or wrong:

The DR. does not have any idea about VA system

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If the letter does not put a nexus to a related issue in service in the form of at least as likely ( 50 percent)

more likely (75 percent) Was due to (100 percent) Then it is worthless.

Anything less will open a area where the VA can shoot down the opinion in a negative manner.

It may be wise to show the regulations to the Examiner and state that is what the VA needs.

On a more important basis , The examiner should state what medical records have been reviewed.

If this os done, Then less headaches are likely.

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Unfortunately a doctor needs direction on these IMOs- the VA certainly has no format for a vet to get one-

Here at hadit somewhere there is some sort of IMO template-

This is one reason why I recommend Dr. Bash-he understands VA lingo and the regs and mentioned this clearly in the last IMO he did for me last week-

He read my SSOC of Dec. and could knock down the VA "expert" very well-

I posted this under another topic here today-

something about nexus and IMO topic-

I wrote letters for 2 of my local vets to give their private doctors as to how to shape their IMOs.

I enclosed in one case the VA Asbestos training letter info and explained to the private doc exactly what the vet needed in the IMO-

in the other case I enclosed something else from the VA as to what they would look for in this IMO_

This doc was a little upset too because VA questioned him-

and upset because I copied his health grade background off the net and told the vet to attach it to the second IMO-he thought I questioned his credentials- I had to explain we were knocking down the C & P docs credentials-

with his because they were profoundly much better than the C & P doc.

The nexus to this case- 12 years in process- was in the first paragraph of his BVA decision-

I was stunned when the vet came here, I clicked on BVA and got a decision with a ne=xus in it that NO ONE had clicked on-the key to his claim.

I had to clearly explain to his IMO doc that this inservice nexus had to be highlighted in the IMO as this is what the VA needed.

The SMRs etc went back to the IMO doc, the VA screwed around some more, then suddenly the vet called me, he got an award! After 12 years he was joyous at 40%SC , 8,000 retro but I immediately prepared his NOD -they owe him 100% SC plus SMC and much more retro.

Dont be hesitant to tell your IMO doc what you need.Otherwise you will be waiting for a denial-if you have an IMO or not.

Look at the five point criteria the VA uses for their docs opinions -posted here today-and apply this as to what you need from your doctor.

Edited by Berta (see edit history)
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  • HadIt.com Elder


I agree with you. If the letter does not support the nexus it is worse than useless, and could be used against the veteran. The VA will quote out of context and turn your own doctor's opinion against you. The last thing you want to do is give the VA ammunition it can use against you.

I had a great report from my psychologist and the VA took part of a sentence out of context to shoot down my TDIU request. I won in the end but it just meant another year of waiting and another IMO. We used to have a sample IMO letter here that had the correct buzz phrases like "After a careful review of all the veterans service medical records and current medical records" ending with a statement that the vets disability is "more likely than not" a result of a service connected injury or illness. If you plug these kinds of statements into the report that is what the VA wants to see.

The kind of IMO I like to see starts with a review of the patients medical, military and social history. It then goes through all the symptoms and degrees of disability with all the whys, whens, and wherefores and ends with a nexus statement to tie it all up in a bow. The report should rebutt the VA's contentions and show evidence and opinion as to why the VA is wrong and the vet is right in his contention.

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Guest jangrin


One of the reasons my husband got an IME/IMO from Dr. Bash is because Dr. Bash understands the VA requirements that vets must meet in order to substanciate their claims. The reason we got an IME instead of an IMO is because my husband very seldom went to the doctor. He has very little in the way of medical records (except for very recent VA records).

When his medical problems became apparent we needed a doctor that would be an advacatev for my husband much like a private insurance doctor. So Dr. Bash was choosen because of his experience and his education (curriculum vitae). His report was the first report in my husbands records. We gave a copy of his report to the SSA doctor. Any future C&Ps will also have a copy of his report in the records. The records are what is called "thin" but what is in them is very powerfull, and influential to other providers. (doctors do not like to contradict each other and when they do it is usually very subtle.

If you are unable to use DR. Bash, someone on the site here ( I think it was John999) reccommended that you contact a lawyer for a referral to a doctor for IMO. It is an excellent idea because they know exam/opinion doctors as they use them for their cases all the time. These doctors do report writing like this for a living. They may not know VA but because you hire them they will listen to your needs and keep that in mind when writing the report. They won't lie but they will write the report they way it needs to be done for the VA.

Most private practicing doctors, do not have the time to research what you need.They are into treating patients not writing reports. It is very seldom that you can find a doctor to do this for you inexpensivly. Once in a while you might find one, but the odds are against it.

I hope this helps you, it is one of the most important things you can do for your case and well worth the money, please DO NOT submit a report that is not in your favor or that can be turned against you.


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  • HadIt.com Elder

When dealing with conditions that demonstrate symptoms both in service and post service there is other terminology that works just as well. Other terminology was used in my case and many I read in BVA decisions.

A notation in the post service medical record that the symptoms in-service were for a chronic condition whereby there is no evidence that the condition resolved post service is cited in many successful BVA decisions. In my claim I took a letter explaining the 50% etc. The doctor completely ignored the letter and wrote that I had a current diagnosis of angioedema for which I was treated for the first time while serving in the armed forces. The disease is chronic and has no known cure. This note was cited as well grounding the claim. I was service connected based on this report and a stack of post service treatments in ER's at various VA hospitals.

Post service treatment is very important. Conditions must be sufficiently chronic post service to be considered disabling even if it started in the military.

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