Imo

[sbrewer]

I have two questions reguarding an IMO. I know this one has been here before, but for some reason, the search feature does not work for me.

What all needs to be included and the format?

And I kinda thought of this and thought I would ask it for other opions....

Since most drs. are too busy just about to spend time needed on patients, I was wondering if the IMO could be written by ones self, and the dr could read over it and sign off on it. Would this be the same thing as the dr. sitting down and writing it him or herself?

Thanks,

sbrewer

[Guest jstacy]

You need a medical professional to write one. They need to go over the evidence and put it into medical terms.

[Berta]

Absolutely-

the doctor will need complete SMRS unless the disability is presumptive or already SC and the IMO is for a higher rating.

ALso he/she will need the complete medical records available.

The doctor should state their rationale behind their opinion- meaning what area of special expertise do they have that allows their opinion to have merit.

They should refer to specifics in the SMRs if needed and thoroughly link those entries to the present condition.

They should use -in my opinion-the best terms of linkage-such as more than likely-if they believe that the evidence warrants that statement.

They should also refer to treatises whenever possible.

In my IMos Dr. Bash refered to medical treatises, his special areas of knowledge, the veteran's med records, prior SOC statements, and a recent VA "expert" opinion which he called "medically inaccurate"and told them why it was wrong.

He also mentioned his knowledge of 38 CFR , and the VA rating schedule.

His statement was strong as to the fact that he has interpreted CT ,MRIs etc on thousands of patients with this patient's (my husband's) type of disorder and that he had correlated the findings with the clinical record.

He added the veteran's disability that contributed to his death was presumptive under the Agent Orange regulations in 38 CFR.

He also incorporated a favorable opinion from a VA doctor that I got prior to contacting him.

He attached a 9 or 10 page Curriculum Vitae as to his extensive background.

IMos like this contain the elements needed for SC.

I prepared the med recs for him by tabbing the most important ones,although he looked at everything.

I also sent him medical treatises that I had found that supported my claim.

There were other factors he had to consider. The veteran's death was already determined by VA as due to negligence and numerous misdiagnosed conditions.

I gave him all of this info and the autopsy.

Also in the recent IMO he referred to conversations with me by phone that provided lay statements he considered.

(what he meant was that there is a significant medical condition I discussed with Dr. Bash that Rod had, that also totally supported my claim. I sent them the evidence on this many times, but attached it again to my BVA remand request. I think he felt the VA would surely address this, if needed.It was well supported by medical facts from the ADA etc. and I have already sent them documentation in the med recs on this unusual condition- a probative symptom that VA overlooked.He did not need to put this into his opinion.)

My point is- a good IMO has to cover all bases.

A friend of mine got one from a very well known professional but it was not written to what the VA needs.This highly respected doctor did not see any reason to tell VA his background.He also forgot to refer to the nexus in the SMRs which I had blown up ,scanned, and highlighted for him.The doctor was ticked that he had to do it all over again but he did and the veteran was awarded his claim.

I certainly feel you can give the doctor input into what type of IMO you need, but the medical evidence itself will determine what the opinion states.

[Berta]

1968 Army- that is an excellent statement on what IMOs should contain- better than the way I put -I am printing this off and saving it-and hope many will read what you posted.

Yesterday I spoke to someone from Medical Opinions Associates, Inc. Although I feel my IMos are well beyond Benefit of Doubt-I think ahead like you sure do -1968 Army- and I also see these IMOs as an investment in getting a proper resolve of my claim.

Medical Associates Inc,

http://www.medopinions.com

I asked them if they could provide a specialist regarding a very unusual symptom that my husband had. You all know Dr. Bash stated more than likely he had undiagnosed and untreated diabetes.He expanded on this well with a full medical rationale.The brief IMO from a former VA doctor (the one who told the vet to expect a fingerstick test)said Rod's glucose was definitely too high. Even though I am confident in these opinions, I cannot predict what the VA will do.

Rod's autopsy and MRI revealed conditions consistent with diabetes mellitus- as to the specific type of heart and brain trauma he had-supported by standard medical knowledge.

In the original DMII training letter , oral candidiasis is one of the symptoms of diabetes.

The med recs reveal that Rod had this in 1988, when he complained about this causing his mouth to burn, after 1988 ,after documenting it once they never documented it again nor felt it was serious-for four years.

Ironically, he had double vision and they(the ER doc) sent him to the audiologist.The audiologist found no hearing problems at all but he was still complaining of this symptom when the double and blurred vision occured (also symtopatic of high glucose) and the audiologist wrote a complete report documenting these symptoms and stating they were not indicative of hearing problems.1988 med recs.

In 1992 when he had this again while hospitalized they did fully document this and treated it with Nyastatin -for the next 2 years until he died. They never said why he had this and by then he was dealing with a major stroke and its residuals.He did not wear dentures nor took any med that could cause this condition but for DMII.

Oral candidiasis is a prime indicator that glucose level is so high that it is spilling into the saliva.

I have numerous abstracts and reports from Mayo Clinic, and other well known medical sources that supports this -along with all the other medical evidence-as prime indicator of diabetes mellitus-untreated and uncontrolled.

Oral Pathologists are taught to check for this symptom when doing dentistry.

My point- if I need an additional medical opinion-and since Dr. Bash covered so much but not this

important symptom (we discussed it and he saw the literature etc)I got an estimate on fee and time frame already for an Oral Pathologist to prepare an additional IMO if I need it.

This company has worked on opinions for veterans with VA claims and they also cover specialists in fields that Dr. Bash does not render opinions in-such as mental disorders and severe skin conditions.

I emailed them and then filled out the guest book thing and briefly described what I might need.I received a call from them within a few hours,discussed the evidence, and what I already had as far as IMos go.They gave me a fee and said the IMO -if needed -could be prepared 12-14 days after receipt of the medical evidence.

I always recommend Dr. Bash but if the specialty is not in his area of expertise,this link might provide some help on finding a specialist.

I was surprised at the many sites I found that do provide IMOs.I believe Dr. Bash did excellent work and covered many bases in his two IMOs. Reading them over again, I see how definitive he was.But who knows what the VA will pull. And then they could find a 3rd opinion from him as accumulative and reject it.

Like 1968 Army does-I look for the potential land mines-and try to be prepared for them.

The only way to win a VA battle is to have more ammo (evidence) then the enemy does.At some point they have to surrender (award the claim).

PS_- as 1968 Army said the NEXUS factor is everything---

The SMRs have to be mentioned as to nexus by the IMO doctor or even if it is a presumptive condition.

The VA doc did state that the veteran had been exposed to Agent Orange as a risk factor (her opinion actually contained support for the claim but she said there was not enough "reg Flags" during the veteran's lifetime to support a proper DMII diagnosis.

I then sent about 40 references to medical reg flags in his med recs)

But Dr. BAsh again expanded on this and stated that the veteran had no other known etiology but for his known AO exposure, to have diabetes.

It did not run in his family. I think Dr. Bash quoted from the actual Agent Orange Ranch Hand report or the AO regs too.

A good IMO can turn everything around on a claim.

Twenty years ago vets seldom got IMos- and in those days most of their evidence was read by the ROs.AT some point they have to acknowledge IMOs that support a claim.

Edited November 4, 2006 by Berta

[john999]

I was recently diagnosed with arterioscelorsis and I have DMII. The association is so strong that according to the M-21 you do not need to provide a nexus via medical report. Do you think the VA or anyone at the VA did anything to advise me of this? Hell no they did not. I bet the VA is going to demand a nexus statement even though their own rules say otherwise. I can see the decision now, so I am going to talk to my VA primary care doctor to try and get them to put something in the record regarding a nexus. I am not excited since there is no money involved but this is another example of the VA not following up on findings.

[Berta]

John-it would not hurt to copy the NVLSP statement on atherosclerosis from the VBM and send that with you claim and even give it to the IMO doc.

I didnt know this was in the M21-1 as to the strong association.

Cataracts too---but I got a vet that they never even rated for cataracts at all and he has diabetes and mentioned his cataracts are due to diabetes in his claim.

[Josephine]

have numerous abstracts and reports from Mayo Clinic, and other well known medical sources that supports this -along with all the other medical evidence-as prime indicator of diabetes mellitus-untreated and uncontrolled.

Berta,

How long have you been working on your claim for your husbands death? Being a type II diabetic, I can see all the signs of diabetes.

Why doesn't the Va see this.

Did the Va. never treat your husband diabetes? This caught my eye, as I lived off of Nyastatin for about 10 years.

I noticed through all of my medical records, it was hand written in his own hand writing- suspect Diabetes, this would be in 1980.

Another notation was written when I complained about turning into one big cramp, 6 months before it was a confirmed diagnosis. Did you husband have many cramps?

December 2002, right in the middle of a snow storm I had trouble with my eyes. I could see anything up close, as when I was a child, but everything was blurred across the room.

I went to an eye doctor and he thought that I hadn't had my glasses changed in 30 years and then he said, " What about your sugar". By that time, my doctor called me, to buy a sugar machine.

Behold, my sugar was at 400 and I sit up here in a snow storm for 3 days and wouldn't eat a bite and went to the doctor and the sugar had went down to 340 with an A1C of 13.

Put on all this medicine.

Within 2 weeks, this is where is is strange. I called my daughter and remember no more. I was at the local hospital and had been taken there by the rescue squad and had all these test and remember none of it.

I was checked for a stroke and test came back fine. It was my sugar and now I have 3 cyst on both kidneys, left eye the vitreous broke loose and I do not have good vision in that eye.

All because, a doctor did not treat the sugar when he suspected it.

The only good that has came out of all of this. He has really went gun hoe on the Va. benefits for Anxiety and Depression that he has been treating me for the last 29 years and of course Dr. BC.C. Physician, now with the Mayo Clinic in Rochester. He treated me in service and I am using his letter as my IMO. He was there, saw it all and knew it all and treated it all.

The Va knew that your husband was a diabetic, they just ignored it. Did you or your husband ever suspect the diabetes?

Always,

Josephine

Edited November 4, 2006 by Josephine