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 (see edit history)

[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 (see edit history)

[Berta]

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

Only when a VA doc told him he believed diabetes was the cause of all of his problems.(1992) He ordered a fingerstick test but it was never done.The glucose readings were high fasting readings.Rod was transferred back home days later and nothing on his discharge cert indicated a further need for the fingerstick test and minimal meds were prescribed.After he had been misdiagnosed for 3 weeks with a major stroke in the local VAMC, we didnt even think about the fingerstick test anymore.

I tracked this former VA doctor to Calif and he provided me with a brief opinion that Rod's glucose readings were definitely too high when he treated him.

The VA admitted to causing Rod's death due to malpractice 9 years ago. But they only used the charges I made when I sued them-heart disease misdiagnosed,, strokes misdiagnosed and inappropriate meds.They agreed to that but did state that multiple errors of malpractice had occurred.

I did not know he had diabetes until 2003, when my daughter-home on leave from the mil heard me talking to an AO vet with diabetes and she insisted I file the Agent Orange claim. She pointed out Dad's symptoms and I had no idea there was any link to his heart disease and strokes. There is no diabetes in our families.

I started to read all I could on DMII and immediately filed the claim.

I then went through the medical records very carefully and sure enough I found the evidence of diabetes, untreated-just like his other misdiagnosed problems.

The VACO said his medical care had been indefensible.

I won the settlement by my own medical opinions supported by evidence from the med recs.It was not easy.And this took three years.

In this case-the 2003 claim , the RO ignored all of my medical evidence,to include 2 IMos and sent the claim to the BVA. I got it remanded very fast and supplied them with an additional IMO.

I told regional counsel two weeks ago that I will play their game until they tire of it. I will get another IMO if I have to.He agreed that he was aware of what they put me through in the past and knew why I had filed an additional FTCA claim against them.One more way to get them to read my IMOs.I also told him I now can pinpoint the day they decided to cover up Rod's heart disease. It is right there in the med recs.He was not the attorney that handled my FTCA but he knew of it and I think he is the one who cued them on something 2 years ago-regarding a old CUE I did not pursue but which the RO granted with orders from Regional counsel.

The RO re-opened a different SC death claim in my behalf this past August.(After they heard from a Senator) That was real nice of them-covering their rear ends like that-

I will take it if they award on this one but NOD it because it is not based on Agent Orange or diabetes.

They know there would be a big difference in the retro if they award the claim they are re-opening.

Josephine-things have changed since the days I won FTCA and Section 1151 death award without an IMO and without a lawyer.

ROs are not reading the evidence like they used to.

Sos are not familiar enough with the claims they are getting.

The violations of the VCAA make things even worse.

I never got a proper VCAA notice but I did find a case in 2006 where the widow didnt get one either and the BVA remanded it and said the RO had to suggest that she get an IMO.

I will use that case if needed-if they continue to ignore my IMOs-I have the BVA's words that say they should have told me to get one.

When I was with the Prodigy Veterans BBS and also Vet link-1980s-we never talked about getting IM0s to support claims.

These days they can be critical to a claim and as 1968 said, they have to be worded properly for the VA to fully consider them.

Edited November 4, 2006 by Berta (see edit history)

[Josephine]

ROs are not reading the evidence like they used to.

Sos are not familiar enough with the claims they are getting.

The violations of the VCAA make things even worse.

Berta,

This is the magic words. I have had to scream to get the BVA to read my claim. I sure couldn't get the R.O to even read it.

That is the only thing that I asked of the BVA- Read this claim and at least I can say that I have been heard.

Well, at least with the action on my claim to date, they have read it and are acting on it.

With three doctors already stating that my anxiety is service connected and one being my military treating physician. One being at the Va. Medical Center. There just isn't much more to add to the claim.

It is all there in black and white in my SMR's.

Just because the two crooked psychiatrist tried to change all the wording of my SMR'S, it sure don't make it true.

The BVA has caught this and now they refuse to abide by the remand. They have caught it because, I took their C&P and tore it apart with my own medical records.

My file is back at the AMC and they can handle them and their lies.

I think they need to take that C&P and trash it. I have the proof of their tactics and the proof of their lies.

Just wanted to add input into your diabetic claim as I live the illness each day.

I am like you, we have nothing, but time on our hands, to wait this out.

Always,

Josephine

Edited November 4, 2006 by Josephine (see edit history)

[Ricky]

I have in the past, since receiving my medical degree from VA U, hahahaha, drafted an example of what needed to be in the imo and gave this along with copies of SMR's and a 3.5 floppy with the draft on it to the doctor. He reviewed the SMR's made the "medical terms" changes, printed and signed the IMO. Seemed to work well. So I guess you could say I wrote it to a degree. Bottom line is it does not really make any difference who writes it as long as the doc reviews the SMR's agrees with what is written and signs the thing.

[Vike17]

When a doctor writes an IMO for a veteran, it is really, really important, as 1968 Army VV and Berta stated, that they review all of your SMR's and post service medical records and give a rational as to why they have come to a certain conclusion. The doctor should also reference certain medical litrature that support his/her rational. In short, the IMO should probably look something like a term paper from college. Check out Dr. Bashes website, he has a sample IMO posted there.

Vike 17

[JohnM]

That is a good point. To make things easier for the private doctor, write the IMO, yourself, save it to floppy disk or CD, and provide it to the doctor as a draft. That makes good sense. Doctors just don't have time to write IMOs. They hardly every write IMOs. They write doctor notes in their medical ledgers, but not detailed IMOs. Then again, I may be wrong about this. It could be that a good MD specialist has a "shell" IMO ready for use/editing. But, it doesn't hurt to give the doctor a draft and I don't think it would offend him.... if he is positive and willing about writing it. Plus, some doctors may not be computer literate, but they have their Office Assistant to type it in the correct format.

I think I will do the draft and save it on CD and give it to my private doctor upon my next office visit. He can either use it or use his own. If he uses it, nothing will be left-out (omitted), and thats a big advantage. Of course, he could always delete something important in the draft IMO and that won't help.

A good place to staart is the VA's own document instructions: VA Disability Examination Worksheets. Make sure all the topics are completed as on the disability worksheet to include REVIEW OF SMR, TESTS ADMINISTERED AND RESULTS, DIAGNOSIS, SOCIAL AND INDUSTRIAL IMPACT, AND PROGNOSIS. I have looked at Dr. Bash's example IMO and it looks good, but is not in sections as I think it should be..... easier to read and understand. B)

Where would you fine the VA's document insturctions for disability examination worksheets.

[Guest allan]

Where would you fine the VA's document insturctions for disability examination worksheets.

disability examination worksheets?

try this link............

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

[JohnM]

disability examination worksheets?

try this link............

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

Allan

Thank You, I printed a few worksheets out, I was wondering if you knew where the worksheet of sheet that would state the words least likely or not would be so I could give that also to our Dr.

[sbrewer]

Where could this be found "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."

Thanks,

sbrewer

[JohnM]

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

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

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

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

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

Where would less likely as not go? between C & D or D & E ?