Possible To Have Private Dr Do Ime/imo?

[SprayedandBetrayed]

Hello Everyone,

I had wanted to know if anyone has successfully had their own private Dr do an IME or IMO? My father's Neurologist has experience with the VA. He was a Neuro there for sometime. We have to go back this week for the results of my Father's EMG. But he is also seeing my Dad for Parkinson's. I have been scouring over my Dad's medical records. I have found many issues within them. I had another post in one of the other forums which explains it all. My Dad is requesting the records from VAMC since he was first evaluated for Agent Orange exposure.

I wanted to ask the Dr if he would do an IME/or IMO since he has experience in this field, also with the VA. I am also having my Father's outside medical records printed up. He has a lot!!!!!! from falls, heart issues. I do have the Discharge summaries, saying what he was treated for. But would like to get the most important records.

Here is a link to the original post

Also he will be filing to get his file of claims from the VA as well.

Any advice would be greatly appreciated.

[bolt_vet23]

Here's what my VSO rep provided.

The Nexus Letter

To win an award of a disability benefit, you must meet 3 criteria:

1. You have to show eligibility of your military service.

2. You must have a current medical diagnosis of a condition or a disability.

3. You must be able to provide evidence that the medical diagnosed condition had its origin

during the time of your military service, or if the condition was preexisting, that it was

aggravated by your military service.

In many cases, the connection of an event that happened while you were on active duty to a

diagnosed condition today may be tenuous at best.

For the purposes of this example, let's consider a back injury.

You may have hurt your back in some fashion while serving your country. That was in 1970 and

you went on sick call. Your sore back was diagnosed as a "pulled muscle" or something similar

and you were given some IBU Profen and sent on your way to light duty for 3 days.

The back was progressively more painful so you were back on sick call a week later. This time

an x-ray was ordered and you were given some stronger pain pills and your light duty was

increased to a restricted duty for a month with orders of no lifting, no PT and so on.

The military culture demands that we don't complain of our "minor" aches and pains. The team

depends on each member being ready to complete the mission and the mission is all that counts.

From day one we're trained that complaints of pain will bring about scorn from superiors and

fellow soldiers will know that they have to carry your load as well as their own.

"Pain", we learn, "is weakness leaving your body."

Your civilian career wasn't as physical as the military and during the years since your discharge

you've had chronic, low back pain but it hasn't required much treatment...until now. In the last

year you've had to seek more intensive medical care and finally you had an MRI. The MRI study

shows numerous issues with discs and nerves and you realize that your old service injury is here

to haunt you.

You file for service connected disability compensation, you have a C & P exam and about a year

later you have a denial letter. The VA tells you that although you had complaints during your

service that your condition today is new and unrelated to those old problems.

Now what?

The nexus letter is the key to overturning the denial. Nexus is defined as "the means of

connection between things linked in series."

The task you face now is to seek an expert physician who will review your complete medical

records and write a letter stating that it it his or her opinion that your injury (condition) today is

related to the military service.

The nexus letter should follow a similar format to all letters that you use to communicate to VA.

It may be addressed directly to you or in a "To Whom It May Concern" style. If the physician is

willing to provide you with a current curriculum vitae (a resume) that will support the physician's

expertise.

The nexus letter should follow the standard business format we always use when writing to the

VA. This template below may be used as a beginning for your letter.

Doctor's Letter Head

Date:

Subject: Medical history of Mr. Veteran

Reference: C-File # and/or Social Security Number

To the Department of Veterans Affairs:

I am the primary care provider for Mr. Veteran. In my capacity as a primary care provider, I

have cared for Mr. Veteran since 01/07/20xx.

While I've provided care for Mr. Veteran, I've become familiar with his active duty medical

history from 07/24/19xx to 08/07/19xx and from VA medical records from 19xx to present, past

and present ailments and I've reviewed pertinent parts of his military record that document his

injury, disease and clinical conditions related to the events that occurred.

I am aware that Mr. Veteran was injured during his active duty military service on or about 1981

in Fort Army while (events description, time and place).

A primary condition the veteran suffers is Lumbar Paravertebral Myositis (an Inflammatory

Myopathy) and an L4-L5, disc desiccation and disc narrowing. MRI reports note sacralization of

the L 5 representing a developmental abnormality and also that paraspinal muscle spasm is

suggested.

Further noted are mild thoracolumbar dextroscoliosis as well as mild spondylosis and

degenerative endplate changes. Schmorl's nodes in the superior endplate of L3. L3-L4 and L4-5

degenerative disc disease are

seen. There is an L4-5 small posterior disc bulge and small posterocentral disc herniation and

L2-3 vertebral hemangiomas.

Mr. Veteran has chronic pain due to his injuries. The veteran suffers radiculopathy with pain,

muscle control difficulty, tingling, numbness and weakness in the legs, likely due the

sacralization of L4-L5.

Mr. Veteran suffers increased fatigability because of his chronic back pain. Standing for more

than 15 minutes will make him become weak and exhausted.

There are multiple other clinical conditions diagnosed that are more likely than not secondary to

or aggravated by the primary back condition(s).

The veteran takes numerous medications for both the primary condition as well as secondary

conditions that are aggravated by said primary back condition. (Medicines and secondary

conditions are listed separately.)

The veteran is not a likely candidate to be rehabilitated.

After examining Mr. Veteran, his chart and medical records it is my opinion that Mr. Veteran is

totally and permanently disabled due to the above discussed back condition. The veteran can not

hold gainful employment as a result of the injury he sustained while in the military. It is also my

opinion that it is more likely than not the that the physical traumas suffered during the veteran's

military service as noted in his record (description of events and dates) caused, contributed to

and aggravated the totally disabling back condition(s).

Respectfully,

Dr. VA Physician, MD

Diplomat of the American Board of Internal Medicine

The language in the example above is specific. Any language less specific may not meet the standard

that VA will require.

Any physician who is qualified to write such a letter on your behalf may do so. While it is commonly

believed that VA physicians aren't allowed to write such letters, that isn't true. VA physicians, as with

many civilian physicians, simply don't like to write such letters as they are not skilled at the task, may

not have the tools to write the letter at hand and they are often so busy caring for a heavy load of

patients this is seen as work that isn't a priority.

It is perfectly acceptable for the veteran to write the letter on behalf of the physician and then ask the

physician to sign it. In any setting, whether VA or civilian, the veteran is advised that he or she should

not ask a nurse or clerk to perform the task of obtaining a signature for them. These ancillary members

of the care team often see themselves as "gatekeepers" to guard and protect the physician from tasks

that will only take up more valuable time.

They may believe that "rules" or "law" won't allow the physician to sign such a document and the

veteran may be refused access to the doctor. It's best to make a routine appointment, wait until the

veteran is face to face with the M.D. and ask that provider directly.

Most physicians will sign such a letter if it is brief, to the point and factual. When writing a nexus letter

great care must be given to recording only facts and the doctor's conclusions.

There are physicians available who will perform records reviews and/or Independent Medical

Examinations and provide opinions. Often these doctors do a very good job of providing a nexus letter

if the veteran isn't otherwise able to obtain one.

The charge for such a letter from an independent physician can vary depending on the extent of the

services. The veteran must pay that fee in advance with no guarantee that any award will be won. The

Independent Medical Examining doctor does not treat or prescribe medications but only provides

services of review and report.

The importance of the nexus letter can't be overstated. In many situations the nexus letter from

an expert is the only evidence that will tip the scales in favor of the veteran.

In the C & P Service Clinicians Guide instructions are given to the examiner as to the exact

phrasing that should be used, as follows here;

Q: How do I give an opinion for nexus(relationship to a military incident)?

A: When asked to give an opinion as to whether a condition is related to a specific incident

during military service, the opinion should be expressed as follows:

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%)

That key phrase of "more likely than not" is right where the DRO wanted it.

The only thing missing from this letter is an often used statement to point out that there are no

other known or apparent causes for the current condition. That might read like; "There is no

known history of the veterans family having this condition..." or "The veteran has no other

known history that would cause or contribute to this condition...".

I only include that statement when the cause of the condition is less than apparent. I might use

that to show that a cancer was more likely than not caused by exposure to Agent Orange and that

the veteran had no family history or exposure to other carcinogenic chemicals that may be seen

as a possible cause for the current condition. In this case there were 2 documented traumatic

events that were the likely cause of the injury making any reference to other possible causes

unnecessary.

Remember, just because your Doctor writes a letter stating you have a medical condition that

WILL NOT be enough to award you a disability benefit. Your Doctor must write the condition

MUST BE (1) linked, (2) caused / contributed or (3) aggravated by your military service. If you

have a letter without this information your claim WILL MOST LIKELY be denied. We cannot

stress this enough. Also, just because you are going to the VA for treatment for your condition

that does not automatically qualify you for compensation. You will still need the "Nexus" letter

and file a claim for compensation.

[SprayedandBetrayed]

Thank You everyone for your replies. I will discuss this with my father. We have an appointment towards the end of this month with the VSO. Also he sees cardiologist this week as well as Neuro. Berta I will be looking at your other reply.