IME and Physician conflict of interest

[OldJoe]

Instead of continuing a thread that dealt with CUE and beating a dead horse I thought it wise to start a new thread.

In the pursuit trying to fixed my messed up claim I finally have found a physician that does IMEs

Here is how he responded to my email explaining my situation:

<...>

"I read your email. It does sound like you could use some assistance. 

A bit about myself. I do perform IMEs for civilian cases but I am also employed by a company that is contracted by the VA to perform similar disability assessments. I will have to check with my employer to see if your case presents a conflict of interest."

<...>

Of, all the flipping luck!!!

I responded and explained further my situation.

Hopefully he responds soon.

That said, I need any advice possible on what I should do next.  I know this could be a blessing or this could be a curse, I don't know which...

[Buck52]

'' I finally have found a physician that does IMEs ''

Who was the physician?

[OldJoe]

John C. Lucio, DO

[OldJoe]

Still waiting on this Dr to get back with me, hope he does it soon.

I know with the holiday weekend I am willing to give the benefit of the doubt that it played a hand in getting back with me.

[OldJoe]

In other news, got a nice surprise when the VA awarded me retroactive pay for tinnitus.

Have filed NOD, through DAV.  Rep is a cantankerous old man, I think he is kind of neat, just hope he lasts long enough to see my claim through (unfortunately he is not what you could easily confuse with a spring chicken).

But it does give me some warm fuzzies that even was even dumbfounded when he read my initial rating letter that it explicitly left out the key evaluation concerning my back.  That alone should have one the "benefit of the doubt" rule.  Unfortunately I know they they wrote it off by using their "expert" as not being probative vale.

Got to love how they can twist a few things in order to deny a claim.  And then conveniently ignore last little part of Title 38 CFR §3.156(a) about raising a reasonable possibility of sustaining a claim.  Yes the evidence may be cumulative, but that said the evidence displayed continued symptomology.  Seen several claims before the BVA with very similar circumstances and not have an IME/IMO.

 

[OldJoe]

That said is there anything being done about IME/IMO this seems to be getting a bit ridiculous that in a "non-adversarial" system that a vet has to get a IME/IMO just to stand a chance of getting properly assessed (even low balled).

And the more I seem and hear it sounds like IME/IMOs will soon start to be discounted because all the vets are doing them just a standard practice when filing a claim.

Then where are we going to be?

[broncovet]

You have about 3 choices:

1.  Wait for this doc. to respond. 

2.  Go ahead and look for another doc.

3.  Do nothing.  

I recommend you wait a reasonable period, but then go to number 2.  I dont recommend number 3.  

[ArNG11]

Old Joe I would say Veterans are fine as long as the "benefit of doubt" does not go out the window. Most folks resort to an IME/IMO because the VA is scandalous, the VA breaks the law and goes against clear, crystal clear, regulations.  It is only with an IME/IMO that you can blow their hired docs BS out of the water.

The system is a completely adversarial nightmare, even though the law states differently. That is the way it is.  I don't agree with it, and I don't put up with that crap, just like most of us, Veterans and dependents, who fight for benefits and win, not because the VA finally gave in, but because the VA can't keep dodging the law.

As long as we, Veterans alike, keep fighting,we will be victorious, because the regulations and laws state when we are in the right.

[OldJoe]

Thanks for both of your replies broncovet and ArNG11.

I do still intend to get the IME/IMO just don't want to start jumping from one thing to the next or wait to long; done both in the past and gotten bit in the backside (for both).

Weird, I am  I.T. by trade tell people to be patient give it a chance.  What do I do, I start chomping at the bit.

If he doesn't respond by the end of the week I will send another email to follow up and see if he responses to that.  If not, then I guess I start looking again....  (ARGH!!!!)

[OldJoe]

A little proactive research in case this doctor doesn't pan out.

Has anybody heard of Garth S. Russell, MD in Columbia, Mo?

Either working for the VA as an IME or providing them for vets? 

 

Where he has his practice happens to be near the VA hospital in Columbia, Mo (shouldn't matter I know).

[OldJoe]

Well, that blows chunks.  Checked back with the doctor and he told me to read his last email and that it was a conflict of interest.

His last email stated that he needed to check.

Thank God I asked now and didn't wait any longer.

Now to the next doctor...

Hope I can find one soon.

[OldJoe]

Started the balling rolling with the new Dr.  Hopefully this one works out.

Just need to set up an examination date and get it done.

Sent his secretary the BDQs related to that items that needs to be rated so he has some idea what the VA will be looking for.

Dr. Garth Russell is a vet and his bio does contain some promising things:

" Dr. Russell is board certified by the American Association of Evaluating Physicians and the American Board of Orthopaedic Surgery. He is a founding member of the North American Spine Society and the Missouri State Orthopaedic Association and is also a member of numerous other associations including the American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Academy of Disability Evaluating Physicians, Clinical Orthopaedic Society, and the American Medical Association. From 1967-1976, Dr. Russell served as the Chairman of the Missouri State Crippled Children’s Commission. He was a member of the Board and President of the American Academy of Orthopaedic Surgeons. Also, from 1988-1994, he served as Chairman of the Council of Clinical Policies and Standards for the American Academy of Orthopaedic Surgeons. Dr. Russell was also the President of the Board of Trustees at Columbia Regional Hospital from 1978-1993. "

From SEAK:

" Experience:
35 years performing IMEs
2,000 IMEs performed

IME Certification: CEDIR
IME Training: 35 yrs. Orthopaedic practice with subspecialty in spine "

 

We will see...

[OldJoe]

Well, so far it looks like there might be some light at the end of the tunnel, just hope it isn't another semi...

The secretary for several doctors at Columbia Orthopedic Group (Columbia, Mo) told me that one of their doctors was going to review my records and get back with me to see if there was anything they could do.   If they could they would also tell me how much it would cost.

Her biggest question was about some of the information I had left them.  I gave them a flash drive full of stuff, some of it not directly related to my medical records but reference material from my researching.  I didn't have time between when they said give them the information and when I delivered it to clean up the flash drive.

Also, told them I would put a plug in for them because trying to find doctors to do IMEs and/or IMOs can be rough for vets.

If they work out and do it then I would say that we (VETS) have a resource for orthopedic issues we can use.

One thing that I did take as a positive is that the secretary said she saw cases from Postal Workers that like us seem to get the shaft from the USPS in that they USPS tries to wriggle out of any responsibilities it might have for its employees.

I hope this means I have a good chance of getting the IME and IMO from them.

Right now I am just scared stiff that yet again I am going to get turned away.

The next closest SNEAK qualified examiner for my claim is in St. Louis.

[OldJoe]

Of all the flipping mistakes, thank God I called to check on the status of my records request.

I found out I sent my request to the wrong place.

I should have sent it here:

     Evidence Intake Center

 

     P.O. Box 4444

     Janesville, Wisconsin 53547

Anybody know if this is correct?  With my luck I will find out this "Evidence Intake Center"  is also known as the "Secure Shredding Facility".

[OldJoe]

I don't think they have the brightest people working at the call center.

I started off asking for the address so I can get a copy of my c-file.

The operator asked why, I told him so I could review it because I am filing an appeal on a claim.

The operator then effectively states that I am asking how to submit a NOD and gets ready to explain how to do that.

I tell him no, I want a copy of my c-file, my claims file.

Operator says he is confused.

I explain to him I want a copy of my c-file, claims file for everything that I have ever submitted a claim for to include all the medical records, temp files and everything.  Where do I need to send the request to?

Finally he gives me the above address.

[Chuck75]

On 5/31/2016 at 1:01 PM, OldJoe said:

That said is there anything being done about IME/IMO this seems to be getting a bit ridiculous that in a "non-adversarial" system that a vet has to get a IME/IMO just to stand a chance of getting properly assessed (even low balled).

And the more I seem and hear it sounds like IME/IMOs will soon start to be discounted because all the vets are doing them just a standard practice when filing a claim.

Then where are we going to be?

"will soon start to be discounted " That's been going on for some time! The VA, unless forced to do otherwise, has often taken the less favorable opinion (usually from a VA examiner) even when the examiner is marginally qualified, over the favorable one from a fully qualified physician. (I.E. Board certified specialist, etc.)  On appeal, the BVA usually catches this. But, it's occasionally necessary to have more than one favorable IME/IMO to counter an unfavorable in house opinion and C&P.  One of the "reasons" the VA uses is calling an expert opinion "Speculation".  After all, an opinion given decades after a nexus event is less probative than a more contemporary one. It's all in the evidence.

I really get upset when the VA calls for a C&P that is clearly not needed, due to sufficient medical records and test results. At one point, the VA RO was trying to make me take a treadmill stress test, even though the medical records, test results, etc. showed that such a test was extremely hazardous to me, and the VA's own regs and guidelines said that a stress test was not to be given. On appeal, via Nehmer (the VA failed to place my name on the Nehmer list, etc.) the appeal results politely said that the VARO screwed up, and that the existing medical evidence was conclusive without the C&P and stress test.  The fact that the VA was trying to force me to drive over a hundred miles over snow covered two lane roads in Georgia to attend the C&P was not even mentioned. There were two other VAMC locations that were closer or easier to get to that had the ability to do the C&P, including the VAMC across the street from the VARO.

 

 

Edited June 12, 2016 by Chuck75 (see edit history)

[OldJoe]

14 minutes ago, Chuck75 said:

The fact that the VA was trying to force me to drive over a hundred miles over snow covered two lane roads in Georgia to attend the C&P was not even mentioned. There were two other VAMC locations that were closer or easier to get to that had the ability to do the C&P, including the VAMC across the street from the VARO.

 

 

I know we all go into "conspiracy mode" when the VA pulls lame brain stunts like this, but is there some reasoning to the logic? 

I know this is the VA we are talking about they would send a Vulcan into an epileptic fit, probably would be considered inhuman and cruel punishment to even let one within 500 feet of a Vulcan.

[ArNG11]

Old Joe , I quite disagree.  At least in my experiences.  The VA totally discounted a well rationalized medical opinion which supported service connection using service medical records and medical rationale.  In my instance, my back and sleep apnea claims.  

In the both these claims the OBGYN opinion was favored.  Her opinion used no medical rationale, was not an expert in the field, and the very opinion contradicted itself with stating a breathing device was not used ( CPAP) for sleep apnea, yet to discount the fatigue associated with Hypothyroidism stated that with CPAP use I wake up refreshed, so no higher rating for hypothyroid. No service connection for sleep apnea, because no use of breathing machine and no complaints in service.

While I rather enjoy getting on the bashing session of criticizing  the VA claims practices, I cannot dismiss how these actions are more than just coincidental.  JMO

Heh in regards to the Evidence Intake Center.  That is the address that was given to me according to the region I am associated with, however, no green card receipts have been sent back.   I'm starting to wonder if this new process isn't just another kink in the hose.

[Victor Ray]

8 hours ago, Chuck75 said:

"will soon start to be discounted " That's been going on for some time! The VA, unless forced to do otherwise, has often taken the less favorable opinion (usually from a VA examiner) even when the examiner is marginally qualified, over the favorable one from a fully qualified physician. (I.E. Board certified specialist, etc.)  On appeal, the BVA usually catches this. But, it's occasionally necessary to have more than one favorable IME/IMO to counter an unfavorable in house opinion and C&P.  One of the "reasons" the VA uses is calling an expert opinion "Speculation".  After all, an opinion given decades after a nexus event is less probative than a more contemporary one. It's all in the evidence.

I really get upset when the VA calls of a C&P that is clearly not needed, due to sufficient medical records and test results. At one point, the VA RO was trying to make me take a treadmill stress test, even though the medical records, test results, etc. showed that such a test was extremely hazardous to me, and the VA's own regs and guidelines said that a stress test was not to be given. On appeal, via Nehmer (the VA failed to place my name on the Nehmer list, etc.) the appeal results politely said that the VARO screwed up, and that the existing medical evidence was conclusive without the C&P and stress test.  The fact that the VA was trying to force me to drive over a hundred miles over snow covered two lane roads in Georgia to attend the C&P was not even mentioned. There were two other VAMC locations that were closer or easier to get to that had the ability to do the C&P, including the VAMC across the street from the VARO.

 

 

Chuck.

I have seen this "Nehmer list" mentioned a couple times, and it sounds like something I missed also. I filed on April 04 1983 and remember Berta mentioning Footnote 1 claims. Is this what you are talking about? I filed before those 1985 dates to those ??? dates, but it is hard to believe the law would allow a veteran to not be compensated on the grounds he filed too early. In brief, what is the Nehmer list? is it the 150,000 that the VA was looking for, and still haven't found 500 or so? Who is suppose to be on that list and how would you know? Sorry about all the questions,   :-(  Thank you.

Victor

[Buck52]

Make sure you make double copies of everything you send to the VA.

ArNG11

ITS WERID we can't sleep good without a CPAP and then we get one and we do sleep better...so do they think we love the C-PAP? of course were going to sleep better, thats like telling a vet well you have a prosthesis leg now your good as new.

crazy BS is all it is with the VA.

[Gastone]

Old Joe, did you ever post a redacted copy of your SA C & P DBQ?

A redacted copy of your SA Denial Letter would really help understand your situation. How exactly are you attempting to link your current SA DX, as a Direct or Secondary SC?  What's the Nexus?

Have you seen a Non VA Sleep Specialist, Neurologist preferably? For a couple $100.00 to cover the office call, if they agree with your Nexus and opine as such in their Clinician Notes, you should be good to go. You don't really need to pay $1000.00+ for an IMO.

The above "Clinician Notes" approach worked for myself and (2) other Vets here on Hadit. They actually visited my Board Certified Sleep Specialist Neurologist and shortly thereafter, notified me that they were awarded their SA SC. The Dr agreed with their Nexus Theory, and they left his office with a copy of the Exams Clinician Notes indicating a "More Likely Than Not," DX association. Total cost for the office call, was less than $200.00.

Semper Fi