Why Wording And Rationale Of Imo

[Berta]

In a recent BVA decision :

"Since Dr. S. A. G.'s opinions

are not supported by the scientific literature she submitted

as a basis for her opinion, they lack significant probative

value. See Bloom, 12 Vet. App. at 187"

The VA opinion was decribed thus:

"In contrast, the January 2006 IME's opinion indicates that

prior to formulating his conclusion, he completed a full

review of the claims file, along with an extensive search

for, and review of, relevant literature. His opinion

provides a complete rationale and explanation as to why he

concluded that there is "no meaningful evidence to support

an association between CML and exposure to Agent Orange."

"In summary, greater weight may be placed on one physician's

opinion over another's depending on factors such as reasoning

employed by the physicians, and whether or not and to what

extent they reviewed prior clinical records and other

evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). Here,

in weighing the respective medical opinions, the IME's

opinion must be given the greatest probative weight, as it is

supported by detailed findings and extensive research; is

couched in terms of greater certainty; and provides a better

explanation of the rationale for the opinion given.

Accordingly, the Board finds the opinion persuasive of a

conclusion that the primary cause of the veterans death,

CML, was unrelated to his service."

from:http://www.va.gov/vetapp06/files4/0623752.txt

This was a widow's claim and it was denied.

It shows how the BVA weighs these opinions.

[LarryJ]

Well, Berta, I can see as how, if the literature that the doctor submits to substantiate her opinion does not, in fact, do so, then there could and should be a problem vis a vis "probative value".

just sayin.......

[Berta]

Exactly-

In my IMo the doc referred to Braunwald medical text and then to how this information applied to the veteran. He used another text in an additional IMO with a specific rationale and also referred directly to the Agent Orange and Ranch hand reports even though the veteran's exposure to AO has already been confirmed.

There are plenty of good treatises and abstracts on the net from great medical sources.

I feel they should only be used to enhance an opinion from a real doctor as the VA seems to ignore them when vets use them to support their claims-

which is against VA case law-if the medical printout can be fully associated to the claimed disability.

What I mean is -say vet has cataracts and DMII from AO. The vet requests cataracts claimed as secondary to the SC AO DMII.

The vet sends them statement from NVLSP in the VBM as to the strong association, also tells VA they have no other known etiology but for the DMII- as causing the cataracts and then they send the VA their own VA DMII training letter and an internet abstract from Diabetogica -a well know medical source-proving the association of cataracts to DMII.

Even if the VA ignores all of the above except for the internet abstract- the veteran with current documentation of the cataracts-and the internet printout- has supplied probative competent medical evidence and VA must consider this under 38 CFR 3.159.

NVLSP also made a statement regarding abtracts and medical info from the net-I put the page # etc here somewhere at hadit-cant find it-

Maybe best thing to do is attach that page too to any abstracts.

[Guest allan]

try this one...............

S3_159.DOC

http://www.warms.vba.va.gov/regs/38CFR/BOO...ART3/S3_159.DOC