Medical Opinions Associates, Inc.

[smoothc100]

Has anyone used Medical Opinions Associates, Inc. for an IMO?  If so what was your experience and the fees.  I'm trying to obtain an IMO for my sleep apnea.  The current company I was dealing with has been nonresponsive as of late.

[Gastone]

Have you given consideration to seeing a local non VA, Board Certified Neurologist specializing and Board Edifier Sleep Specialist? 1 appointment should be in the $150.00 area. His Clinician Notes regarding a possible Nexus supporting your claim, could Seal the Deal.

Worked for me, on the 1st try.

I was recently reading about VA IMO Fraud and the VA Policy regarding extra scrutiny for IMO's from known Drs, specializing in For Profit IMO's, not treatment. Very common for the Dr writing the "For Profit IMO," not to be  "Board Certified," in anything, just A PCP. If I were thinking of paying $1+K for a Medical Opinion, I'd certainly be looking for a Board Certified Specialist regarding my DX.

Semper Fi

 

[broncovet]

I agree with GASTONE, but, I also think the VA is treading on thin ice when they do this.  

The courts have ruled the Veteran's lay evidence is acceptable, absent evidence to the contrary, even tho the Veteran is an "interested party".  

In other words the VA CAN find your lay evidence is not credible or probative, but not based solely on the fact the Veteran is an "interested party".  

I would suggest the same standards apply for lay evidence as they do for medical evidence as far as their relation to an interested party.  Otherwise, VA could simply "throw out" any/all IME/IMO's as the doctor was getting paid by the Veteran for his opinion, and it "had to be biased" for that reason.  

This is real bad for VA, reminding you that VA hires your C and P examiner, and this examiner is often a contractor, not an employee of VA.  The VA can/does track how many benefits a particular examiner gets approved, and, perhaps award bonuses on these numbers.  

[pwrslm]

I think the VA must provide the reason and basis for them to ignore a lay statement by a Vet for disability claims.  The absence of a reason and basis is a guarantee that a denial will be returned for them to provide the missing information on appeal.  Same goes for the claim that they ignore IMO/IME, if they do not have a sufficient reason with a valid basis they cannot return a denial without the appeals judge returning the case and requiring them to provide the missing info. 

If they apply the missing info, its got to be valid, not arbitrary and biased.

[Buck52]

Most Medical specialist that are ''Veteran Friendly'' will certainly help out a veteran,

We just got to call around until we find one!

When I needed an IMO to rebut a VA ENT specialist  I called around and was just open and honest as to why I need his help, I found one specialist  board certified in all areas of my disability and he had me to get the VA guidelines and the VA  Regulations on this current disability & my medical records &  he read them examined me and wrote his impression to my disability.

It took about a week and 150.00 bucks   well worth every penny.

He did what I had ask of him and I took him the regulations that show how Equipoise is applied with VA...And what he wrote after he examined me...Well the VA Rating specalist and DRO took his  word /&more precise detail opinion over the VA Dr word  & over about 10 pages of the VA Dr's Opinions Crap and lies.

but this was about 15 /16 years ago.

[smoothc100]

Thanks everyone for the feedback.  I plan on looking for a specialist in my area.  I have the diagnosis and the CPAP from the VA, but of course they say its not service connected.  I'm going to need a nexus statement.

[Gastone]

Smooth, there is always the possibility that your OSA DX will not be SC'd.

Just went back and reviewed you 02/13 PTSD DBQ, you were Denied a PTSD SC right, did you end up with a Depression SC? That Negative VA PTSD DBQ was a real nut buster. The Dr made some very troubling observations, which in my Lay opinion,  could and probably will affect future claims.

What's your current MH SC%? Other than the mention of insomnia and a minor daytime work related concentration problem in the 02/13 DBQ, when & what other OSA symptoms did you present with? Is there a "Paper Trail" in your VA or private Med Recs.

I didn't see any mention of "Buddy Letters" or Stmt support of Claim by yourself or Sleeping Partners documenting your Sleep Problems (Hygiene, I think the Dr's call it).

Severe PTSD has been linked to SA, not so sure about Depression.

You definitely need a Board Certified medical Expert Credentialed in SA.

Semper Fi

[smoothc100]

Gastone,

I am finally SCed for PTSD 70% at the moment they are trying to figure out the retro, so I have not received the official brown envelope in the mail.  I saw a copy of the decision in my C-file and confirmed the rating with case management. My SC are: 70% PTSD, 20% herniated L5-S1 disk, 10% right lower extremity radiculopathy, 0% nephrolithiasis (kidney stones), and 50% bilateral plantar fasciitis.

[Gastone]

You got the PTSD 70% on Appeal, DRO or BVA? That 2013 DBQ sure looked very Negative for a  PTSD rating, I saw a possible Depression SC. You did something right, to end up with a 70% PTSD SC on Appeal.

My VA math could be off, with what SC's you list above, I see a combined rounded down SC Rating, of 90%.

If that's the case, spending a couple $K for a Top Board Certified Sleep Specialist's IMO, linking your SA to PTSD is definitely worth the $$. That Secondary SA SC on Cpap 50% would make you 100% SC Scheduler, no SGI limitations.

Semper Fi

[Buck52]

 IF you never had any OSA problems or Sleep Apnea or any medical records for it while in the military  it will be hard to get it S.C.

You could see a sleep specialist and ask him/her to link your OSA (Sleep Apnea) secondary to your PTSD or state their opinion that your OSA is

''Aggravated  by'') PTSD''

but they will need to read your medical records and examine you, you could possibly use the sleep clinic that did your sleep study?

Private or VA...>  but good Luck on the VA.

[smoothc100]

Gastone,

Yes, it did look pretty unfavorable, but after submitting all the notes from my therapy sessions (4 years) at the Vet Center and a recent IMO. I then filed a claim for anxiety and depression since the VA already stated I had it due to military service.  When I went to my C&P exam the examiner diagnosed me with PTSD instead then a month later I had a PTSD exam, which confirmed the findings. Yes, you right it will put me around 90%.  

 

Buck,

I never had sleep apnea in my military records just sinus and insomnia.  The VA did the sleep study and diagnosed me with sleep apnea. I'm thinking of a secondary for PTSD or my back pain.  I'm currently looking for a certified sleep specialist in my area. 

[RyanS]

Please keep in mind, if anything, about the relationship between PTSD and Sleep Apnea. The crucial aspect is what type of sleep apnea you are clinical diagnosed with: obstructive, mixed or central. I just got back from a hearing with Judge Kramer (a very experienced BVA judge) and we had an entire argument over when sleep apnea can be linked secondary to PTSD. He threw out the entire argument because my guy had obstructive sleep apnea. And he's honestly mostly correct. Obstructive sleep apnea is mechanical in nature...the muscles are collapsing due to something extraneous, like too much neck fat or skin or terrible sleep posture or a problem with the cervical spine. Mixed and central are where the body's nervous system are in such disarray that it literally interrupts your body's ability to regulate breathing (an involuntary reflex mind you). With PTSD, essentially the argument is that the nightmares and sleep deprivation remove the body's ability to have REM sleep, or at least it's highly fragmented REM sleep. This lack of REM sleep is what, over time of course, throws havoc to the nervous system. It creates not only central or mixed sleep apnea but also a whole host of other issues, although most are cognitive. So, when trying to claim PTSD is causing your sleep apnea, you either need an initial clinical diagnosis or mixed or central or you need a MODIFIED diagnosis with an explanation for the change. Then, and only then, will you get an IMO that is proper to show the linkage. I dare anyone on here to counter my statements that obstructive is medically linked to PTSD...there are no journal articles or scientific studies to corroborate that. There are a ton on central or mixed however, and most BVA judges know this. Just food for thought.

[Palma114]

On 1/12/2017 at 9:31 AM, RyanS said:

Please keep in mind, if anything, about the relationship between PTSD and Sleep Apnea. The crucial aspect is what type of sleep apnea you are clinical diagnosed with: obstructive, mixed or central. I just got back from a hearing with Judge Kramer (a very experienced BVA judge) and we had an entire argument over when sleep apnea can be linked secondary to PTSD. He threw out the entire argument because my guy had obstructive sleep apnea. And he's honestly mostly correct. Obstructive sleep apnea is mechanical in nature...the muscles are collapsing due to something extraneous, like too much neck fat or skin or terrible sleep posture or a problem with the cervical spine. Mixed and central are where the body's nervous system are in such disarray that it literally interrupts your body's ability to regulate breathing (an involuntary reflex mind you). With PTSD, essentially the argument is that the nightmares and sleep deprivation remove the body's ability to have REM sleep, or at least it's highly fragmented REM sleep. This lack of REM sleep is what, over time of course, throws havoc to the nervous system. It creates not only central or mixed sleep apnea but also a whole host of other issues, although most are cognitive. So, when trying to claim PTSD is causing your sleep apnea, you either need an initial clinical diagnosis or mixed or central or you need a MODIFIED diagnosis with an explanation for the change. Then, and only then, will you get an IMO that is proper to show the linkage. I dare anyone on here to counter my statements that obstructive is medically linked to PTSD...there are no journal articles or scientific studies to corroborate that. There are a ton on central or mixed however, and most BVA judges know this. Just food for thought.

Decision by the BVA (Docket No. 11-09 193, Feb 28, 2014) the BVA granted service connection for Obstructive sleep apnea secondary to PTSD.

Another Board decision (Docket No. 11-01922, Mar 28, 2016) Obstructive sleep apnea granted service connection to PTSD.

[RyanS]

On 1/15/2017 at 4:14 PM, Palma114 said:

Decision by the BVA (Docket No. 11-09 193, Feb 28, 2014) the BVA granted service connection for Obstructive sleep apnea secondary to PTSD.

Another Board decision (Docket No. 11-01922, Mar 28, 2016) Obstructive sleep apnea granted service connection to PTSD.

Tell that to Judge Kramer.

[Berta]

I couldnt find those awards but found this one:

https://www.va.gov/vetapp16/Files5/1638237.txt

In part:

(Of course the C & P went against the claim but the IMO/IME doctor gave an outstanding medical rationale)

“In contrast, a private independent medical opinion dated in July 2016 reveals that a private physician provided the opinion that after reviewing the Veteran's claims file and the pertinent recent medical literature, it is more likely than not that the Veteran's sleep apnea is secondary to his service-connected PTSD.  He noted that 47.6 percent of combat veterans with PTSD were found to have obstructive sleep apnea compared to only 12.5 percent of healthy controls.  The physician discussed an article that talked about a recent study conducted by scientists at the Madigan Army Medical Center noting that they observed sleep disturbances were increasing in frequency and are commonly diagnosed during deployment and when military personnel return from deployment.  Recent evidence suggests the increased incidence of sleep disturbances in redeployed military personnel is potentially related to PTSD, depression, anxiety, or traumatic brain injury.  The physician also noted that there is a growing body of evidence that suggests that disturbed sleep is more likely to be a core feature of PTSD and hypoxia, sympathetic discharge from respiratory disturbances, dysfunctional REM sleep, and abnormal REM mechanism have been proposed as a mechanism for sleep apnea in PTSD patients.  The Board finds that this medical opinion is persuasive and probative as to the issue of whether the Veteran's obstructive sleep apnea was caused by the Veteran's PTSD, as the examiner provided a clear explanation based on a review of the Veteran's claims file and recent medical literature. “

 

“ORDER

 

Entitlement to service connection for obstructive sleep apnea is granted.

 

Entitlement to service connection for hypertension is granted.”

 

The claim was also remanded for a potential higher PTSD rating.