IMO from Dr. Anaise, CKD

[Palma114]

On 8/24/2016, VARO made a decision on my Chronic kidney disease claim. They granted me a 60% rating, on CKD stage 3, and Definite decrease in kidney function. I was initially at stage 4 CKD and sick, so they put me on several medications to get my numbers to come down, well after about 45 days it drop from stage 4 failure to moderate stage 3. So I initially filed my claim back in 2004, as all of this was occurring. So I just recently filed a NOD, which states I should have been granted 80%, for stage 4 CKD.

So the C&P Examiner in 2015, never mentioned that I was ever at stage 4. So they only rated me on my now medical status, which is stage 3. So I got an IMO from Dr. Anaise, and he states: A BVA decision in a similar case dated October 26, 2012 states (David Jones, Appellant v. Eric K. Shinseki, Docket No. 11-2704):

The court holds that the Board committed legal error by considering the effects of medication on the appellant's IBS when those effects were not explicitly contemplated by the rating criteria...As this Court has made clear, the Board's consideration of factors which are wholly outside the rating criteria provided by the regulations is error as a matter of law. "Massey v. Brown, 7 Vet. App. 204, 208 (1994); see also Drosky v. Brown, 10 Vet. App. 251, 255 (1997) (finding legal error where the Board, "in essence, impermissibly rewrote" the regulation by considering factors wholly outside the rating criteria); Pemorio v. Derwinski, 2 Vet. App. 625, 628 (1992) ("In using a standard that exceeded that found in the regulation, the Board committed legal error").

Conclusion

After reviewing all of the veteran's medical and military records, it is my expert medical opinion that the veteran's service-connected renal dysfunction warrants an 80% rating. It is abundantly clear from the record that the veteran was diagnosed with stage IV renal failure with a creatinine of 4.5. It is true that the creatinine has improved once medication allowed for some recovery of kidney function. Yet, the rating specifically states that the veteran is entitle to 80% disability when his creatinine rises to 4.5, with no disclaimer to that statement.

A higher evaluation of 80% based on renal function is not warrant unless there is:

* Persistent edema and albuminuria; or, * Creatinine 4 to 8mg%; or, * BUN 40 to 80mg;

Edited December 20, 2016 by Palma114

[Oceanbound]

No ZZZs,

He may be right because he also had published a book (that i bought) which includes sleep apnea, so he's speaking as a VA attorney, besides a MD, and doesn't want you to go through the process only to be denied at the BVA.

Go to sleep clinics and ask the Board Certified Otolaryngologist front desk if the doctor have done apnea test for military veterans? Also ask if they would do an IMO after the apnea test?  If they say no find another Otolaryngologist,  that would be veteran friendly.

Edited December 24, 2018 by Oceanbound

[jamescripps2]

We veterans need to understand that when we ask a doctor to write a NEXUS, an IOM, or IME we are asking for their professional medical opinion. They put their professional reputation on the line every time they opine. They are required to back up their opinion with sound medical rational. If your claim is one that cannot be supported by sound rational, the doctor cannot just manufacture evidence, or just pull sound rational out of the thin air. If you do find a doctor to write a opinion that can't be supported and is based upon pure speculation he will then be exposed as being incompetent, and therefore of no more use as far as supporting veterans claims.

Reading this post, I am seeing that the OP suggest that the doctor write an IMO covering multiple issues. That is not how I think it works. I would think one $1500.00 fee for one IOM on one stand alone issue is more like what I would expect. An IOM or a NEXUS is not a one size fits all custom built item. But again, how would I know? I have never forked over large amounts of money to buy one.

[Berta]

James, this is an older thread but your advice is Solid!!!!!!!!!

Even though I won FTCA and 1151 wrongful death settlements/1151 DIC without any IMO or any lawyer, I knew the VARO would give me problems when I re-opened my claim - as accrued- for a direct SC death due to my USMC husband's DMII from his AO exposure in Vietnam.

I studied Cardiology and Neurology  for those claims( FTCA/1151) and had a small neuro background due to my prior Army husband's death.

It was the most important  claim I had ever filed.

I studied Endocrinology for the DMII claim and  I spent 4,000 on 2 IMOs and had sent a forensic cardio firm 

the IMO fee they requested ( $1200  ? I forget) for an additional IMO but the firm refunded about 800-900 to me because the BVA awarded me before the forensic opinion had been prepared.

I also had a Neuro freebee opinion in email that Dr. Bash incorporated into my second IMO-which BVA gave  much weight to-

my point is,

I didnt need a Nexus to my husband's SMRs, but many claimants do need that nexus and no lawyer or IMO/IME doctor can establish that nexus if the SMRs are "silent" as VA likes to say, for inservice documentation that could prove the nexus to the veteran's claim. or widow's/widower's  claim.

A full review of SMRs by a real doctor could reveal they are not silent at all-and  this happened to me when I used to help local vets one to one. Some had loud and clear nexus info in their SMRs.

This is really up to the vet themselves to do-however- and never depend on your vet rep or VSO anyone else to do it. It can be a very time consuming job and you might need to look up medical acronyms and even access the 201 file if the vet has a copy of it- (all vets should request their 201 Personnel file from NARA along with their request for SMRs)

 

That means the veteran must seek valid  buddy statements  ( if the SMRs are silent-which I don't believe half the time if VA says that) that could hopefully establish their nexus.

No doctor or lawyer can perform a Miracle regarding a Nexus.

But if you feel you need an IMO/IME- it could become the best investment you will ever make and easily the cost can be absorbed by  compensation  you would never see without it.

The VA never rated my husband's DMII or paid me any retro for accrued rating under Nehmer.The veteran never knew he had DMII and the VA failed to diagnose and treat it. 

The award was that it contributed to his death.( It was additional VA malpractice but I filed it for direct SC)

However the additional benefits the award provided to me were FAR more than the IMO fees, and I already rattled them off here before, REPS, Chap 35 refund, funeral bill  and complete refund of my FTCA offset.,ordered by OGC -VA. ..about 100,000 when I add it all up...and tax exceptions on my farm.

I hate to see vets waste cash on IMO/IMEs that will not help them, and as you said, the IMO/IME doctor has to make a full medical rationale for their opinion, and also they should bolster their opinion from well know medical texts and abstracts, and either give the VA a copy of their CV ( Curriculum Vitae or at least a rundown of their expertise ,in the field of claimed disability, that renders their opinion valid.