Need advice on denial and appeal

[joevet]

I filed for VA benefits secondary to diabetes related to Agent Orange exposure for glaucoma, cataracts and hypertension. I am receiving 70% for diabetes and stents in my heart. The VA has denied my filing for secondary aliments because they say I have no proof that they are caused by diabetes. In their words they are "at least as likely not caused" by diabetes. My question is how does one prove that they are at least as likely caused by diabetes since all medical evidence reports they can be caused by diabetes? I have my claim under NOD. Any advice would be appreciated. Thanks.

[joevet]

Major problem! How does one get an IMO on a secondary disease? I have contacted three Ophthalmologists and four medical doctors requesting an examination and a letter/statement  reporting, in their professional opinion, that my hypertension, glaucoma and cataracts could be "as likely as not" secondary ailments caused by my mellitus diabetes Type 2. None of them are willing to make such a statement including my long time PCP.

I have three questions I hope someone can answer.

(1) Is it a normal and acceptable proven medical fact that diabetes can cause these secondary aliments? Where is the evidence/medical research?;

(2) Is it factual, and does anyone actually know for sure, that the VA will accept an IMO statement and approve these ailments as secondary? Is there anyone on this forum that has been successful filing such claims?;

(3) And perhaps the most important question, where in the hell does one find a medical professional who will provide a IMO? If you know of a doctor that will provide such a statement, what is his/her name and contact information?

Thanks to anyone who can provide real answers to the above three questions. I don't want to discuss generalization but actual proven factual information.

[Berta]

You got "real" answers from me and others here.

As I had replied, I had a 1151 issue ( I discovered VA had never diagnosed and treated my husbands  diabetes mellitus, 9 years after his death.

I already had won wrongful death case...but discovered  3 more malpractice conditions, emailed Dr Craig Bash, then he called me, I had prepared a cover letter and highlighted the evidence to support my lay medical opinion. mailed it to him with his IMO fee, and within days he called me to say he had prepared the IMO.

You will need an IMO. If you were denied by the BVA can you give us the Docket number so that we can read the decision.

If you were denied at RO level can you scan and attach the decision here? (Cover C file , name prior to scanning it)

You posted in different threads and those replies are somewhere here, and in your profile page.

The General COunsel of the VA accepted my lay medical evidence and I won wrongful death without any IMO. 1997. These are lawyers who can read.

VACO got an opinion from their top cardiologist and it supported my claim.

Prior to that VA hid from them a Peer Review report done a few months after I filed SF 95, that fully supported my lay medical opinion.I didnt find it until many years later....and used it for my AO IHD death claim.

My point is -I was unwilling to take a chance with the DMII claim and I got 3 IMos and ordered a 4th IMO but the  BVA award came in the mail and the Forensic IMO docs refunded half of my prior fee payment.

They had not prepared the IMO yet. 

IMO docs can be searched for here and even by searching at the BVA in recent claims for DMII , in cases where an IMO caused the award. Sometimes those doctors names appear in the BVA decision.

Also there is a list of Endocrinologist IMo docs here somewhere......but maybe that was on the older hadit board.

IMos for me were an investment I was glad to make. If an IMO or IME  follows the criteria here at hadit, (which I based on 2 IMOs from Dr BAsh-a former VA doctor) then regardless of what some  dumb C & P doctor says, the VA will award the claim under Relative Equipoise.....

IF the secondarys can definitely be attributed to the DMII with no other medical etiology.

 

 

 

[broncovet]

There is no guarantee that the VA will accept an IME/IMO.  The BVA, however, is required to give a "reasons and bases" as to why a particular competent medical opinion was not considered to be probative.  The VA "rejected" my VA doc's opinion and stated the reason was that it conflicted with other evidence.  They then cited a very old (2002) Voc rehab opinion, which was not really relevant.  Still, they did give a reason as to why they rejected my doctors opinion that I "was unable to to maintain Substantial Gainful employement due to SC conditions".   The BVA did not say, however, why they also rejected 4 other of my docs who basically said the same thing.  

My attorney recommended a "Voc Rehab" IMO, done by an experience Voc Rehab Counselor.  

One problem with many independent medical opinions is that the doctor does "not" know how to put his opinion in a format that VA will accept.  One example is that a well meanining 

doc may say something like, "I can not say for sure, but its possible that the Veterans (condition) is related to military service."   Or, that it "could be" related to military service.   Or that it "may be" the result of military service.    All  of these terms are deal breakers, and almost always result in a denial as they care considered "speculative".   If you get a copy of an IMO/IME and your doc used thise terms, then take it back to him and ask him to change it to a format VA will accept.    Better yet, explain to the doc you need this in "the VA way" format to be acceptable.

The VA's "nexus format" needs to be close to "The Veteran's condition is "at least as likely as not" related to xx events in military service".  Then the doc needs to give a medical rationale as to why he made said statment.  For example, he could cite the NEW England Journal of medicine article which stated that "58 percent of patients with peripheral neuropathy had diabetes".  Therefore, the Veterans peripheral neuropothy is at least as likely as not secondary to the Veterans Diabetes Melitius.  

You need to select your IMO/IME doc wisely and make sure he understands the "VA way" of a nexus statment.    You can ask any of your local docs to do an IMO/IME that does them as long as they have expertise in the applicable field.  Do not ask your friend who has a Phd in sociology to make an opinion that your knee injury is at least as likely as not due to jumping out of airplanes in military service.  Its useless unless he has medical expertise in treating and diagnosing knee injuries.  

1.  It MAY be a proven medical fact, but VA wants it to be proven IN YOUR CASE.  This means a doctor needs to say YOUR diabetes "at least as likely as not" caused  YOUR secondary conditions.  

2.  Yes.  Again, you need a secondary nexus:  YOUR diabetes "at least as likely as not" caused YOUR xxxx conditions.  

3.  A IME is generally at least as good as an IMO (IME means the doc examined you, IMO means he examined your records).  BOTH of these should state, "I reviewed the patients records".  To get an IME, you need to have a doctor examine you.  An IMO can be done without seeing the doctor, but by sending him your medical records.  I suggest you simply ask a LOCAL doctor, who has expertise, say in diabetes if you want an opinion on diabetes.  You can simply do a google search on "doctors who specialize in diabetes", OR, doctors who are experts in diabetes (in your area).  You can also hire Dr. Bash or Dr. Anise who are very familiar doing Veteran IMO's and know exactly what it takes and will do so with your medical records.  Drawback:  Dr. Bash is very expensive, and, the VA does not particularly regard his opinions all that high because he has done hundreds of them and VA is very familiar with Dr. Bash.  Its controversial, but if you can get a local doc's opinion, in the "va way" format, at a reasonable price, I say do that.  I think Dr. Bash's IMO's are Thousands of dollars.  You may get a local doc to do it for 200 to 500 or so.  

Dont assume that because someone has an "MD" behind their name that means that they know how to do "VA way" IMO/s or IME's.  

Edited June 22, 2017 by broncovet

[joevet]

Berta and Broncovet thanks for your reply and information. I have contacted seven local doctors and none of them will do an IME or IMO.

They probably are not familiar with these types of reports/examinations or they don't want to get involved with the VA. I don't know of any local doctors that will do this and I have searched on the Internet. Dr. Bash and Dr./Attorney Anise came up as people who will file an IMO. I have contacted Dr. Bash using the form on his Internet site today. Of course I have not heard from him yet. I realize his fee is expensive but it appears I have no choice since I can't find a local doctor. I am hoping Dr. Bash at least will advise if he thinks I have a chance of being successful in obtaining approval before he accepts my case for the money only knowing I have little opportunity of winning. It is disheartening to hear the VA do not regard his opinions very highly.

It is a shame a veteran has to be put through this type of hassle and expense to get approval for VA benefits.

[Gastone]

Yo, Joe, did I miss where you heard back from the VSO Honchos on the Top Floor? What's the latest update there?

If I've got this right, you're 75/76 and retired, no current actual Earned Income, correct? What is your reasoning for not filing an IU Claim?

 

This is strictly my take on your current situation, the DM II and Glaucoma aren't going to kill you and would be very low %$$ SC's if eventually Awarded, but keep the Claim alive with an Appeal. Your DM II @ 20% may get worse (Think SC Increase) but probably won't kill you in the immediate (2 - 10 yrs) future. You don't discuss any Cancer, so that's not an Issue, right? At 76+, if you don't get hit by a car or shot by a jealous husband, the CAD will probably be the cause your eventual Dirt Nap. Quit jerking around worrying about the Appeal, let it play out, ask for "Hardship advancement" due to age.         Have your VSR file a New Claim for IU, your age is currently not a factor. You'll get the IU T& P No Future Exams (because of your age) within approx 6 Mos based on a "Hardship (age) Filing."               Semper Fi

[joevet]

6 hours ago, Gastone said:

Yo, Joe, did I miss where you heard back from the VSO Honchos on the Top Floor? What's the latest update there?

If I've got this right, you're 75/76 and retired, no current actual Earned Income, correct? What is your reasoning for not filing an IU Claim?

 

This is strictly my take on your current situation, the DM II and Glaucoma aren't going to kill you and would be very low %$$ SC's if eventually Awarded, but keep the Claim alive with an Appeal. Your DM II @ 20% may get worse (Think SC Increase) but probably won't kill you in the immediate (2 - 10 yrs) future. You don't discuss any Cancer, so that's not an Issue, right? At 76+, if you don't get hit by a car or shot by a jealous husband, the CAD will probably be the cause your eventual Dirt Nap. Quit jerking around worrying about the Appeal, let it play out, ask for "Hardship advancement" due to age.         Have your VSR file a New Claim for IU, your age is currently not a factor. You'll get the IU T& P No Future Exams (because of your age) within approx 6 Mos based on a "Hardship (age) Filing."               Semper Fi

Gastone, I have not heard a word from the guy that works in the Nashville VA office. He was not a VSO but an employee of the Nashville VA office.

Yes, I am 74 and retired with no actual earned income. I am not familiar with filing an IU claim. What is this and what are the benefits/purpose?

The main secondary claim I was wanting is hypertension because there are several other potential SC's that might become a factor in the future due to hypertension. One of those is sleep apnea which I have. See these two reports concerning diabetes and hypertension affecting sleep apnea. http://www.aasmnet.org/articles.aspx?id=3935 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799991/pdf/nihms-162897.pdf I have not file for sleep apnea  waiting for approval of hypertension as a SC.

As I have said, I have been very passive about filing for and following through with VA claims. I have had ptosis of both eye lids before entering service. Several doctors have recommend surgery. I didn't know until I started checking into my current VA claims that ptosis is covered under the VA claims.

I agree that none of these SC conditions would rate over 10%.  I am at 90% now but receiving compensation at 70% based on the weird system the VA uses.

Any advice or information you can provide would be appreciated. Thanks.