There Is No "treating-physician Rule" At Va

[Guest rickb54]

Read this story from vawatchdog.. Based on this the va doesn't have to accept any IMO's and there is nothing a veteran can do about it.

http://www.vawatchdog.com/07/nf07/nfJAN07/nf010907-1.htm

[Ricky]

Rick, after reading the article a couple of times I think it sets presedence for the VA to follow - in that if you have a heart problem and a cardio guy weighs in for you then the VA, by their own admission, would have to give that opinion more weight than the call by one of their fly by night C&P docs. Now I could be wrong but we vets throw this in their face day after day. That is why they tend to overlook IMO's provided by neuro, cardio etc..... kind of guys. They feel that if they close their eyes then maybe they can get away with it, but it always gets caught by the BVA or CVA. Just my take but like I said i could be wrong. It would not be the first time hahhahahaha.

[Berta]

"Read this story from vawatchdog.. Based on this the va doesn't have to accept any IMO's and there is nothing a veteran can do about it."

Rickb -I see this differently than you do- I hope others will comment on this too-

from VA Watchdog--

UNITED STATES COURT OF APPEALS FOR THE FEDERAL CIRCUIT

243 F3d 1378 (2001)

MARGARET E. WHITE,

Claimant-Appellant,

v.

ANTHONY J. PRINCIPI,

Secretary of Veterans Affairs,

Respondent-Appellee.

March 27, 2001, Decided

"If the treating physician's opinion does not support the claim for benefits, then giving it more weight might result in a decision against the claimant, which would be contrary to § 5107(B) if the evidence were otherwise in approximate balance."

great point there-

and:

"Ms. White applied for DIC benefits in February of 1990, asserting that her husband's service-connected arthritis was a contributing cause of his death. The regional office of the Department of Veterans Affairs ("RO") denied the claim, determining that there was no evidence substantiating that Mr. White's arthritis contributed to his death. Ms. White appealed the denial to the Board.

The evidence before the Board included letters from four physicians: (1) Dr. Alston, an internist and Mr. White's personal treating physician; (2) Dr. Oppenheim, M.D., J.D., L.L.M. (medical specialty unknown), who issued his opinion at Ms. White's request after reviewing Mr. White's medical records and the transcripts of hearings that had been held before the RO; (3) Dr. Miller, a Department of Veterans Affairs ("VA") physician and specialist in pulmonary disease, who issued his opinion at the request of the VA after reviewing Mr. White's VA records; and (4) Dr. Schnader, a VA physician and specialist in pulmonary disease and critical care medicine, who issued his opinion at the VA's request after reviewing Mr. White's VA records. The letters from Dr. Alston and Dr. Oppenheim supported Ms. White's DIC claim. The letters from the VA doctors indicated that it was unlikely that Mr. White's arthritis contributed to his death."

"White asked the Board to apply the "treating physician" rule to resolve the conflict. The rule would have required the Board to give more evidentiary weight to the opinion of the physician who actually had examined Mr. White, Dr. Alston, and would have required the Board to accept his opinion unless it was contradicted by substantial evidence. The Board did not apply such a rule. Instead, the Board determined that, because Mr. White died of pneumonia, the physicians who specialized in pulmonary medicine were better qualified to give opinions as to whether Mr. White's arthritis contributed to his death. The Board found that the conclusions of these physicians, that Mr. White's death was not related to his service-connected arthritis, constituted persuasive evidence against Ms. White's DIC claim. The Board also determined that there was no contemporaneous clinical support for Dr. Alston's and Dr. Oppenheim's opinions that Mr. White's service-connected arthritis led to diminished pulmonary or cardiovascular function and thereby contributed to his death. The Board therefore denied Ms. White's claim for DIC benefits.

Ms. White appealed the Board decision to the Court" etc---

It appears to me that the 2 IMos doctors did not give a rationale for their opinion-

by stating whatever background they had in supporting their opinions- as to Mr. White's death.

A 'treating' physician- while treating a vet with a disability out of their area of expertise, cannot always render a strong opinion with a full rationale.

Many here get IMOs from Dr. Bash that the VA might consider an internist as well as a radiologist.

His opinions have probative value, however, when the disability involves expert interpretation of X rays and CT scans-therefore he can give a complete medical rationale for his opinion.

In my IMO he told VA he had interpreted thousands of MRIs of diabetics and correlated the clinical record and my husband's MRI with the resulting facts-that the brain ischemia was consistent with diabetes.

I also had sent excellent probative medical treatises that support that fact too.

But this widow seemed to rely on the fact that the veteran's treatment came from long term relationship with non- VA doctors- without the ability or medical experience to provide medical rationale strong enough to overcome the pulmonary and cardiovascular VA opinions.

"the Board determined that, because Mr. White died of pneumonia, the physicians who specialized in pulmonary medicine were better qualified to give opinions as to whether Mr. White's arthritis contributed to his death"

makes sense to me-and the widow should have gotten a IMO from a pulmonary expert-or these IMo doctors should have stated their medical rationale better.

It bears out the fact that say a vet has a private doctor for years and is able to get a free IMO to support their claim-

but the private doctor might have no medical rationale at all for the IMO.The VA will not buy what they are selling.

There is the factor of medical status too- a Neuro doctor can outweigh an internist, a psychiatrist can outweigh a psychologist. They all can outweigh a GP doctor.

In addition to my Bash IMos I had obtained a very probative statement from a former VA doctor- a Neurologist-who had treated my husband before the doctor left VA for private practice.He was the only VA doctor who wanted to properly diagnose Rod and was overruled.

Along with the med rec entries he made, this statement I obtained 2 years ago emphatically was a neurologist's support for the very basis of my AO claim. Dr. Bash loved it, and used it in his subsequent IMO.

I have a good friend who is a psychologist. I worked for him and he and his wife became good friends of mine.

I was asked if he could provide an IMO for a vet with PTSD.That is- the vet says he has PTSD -the VA said he didnt have it-and there was no proven nexus to service of PTSD-

This doctor worked in a psychiatric hospital for decades and then in private practice but he has no expertise at all in PTSD.Most of his patients are not veterans and they do not have PTSD.

He is a vet but of the Indian Army.The military in India is not really similiar too American military.

He was calvary -meaning he did all his training on horseback and it involved sword exercises as much as gun stuff.(maybe more then)

I didn't even ask him if he could provide this IMO because he has no rationale or expertise to support any opinion he could render for this specific veteran.

This vet needed a psychiatrist with the ability to give a battery of tests that could medically rule PTSD in or out.

It pays -if you consider an IMO- to get one that will provide the best rationale and expertise possible for the disability you are trying to service connect.