Which is More Effective: DBQ or IME/IMO?

[FlyHigh1995]

I've recently come to the conclusion that I will have to seek second opinions from medical professionals with either DBQs or IMEs/IMOs. After submitting a FOIA request to see what C&P physician put in my file; I noticed most of what I told her was not in record and some things she claimed she did during my physical  exam...she never actually did. I have been contacted by many IME doctors that are willing to give a second opinion. I would appreciate if anyone could give their experience as to which is better regarding a DBQ or IME/IMO. 

[El Train]

13 hours ago, FlyHigh1995 said:

I’m more confident now with an attorney and my evidence that I have a pretty good chance of rebutting the C&P examiners report. Not sure I want to spend more money on DBQs, IMOs, IMEs...if VA seems to ignore them.  But I may give Dr. Anaise a try after consulting with him on getting an IMO for recent obstructive sleep apnea, chronic fatigue, peripheral neuropathy, diabetes Diagnosis secondary to Gerd. Been working overtime paying for medical expertise...just making my disabilities worse. But I will prevail in my quest for benefits. 

I had a similar experience.  VA gave more credibility to a VA NP vs. Dr. Ellis who is well versed in this stuff.  I even had an HLR deny it too.  I definatly would win in an appeal.  But since I've gotten 100% P&T thanks to the wonderful Dr. Ellis on a host of other contentions, I'll let sleeping dog's lie.  Throw the VA a bone, so to speak.  Let them have there small victory.

[FlyHigh1995]

8 hours ago, El Train said:

I had a similar experience.  VA gave more credibility to a VA NP vs. Dr. Ellis who is well versed in this stuff.  I even had an HLR deny it too.  I definatly would win in an appeal.  But since I've gotten 100% P&T thanks to the wonderful Dr. Ellis on a host of other contentions, I'll let sleeping dog's lie.  Throw the VA a bone, so to speak.  Let them have there small victory.

Your point of view and experience gives me a lot to think about! I like the perspective of  looking at the challenge as “letting VA have there small victory”. Honestly, there decision letter & reasons for denial  pretty much make my case look even more promising and my rebuttals/evidence even stronger. 

[vetquest]

On 2/11/2020 at 3:04 AM, FlyHigh1995 said:

I was actually told by a VA employee that the system is designed to deter veterans and hope we give up. The more we pursue benefits the better chance we have. I have a 10% and several 0% service connections. Recently, in my quest for an increase my claims were denied even after submitting an IMO/IME from Dr. Ellis and DBQs from another doctor who previously worked for VA and had experience in C & P exams (both were very knowledgeable and professional)I kind of feel when the VA sees some of same doctors writing IMO’ s for vets, they tend to not value the expertise any longer. But it’s challenging to find doctors willing to write expert opinions or do DBQs. I was sent for C&P exam 1 month after I submitted my evidence.  The denial letter basically said VA took the words of the C&P Nurse Practitioner over the private MDs...claiming Nurse Practitioner  supplied the most recent evidence, although the IMO/IME and DBQs were done a month prior.  Now I have an attorney who is VA certified and gets compensated by VA if attorney helps me win my claim.  Fingers crossed, I don’t think they accept cases unless they think they can win! Lol

Do not know where heard that about veterans giving up but it is true in some aspects.  They can increase their numbers and give a lot of 10% ratings at what a single 100% rating costs. 

As for the NP's exam being most recent, that is bunk.  If you have two exams and one is more favorable than the other the win goes to the veteran.  One of my appeals the BVA likened it to sandlot baseball, the tie goes to the runner when administering the benefit of doubt.

Finally, if you have a lawyer accept your case they think they can win, I am of the same opinion.  If they lose they do not get paid and they do not want to spend a lot of hours and effort in a losing case.

[JKWilliamsSr]

19 hours ago, El Train said:

I had a similar experience.  VA gave more credibility to a VA NP vs. Dr. Ellis who is well versed in this stuff.  I even had an HLR deny it too.  I definatly would win in an appeal.  But since I've gotten 100% P&T thanks to the wonderful Dr. Ellis on a host of other contentions, I'll let sleeping dog's lie.  Throw the VA a bone, so to speak.  Let them have there small victory.

I am having the same experience.  I filed claims for 12 disabilities in in my denial they only referenced 3 of his opinions as justification for denial (which they applied the wrong law)  but ignored the opinion of the other 9 disabilities.  I will win easily on appeal. 

As far as the original question.  I will always go for an IMO/IME over a DBQ if I am getting it from a non VA provider.  My reason for this is I filed my claims with the presumption that I would need to win on appeal. I had every reason to believe the VA would deny me even with solid evidence and I was correct.  My mistake this time around was filing an HLR instead of going straight to the board.  I wasted time doing that.  I am still waiting for my HLR and Supplemental claims to be completed before I move forward. 

Some Key Points:
1. Most of us that use an IMO/IME get one from an actual MD.  I think this is very important because most C&P exams are done by either NP's or PA's.  I personally have never been given a C&P exam by an actual MD.  What makes this important is during my appeal to the BVA I am going to challenge the qualifications of the PA that did my C&P exams.  This will force the VA to provide the PA's curriculum vitae and when I provide the challenge I will force the VA to explain how they found the PA more qualified than Dr. Ellis who is an actual MD and his curriculum vitae is actually quite impressive. 

2. I submitted a lay statement for every disability that I claimed.  I also have lay statements from my wife and ex wife that support my claims.  I think many people sleep on how powerful lay statements are.  Raters tend to ignore the fact that it is just as important as any medical statement.  Raters state specifically why they find any lay statements no credible.  They just can't make a blanket statement saying it was not credible.  It will not stand up to legal scrutiny. From the onset lay statements are presumed truthful and credible.  This is stated in Caluza v. Brown.  So the VA has to prove it is inaccurate and not credible. 

3. Right now I am working on project that has me going through a large number of CAVC cases.  Something is standing out and that is the importance of a proper reasons and bases for decisions.  The CAVC has Vacated and Remanded a large number of cases where the BVA did not provide proper reasons and bases for denying benefits.  In other words they were not specific.  In order to deny a benefit raters are required to explain the specific reason they did not find any evidence credible.  They cannot make blanket statements denying credibility.  They have to be specific. 

[FlyHigh1995]

Besides IMO/IME, DBQs as supporting documentation.  I was given advice to use Ebenefits secure messaging system to show documented communication between my provider and I. Fortunately, I have a dedicated and caring VA provider.  However, I notice doctors, even the non-VA doctors don’t necessarily document in their notes pertinent info./symptoms I tell them that are important to my claim. I kept asking my primary care provider for a referral for sleep study and kept getting delays.  I paid for a study and was diagnosed by non-VA pulmonologist. I used secure messaging today and was told I can consult with VA sleep center for a CPAP and titration test. If I hadn’t put it in email and attached my records, I think I’d still be waiting.  Same thing occurred when I applied for VA vocrehab, I was denied initially, but I sent my counselor email communication and quoted regulations as to my entitlements and finally counselor approved me (he didn’t care for me after the emails) but I got results. DOCUMENTATION is everything! EMAIL communication makes people a bit more professional and accountable.

Edited February 14, 2020 by FlyHigh1995

[FlyHigh1995]

On 2/11/2020 at 2:08 PM, JKWilliamsSr said:

They If they give more weight to a C&P examiner they have to state the exact reasons why.

I agree wholeheartedly. They definitely lacked in giving exact reason within my denial letter. After reading their reasoning, in my opinion they have actually helped my appeal.

11 hours ago, JKWilliamsSr said:

They cannot make blanket statements denying credibility.  They have to be specific. 

Makes a lot of sense!