Submitted IMO Not Mentioned in Denial

[paulstrgn]

I recently had the VA deny my SA and HTN (via Higher Level Review). The rater mentions the VA IMO as the one of the reasons for my denial, but does not mention the IMO I had submitted. Should the rater have mention my IMO in the decision?

I also do not understand how they say I did not have an event, disease, or injury in service. I was not treated for HTN while in the service but should have from 7/92 - 2/1995 my average blood pressure reading was 150/85 which was Stage 1 Hypertension (this was the old standards now it is considered Stage 2 Hypertension). I should not be penalized if the service failed to diagnose me for HTN (my IMO mentions that I was un-diagnosed for HTN in the service). When my claim I had submitted every blood pressure reading my medical records listed. The VA did not have an IMO stating I did not have HTN while in the service, apparently they only looked at my records.

The VAs IMO (which was written by a PA) for my SA states I do need a C-PAP but found no link for service connection that the cause was more likely due to age and a higher BMI. The two DBQs and one medical opinion lists reviewing my medical and the buddy letter (I had three, one from my last NCOIC, ex-wife and the last by my adult daughter) as well as my statement and that I more than likely did have SA while in the service. My IMO talks about me having HTN that was not diagnosed while I was in the service along with me having a higher BMI while in the service. I made a chart showing all the weight readings I had while in the service and from 7/1992 - 2/1995 my BMI averaged 29.9 over weight (30 BMI is considered obese). along with my buddy letters and my personal statement. In my opinion the rater never took any of my evidence into consideration.

Since I do not see mention of my IMO should I assume they never looked at it?

[vetquest]

Your IMO should be listed in the evidence reviewed.  If it was not this is reason in itself for appeal.  I had buddy letters that were mentioned in evidence but the BVA called out the rater for not considering them.  I would read your decision carefully to ensure that the IMO was not mentioned in passing and then appeal on these grounds.

[paulstrgn]

This is as close to mentioning the IMO I can find in the decision "Disability Benefits Questionnaire, Sleep apnea Disability received March 16, 2018". Now that I am looking at it I did not realize the IMO was part of the DBQ, I thought it was a separate document which is a 6 page document. I guess by them mentioning the DBQ they are covered. I wished they had gone into detail as to why their DBQ out weighs my DBQs along with the buddy letters. It is a very short denial and not much effort was put into it.

 

[Berta]

I assume when you say  IMO and/our your DBQs -you mean these were done by independent medical professionals- not VA doctors-

This happened to me many times with my RO-

My most recent resolved claim was for a proper rating for an 1151 HBP decision.

My IMO was actually from the VA, due to my past FTCA case.1997 The cardio opinion over my husband's wrongful death is from  the best cardiologist VACO had, and still has,  and she has great expertise in HBP.

The HBP claim was denied with one of  the most ridiculous "examiner "s opinions I have gotten yet.

Although they listed the VACO opinion as evidence , the examiner never read it- I dont think the  examiner read any of the ny deceased husband's medical record at all. It is so ridiculous that I await a copy of the signed opinion and will send it to the Secretary. 

Or maybe I wont wait and just send the opinion as stated in the denial.

I think it was done by the guy who changes the lightbulbs in the RO bathrooms. It was absurd.

In any event I filed CUE on their denial immediately- mailed it by USPS Priority the very next day- and told them they had violated 38 CFR 4.6 to my detriment.

Within one month of the date of the denial , I got the award letter.

IMO/IMEs are usually more intense than what a DBQ could be.

If they ignored, however, DBQs from VA doctors, that were favorable to your claim, that too is a violation of 38 CFR 4.6.

Did the IMO you have follow the IMO criteria here at hadit?

Can you scan and attach a copy of the IMO here ( cover names and your C file # prior to scanning it.)

 

 

 

 

Edited October 14, 2018 by Berta

[paulstrgn]

Thanks Berta. Yes the two DBQ and the IMO were done by private doctors (I had to pay the second doctor to write the IMO), I use tricare for my insurance so I do not go to the VA for care. The one DBQ written by the VA, the PA never saw me it was strictly a paperwork review. The doctor reviewed my service records, by buddy statements, and the previous DBQ which was completed a few years earlier. He stated what evidence he looked at and what evidence in his opinion established that I had SA in the service.

I am assuming that the examiner never looked at any of the evidence I submitted (at lease not in depth), I am sure they had already decided to deny them when they started. The examiner did not mention in the denial )only listed as evidence) anything I stated in the informal conference call I had prior to their denial. The work of the examiner was shoddy at best because they left this twice in there form letter ".(insert reason for denying, elements met and not met)." I have no problem with them using a basic form the section of law, but at least make it look like you are a professional.

I have a redacted copy of the denial letter. I had to have them fax it to me since I never received it in the mail.

VA Decision HTN-SA Senior Review - decision.pdf

[Berta]

The decision was not what I expected....still the IMO might still be probative to the claim if you file a CUE on the decision.

I am focused on the HBP -=we have others here with more SA claims experience, than me.

Did the IMO doctor have your complete SMRs, and if so did they make this point:

 'while in the service but should have from 7/92 - 2/1995 my average blood pressure reading was 150/85 which was Stage 1 Hypertension (this was the old standards now it is considered Stage 2 Hypertension).......

' to use the older standard prevalent when you were in the Military?

Did they give a complete medical rational for their opinion and refer directly  to these readings in your SMRs?

Did they have citations and/or excerpts from any good medical text to support their rationale?

I paid 4,000 for 2 IMos from Dr Bash years ago-

My claim ( which my dumb former vet rep said didnt have a chance)was for a direct SC death based on undiagnosed and untreated DMII due to AO.I had gone through over 6 years of VA medical records, and the autopsy, many times to succeed in my wrongful death (FTCA) claim.My daughter, when she was still in USAF insisted I go over the whole record again because she thought maybe Dad had diabetes and VA failed to diagnose and treat it.

She was right. I could not file 1151 death again, but filed instead for direct SC death.

VA awarded at the BVA level as the RO refused at first to re-open the claim and then refused to consider the IMOs ( I had a freebee IMO too) and should have filed CUE on them but they took  many years to award my other CUE claims. I knew the BVA would award.

My long point is that, medical records need a thorough review, as well as SMRs.

IMO doctors are paid to review them.I provide my lay medical opinon along with my fee check to Dr. Bash-

I know the fee would have been higher if I had not done so much lay medical work.

He used the DMII glucose criteria before it had changed, and that corresponded with my husband's glucose reading in his VA lab reports.

My other point is this- my FTCA case was for wrongful death due to undiagosed and treated IHD, stroke, and HBP which I had proven.

I never saw the DMII connection because of my own stupidity.And not really knowing what diabetes is.

I had gone over the autopsy slides many times and thought I knew what a medical term was when I went over the heart slides. This time, I looked up the specific word I thought I understood years before-but I had been wrong. The slide narrative revealed diabetic cardiomegally- the autopsy used a different term but that was what it meant.Bingo.

That is why we need real doctors to do IMO/IMEs for us. If they have expertise in the field of the disability claimed,they don't miss anything.

Was your HBP IMO done by a cardilogist?

 

 

 

 

 

 

[paulstrgn]

The HBP was done by a doctor who specializes in Pulmonary Disease, Critical Care Medicine, and Sleep Medicine, so no he was not  a cardiologist which looks like it may be a problem for me. I guess by thinking since my medical records show I had un-diagnosed hypertension and as long as the the medical opinion talks about it it would be enough (I guess you get what you pay for, I thought $450 was a lot but it is nothing compared to your's Berta).

I was surprised on how brief the decision was since this was supposedly a higher level review and the person would go into more reasons as to why my evidence does not support my claim. If they would say why it doesn't meet the criteria it would help me in deciding on where I may have gone wrong.

I am not sure if I have enough for a CUE to say I gotcha, mine is more that the examiner does not appear to have looked at my evidence that I had submitted.