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Points to address in IMO



So my doctor seems to up for writing an IMO for my appeal. It seems he didn’t take to kindly to the VA denying his diagnosis.  

Can anyone help me out with the points he will need to address based on my denial. As a point of interest the c&p examiner was a nurse practitioner specializing in gerontology. My doc’s specialization is good to diagnose and treat my conditions. Check out this denial and let me know what he needs to write so he I can make sure he gets everything.  FYI this is just one of multiple joints that were denied.

Service connection for psoriatic arthritis of the left shoulder is not established. Service connection may only be granted for a chronic disability which began in military service or was caused by some event or experience in service.

The evidence does not show an event, disease or injury in service. (38 CFR 3.303, 38 CFR 3 .30~). Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. The VA medical opinion found no persistent disability. 

The medical opinion we received from the VA contract examination was more persuasive than your private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. (38 CFR 3.303, 38 CFR 3.304) The evidence does not show that your disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. (38 CFR 3.307, 38 CFR 3.309)

 The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination. 

Service connection for psoriatic arthritis of the left shoulder is denied because the medical evidence of record fails to show that this disability has been clinically diagnosed. (38 cfr 3.303)"


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First the doctor needs to state that he reviewed all of your service records and current medical records.  He must now make a point to show that your current disability is directly as a result of you service connected disability.  If I remember your denial you posted previously the VA did SC psoriasis.  Now your doctor must show that medical literature supports his contention that the arthritis is a direct result of your psoriasis.

This IMO is not for arthritis but it might give your doctor a roadmap.  Yes it was a winner.

I have again reviewed the medical records and also new medical references which explain neuropathy after a heat stroke.  The studies have shown that the decreased body temperature in some cases cause a metabolic abnormality in the peripheral nerve.  Because this is the most sensitive nerve or the longest nerve, this would cause changes in the leg first.  This would result in numbness and also moderate generalized weakness.  Because of the nerve damage, oftentimes the occiput structure and also ambulation is abnormal, which can result in actually chronic leg pain from the secondary arthritic changes.  In this case I do think that this does explain why he is having some in his leg.

Peripheral neuropathy is cause by many illnesses. However, the most common illness that causes actually generalized peripheral neuropathy is secondary to metabolic changes with can affect the overall metabolism of the nerve resulting in chronic death of the nerve fiber itself.  This is often slow and takes many years.  The most common cause would be diabetes; however, the next most common cause would be other metabolic factors.  The only other metabolic factor which he has been exposed to is his episode of hyperthermia.  Hyperthermia is on of the causes of actually generalized peripheral neuropathy.  This heated recent nerve which was cause by a "heat stroke" the he had while in the military while he was employed.

My rational is based on medical literature which explains peripheral neuropathy causes, one of which is actually hyperthermia.  I investigated this and it varies from the VA impression, since it doe not appear they have done any specific neurological treatment. 



Edited by vetquest
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Since they said I didn't have a diagnosis, should he also include his diagnosis for me?  I believe I've read on other threads that he should give his medical background, basically why he is qualified to opine, correct?  Also, they are saying there was no record in my SMR.  This is because it didn't develop until later.  Does this need to be addressed as well? 

I claimed some of these joint issues in my original VA claim back in 2009, but before i was diagnosed with arthritis and they were denied. I claimed them again this time with a diagnosis. Are these going to be harder to overcome? is there anything I can have the doc include to support them this time around?

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Ok. So my doc is backing off doing an IMO.  He said go to the rheumatologist for an opinion.  Would a dbq from the rheumatologist be good enough if he says he’s reviewed my smr, c-file, and civilian records? Or do I need a full opinion?

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I do not believe the doctor has to recite his full credentials to write a good IMO.  My IMO's were done by a neurologist that just showed he was qualified to make a medical opinion, ie, he was a neurologist in practice.  If you go to a rheumatologist and ask for an opinion at your first appointment they, like most doctors, will balk.  I would try to go back to your other doctor if you still can get him to write his opinion of your case adding that he has read all of your records, just make sure he has them so he is telling the truth.  If he is still unwilling try the rheumatologist and see what they say.  Otherwise you will find yourself in the unenviable position of getting a paid IMO.

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I forgot to ask for their credentials once they wrote the IMOs up, I downloaded the credentials down from the website I paid for one IMO and the other was done for free, the free one was a little light in the info but it did cover the basics.

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On 9/9/2019 at 5:54 PM, paulstrgn said:

I forgot to ask for their credentials once they wrote the IMOs up, I downloaded the credentials down from the website I paid for one IMO and the other was done for free, the free one was a little light in the info but it did cover the basics.

free? how did you pull that off? 


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20 minutes ago, blahsaysme2u said:

how did you pull that off? 

This was the doctor who did my first sleep study. I asked the doctor to write it up and he said he would, he did not ask for any extra money.

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My eyes are watering this morning (again) but this is what you need for a good IMO:

1.  The doc needs to demonstrate he is an expert witness with experience and training in sleep medicine.  This means you need his CV or resume.  Is he board certified in sleep medicine?  Then it should so state.  

2.  The doc needs to state he "reviewed your records".  

3.  The doc needs to provide the nexus in a format familiar to VA.  This means he states "its at least as likely as not" that your sleep apnea is related to service, (or to a SC condition such as PTSD).   If he uses "Your condition COULD be related to...." that is speculative and VA will deny.  

4.  He needs to provide a "medical rationale" as to why he made such an opinion.  He can cite medical journals that link PTSD and sleep apnea, for example.  

5.  He needs to sign the IMO, and he should provide his contact information as well as things like his medical license number.  

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