Points to address in IMO

[SPO]

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)"

 

[paulstrgn]

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.

[broncovet]

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.