Imo Or Treatment Records

[Ricky]

As we discussed in the other post about IMO's this is a medical summary which was provided back to my Tricare family Doc, for his use to justify the continued refferals to the neuro and upcoming hospital test and exams and possible operation. No basis for his opinion except for his objective findings. I sent it to va to support my claim but they did not use it based upon the incredible rating they gave me. The Dejerine Roussy is already service connected however, they failed to rate it for the seperate body areas and simply gave me an overall 10 percent rating. Hope I can upload this. Let me know what you guys think.

hmmm can not get any of my special functions to work so I will have my daughter type it in cause it would take me all night:

MADISON NEUROLOGICAL

LYNN B. BOYER M.D.

ALABAMA USA

RE: Me SSAN

DOB: Long Ago

TO WHOM IT MAY CONCERN:

I am a licensed, board certified neurologist and have been practicing neurology in the state of Alabama for 32 years.

Mr. H has been a patient of mine since February 2005 at which time he was diagnosed with a CVA (right thalamic infarct) and Dejerine Roussy Syndrome (DRS). DRS is caused by damage to the central nervous system and is not associated with normal peripheral nerve damage. It manifest itself in the form of a severe and constant deep burning, aching, cutting, tearing sensation and is mixed with sudden, excruciating shots of pain. It is also mixed with other distracting sensations like ballooning and painful numbess sensations.

Objectively as a result of his CVA he suffers from DRS connoly referred to as Thalamic Syndrome. His DRS has manifested itself as a continuous severe dyesethesia and hyperpathia in the left side of his face and mouth and especially distally in the left arm, hand, leg and foot. Also present is continuous sensory ataxia. His dysesthesia is present both with (evoked ) and without stimuli. His pain is severe and constant and results in his inability to endure the touch of basic clothing, simple temperature changes, and normal speaking and eating functions. Hiw hyperpathia has resulted in complete sensory paralysis due to the sonstant guarding of the areas in an effort to lessen the effects of the pain. As a result of his sensory ataxia he has insufficient sensory feedback to walk securely or grasp and hold items with the hand. He is unable to tell precisely when his foot has reached the maximal impact of weight bearing which greatly affects his ability to perform normal walking functions. The sensory ataxia of the hand has resulted in an extreme decrease in proprioceptive and positional sense of the limb resulting in the inability to use the hand during normal activities throughout the day. As a result of his chronic pain and sensory ataxia, he has become resigned to his symptoms and suffers from moderate depression.

Mr. His is currently being treated with 3200 mg neurontin per day, 1800 mg Trileptal per day and I recently added 60 mg of Cymbalta to further reduce the pain and assist with the depression. Further treatment by me will include a full work up in Birmingham to explore the possible use of (could not make it out but he wants to implant something into my brain to try and stop the pain).

It is my opinion that Mr. H's CVA and resulting DRS have in effect made him severely disabled. The constant pain, which increases with stimuli, coupled with the sensory ataxia has resulted in a complete functional loss of both his left hand and foot. The effects of the DRS will continue and will more likely increase in severity with time.

Now will raters view documents such as this as IMO's and blow them off as "no probative value" or will they use them as notes etc.... from a treating doc and use it to rate your claim? I can tell you that my VARO refuses to accept any medical evidence even if it is signed by GOD Almighty himself. They will not even spend the time to explain if it is probative or not they just simply provide a reason and basis of "your disability does not meet the requirements required by law". Guess they are working off some foreign law as US Code, 38 CFR nor M21 means a thing to them. It is as though they are some rouge organization marching to their own tune. Please belive me that my comments are made simply cause they denied my claim but are based upon my reading of 100's upon 100's of rating decisions and SOC's issued in this state.

Edited February 2, 2007 by Ricky

[Ricky]

To prove my point about my varo - CFR 38 provides for a 100 percent evaluation for six months for a stroke. Mine happened in Jan 05. My claim was filed in Feb/Mar 05 asking for the 100 percent evaluation for six months. In the first of July 05 had C&P. In the end of July rating decision was received. claim was denied due to "no evidence of a active process or disease". There was no mention of any evidence contained in the C&P or any other evidence in support of the claim either probative, non-probative or negative to the claim. Based upon their limited basis for their decision I am not sure what they were looking for. The only thing I can think of is they are saying the stroke was to old at the time the claim was filed (3 months old) previous BVA claims denied the 100 x 6 months because the vets stroke happened 10-15 years prior to the filing of their claim. The ones that have been approved are vets who had strokes within the previous year prior to filing the claim. Below is the medical opinion my doc provided in support of my claim. I think he covered all of the bases but I am just a dumb lay person.

MADISON NEUROLOGICAL

LYNN B. BOYER, M.D.

8371 Hwy 72 West, Suite 206

Madison, Alabama 35758

Phone (256)837-6600

Fax (256) 837-6401

1 August 2005

RE: RICKY

DOB:

TO WHOM IT MAY CONCERN:

Mr. H has been a patient of mine since February 2005 at which time he was referred to this office by Dr. Michael Cooke, Fox Army Medical Center, Redstone Arsneal Alabama. His referral was based upon his 20 January 2005 symptomology of left sided numbness with weakness, slurred speech, headaches and blurred vision. As a result of his symptomology a current Cerebrovascular Accident process was suspected by emergency room personnel and on 24 January 2005 a Magnetic Resonance Imaging study was conducted. The interpretation of his Magnetic Resonance Imaging provided that he had suffered a subacute (recent) right-sided Thalamic Cerebrovascular Accident.

Upon my physical examination, review of his medical history and records along with a review of his Magnetic Resonance Imaging films, my diagnosis agreed with that of the radiology report of a subacute (recent) right-sided Thalamic Cerebrovascular Accident which was productive of both his 20 January 2005 symptomology and residual symptomology present during physical examination. The review of the Magnetic Resonance Imaging films was negative for any chronic (older) lesions.

RE: RICKY

Page 2

In my medical opinion Mr. Hs’ Cerebrovascular Accident occurred on 20 January 2005. His symptomology presented in the emergency room on 20 January 2005 was the result of a current, ongoing and active process of a Cerebrovascular Accident. My opinion is based upon my personal physical examination of Mr. H; his long standing medical history of Hypertension and Diabetes; my review of the Magnetic Resonance Imaging studies conducted on 24 January 2005; my extensive 32 years of experience in the field of Neurology treating patients of Cerebrovascular Accidents and the current accepted medical opinion and doctrine of the American Academy of Neurology, the National Stroke Association and various other prestigious medical organizations. These organizations state that patients presenting symptomology such as Mr. H’, especially those with a long standing medical history of Hypertension and Diabetes, are more likely than not suffering from an ongoing active Cerebrovascular Accident process which will complete within hours and rarely last longer than a few days. After completion of the active process residual neurological deficits will more than likely be present and their effects and severity will be dependant upon the location and severity of the Cerebrovascular Accident.

Sincerely,

LYNN B. BOYER M.D.

LBB/lts

[Berta]

Ricky-that is an excellent IMO-

Did you mean they never listed it as evidence nor never considered this at all?

Also the time frame doesn't matter as to when you had the stroke-as I see this-

The VA Sced under Section 1151 all of my husband's strokes-the award letter was dated 1998-the strokes were in 1988 and then again in 1992-

The Sec 1151 claim he had filed on this 6 months prior to his death- was what I re-opened-in 1995.

It looks to me that they never considered all of this IMO at all-

"These organizations state that patients presenting symptomology such as Mr. H’, especially those with a long standing medical history of Hypertension and Diabetes, are more likely than not suffering from an ongoing active Cerebrovascular Accident process which will complete within hours and rarely last longer than a few days. After completion of the active process residual neurological deficits will more than likely be present and their effects and severity will be dependant upon the location and severity of the Cerebrovascular Accident."

Right- the immediate affect of a major CVA is total disability- the residuals can be anywhere from minimal to having major disabling after affects-

I wonder if the VA read the "are more likely than not" and did not understand it properly in the context this doctor meant-

You are right - 6 months 100% for major CVA-

Have you filed a NOD or have you requested a Reconsideration of this ridiculous decision?

and the VA has the audacity to tell me my husband was not eligible for SMC under "any circumstances"---

I cant wait to see how they handle my CUE on that-

100% SC PTSD and 100% Sec 1151 CVA ( both of which the SSA sent awards letters on) (both documented in VA award letters also)

ths does not count for his undiagnosed heart disease and undiagnosed DMII either under Section 1151.

both 100% disabled

Edited February 2, 2007 by Berta

[Ricky]

Berta - it was listed on the evidence page as "Letter from Lynn Boyer". However, that was it. In the body of the rating decision and SOC there is NO discussion of any evidence whatsoever. It simply states only the information that I provided to the C&P doc such as "you state that on 20 Jan 2005 you were treated for the symptoms of stroke yada yada yada......Service connection for CVA with residuals of dejerine roussy is awarded at 10 percent. The claim for the initinal 100% x 6 months was denied because there was no evidence of an active process. Not even a mention of the objective findings of the C&P doc which fully supported the date of the stroke and the residuals which should have continued with a rating of 100 percent. Based upon the inadequate reason and basis I do not have any idea what they need to prove the claim. The way I read 38 CFR is that if you have a stroke then it is rated at 100 X 6 months, then re-evaluated for the rating of the residuals. Most rating decisions I have seen will at least say "Dr. Boyer stated in his medical decision yada yada yada, however, other records of evidence provide that etc........ At least that gives you some idea as to what you are up against. In my Nod and form 9 the only thing I could do was attack the inadequate reason and basis and then present arguments as to what I thought maybe on the rating officials mind at the time of the rating. Boy, the only thing I know is I am about to go crazy. Although I have requested in writing six times since Jan 06 to have a meeting with the DRO, the latest response from IRIS about my request is "we have received your request for a hearing with a memeber of the board via video teleconference. You are number 224 on the list so you should expect to have the hearing in approximately 18-24 months." Not a damn word about the DRO hearing. I do not understand this for as I said I have six green cards where they signed for the blasted letter requesting the DRO hearing and over 30 IRIS inquiries where I have inquired about it and not ONE WORD in response to the question posed which was:

"This inquiry is being submitted to determine the status of my written requests submitted on (multi dates). This written inquiry was submitted as part of my due process rights provided by 38 CFR and requested that I be allowed a local hearing with a DRO in Montgomery Alabama. This hearing request is in support of my NOD filed in Aug 2005 and ultimately my perfected appeal resulting from VA's SOC issued on 25 January 2006. As I have have been informed of the date of my requested hearing please provide me with such date so I will be allowed the time to prepare for the hearing."

Their replies included - we are scheduling you for the requested travel board hearing to your appeal is being processed. Not one letter in the reply concerning the original question. How can they be so stupid? They are really trying me on this one. Although I do not suffer from PTSD, I do have severe depression and emotional problems due to the dejerine roussy syndrome. If I ever lose it and focus only half of the anger that my poor family puts up with on the idiots they better look out cause there is no telling what will happen. Thanks for letting me rant.

[Objee]

Berta - it was listed on the evidence page as "Letter from Lynn Boyer". However, that was it. In the body of the rating decision and SOC there is NO discussion of any evidence whatsoever. It simply states only the information that I provided to the C&P doc such as "you state that on 20 Jan 2005 you were treated for the symptoms of stroke yada yada yada......Service connection for CVA with residuals of dejerine roussy is awarded at 10 percent.

<Snip>

Ricky, that's IDENTICAL to my decision letter SOC statement. Under "evidence" it lists "Report from Dr. XXXXXXXXXXX, dated August 20, 2003." In the SOC the RO states "A review of your considerable VA treatment records shows you with many disabilities. However, none of these records diagnose any of these conditions as being related to your postoperative thyroid disease. Further, none of these records contain a medical opinion that you may have any additional disability related to your postoperative thyroid disease." OF COURSE THEY DIDN'T - THEY WERE CLINICAL PROGRESS REPORTS!

Once my thyroidectomy was determined to be service connected, the "Report from Dr. XXXXXXXXX. . ." should have been reevaluated for medical opinion content and probative value. My causative factor was ionizing radiation which wouldn't show in my SMRs, so they were irrelevant in my case. Dr. XXXXXXXXX didn't need to see any SMRs to write an opinion. He related a number of my ailments to radiation exposure in his medical opinion (report.) The VA totally ignored his opinion which they were required to examine once my thyroid problems were service connected. No acknowledgement of his medical opinion appeared anywhere in the SOC.

Result? A lowball 10% because I take thyroid pills.

Looks like this is SOP for the VAROs to lowball legitimate claims and start the "Delay, deny until you die" process.

Ralph

[Objee]

Berta - it was listed on the evidence page as "Letter from Lynn Boyer". However, that was it. In the body of the rating decision and SOC there is NO discussion of any evidence whatsoever. It simply states only the information that I provided to the C&P doc such as "you state that on 20 Jan 2005 you were treated for the symptoms of stroke yada yada yada......Service connection for CVA with residuals of dejerine roussy is awarded at 10 percent.

<Snip>

Ricky, that's IDENTICAL to my decision letter SOC statement. Under "evidence" it lists "Report from Dr. XXXXXXXXXXX, dated August 20, 2003." In the SOC the RO states "A review of your considerable VA treatment records shows you with many disabilities. However, none of these records diagnose any of these conditions as being related to your postoperative thyroid disease. Further, none of these records contain a medical opinion that you may have any additional disability related to your postoperative thyroid disease." OF COURSE THEY DIDN'T - THEY WERE CLINICAL PROGRESS REPORTS!

Once my thyroidectomy was determined to be service connected, the "Report from Dr. XXXXXXXXX. . ." should have been reevaluated for medical opinion content and probative value. My causative factor was ionizing radiation which wouldn't show in my SMRs, so they were irrelevant in my case. Dr. XXXXXXXXX didn't need to see any SMRs to write an opinion. He related a number of my ailments to radiation exposure in his medical opinion (report.) He is a Board certified Forensic Physician - like CIS on TV. The forensics reconstruct old medical histories which is what was needed. The VA totally ignored his opinion which they were required to examine once my thyroid problems were service connected. No acknowledgement of his medical opinion appeared anywhere in the SOC.

Result? A lowball 10% because I take thyroid pills.

Looks like this is SOP for the VAROs to lowball legitimate claims and start the "Delay, deny until you die" process.

Ralph