Appeal IMO

[SPO]

I just got what is basically an IMO from my doctor for my appeal.  Wanted to get some opinions.  The only thing I really notes is that she didn’t directly address the link between psoriasis and psoriatic arthritis, but I have 2 other opinions in my file that do.  As a note I was denied for specifically for no diagnosis on everything but my back, hip, and right ankle.

 

Edited May 3, 2021 by SPO

[broncovet]

I read your IMO.  While it "may" work, it would only work if there was more stuff in your file.  

Instead, you need:

1.  A CV (Curriculum Vitae)  of the doctor.  You have to establish he is an expert in the field.  I saw no CV.  Your doc may or may not be willing to provide a CV.  If he does not, his opinion may not help much.  A CV shows some detali of the doc's qualifications, such as where he went to medical school, what additional training he had in diagnosis and treatment of arthritis, whether or not he is board certified, and the number of years experience at treating and diagnosing condtions like yours.  

2.  I saw no nexus.  A nexus statement is an opinion by your doctor, that the Veterans (condition) is "at least as likely as not" related to an event in service.  Absent a nexus, you have a better chance at winning the lottery than getting SC.  

3.  The doctor needs a "medical rationale" as to "why" he thinks your disorder is related to an event in service (or secondary to an already SC condition, if applicable).  A medical rationale may be something like, "The NIH study, done in 2018, showed a causitive effect on injuries (like the one you had) leading to arthritis" (insert medical mumbo jumbo).  

     However, if you are already SC for this condition and seeking an increase, his explanation of your increased symptoms may help.  

     My guess is this doc is unfamiliar with VA's IMO, this does not appear to be a great IMO that would get you SC.  My reason is that this IMO did not have any of the elements I described, above.  

Edited April 28, 2021 by broncovet

[SPO]

I asked the doc to add a nexus statement with rationale and reference to medical literature.  She has been very agreeable so far to the weird requests for VA stuff.  
I have a copy of her profile from the hospital website that details her education, board certifications, clinical expertise, and a list/links to studies and medical publications she has been involved in, specific to my condition. Would this cover the CV part?

Edited April 28, 2021 by SPO

[broncovet]

You are getting there.

 

1.Ask the doctor to "document symptoms" and state an opinion of etiology: Is this a symptom of arthrits, and have the doctor state if  arthritis visible on xrays or other tests.  If its on the xray, you cant be faking an illness, because its documented on an xray. 

2. Have the doc mention "she reviewed your records".  (they deny sometimes if the doc does not indicate he knows your history).

3.  It sounds like this may suffice for a CV, to establish medical competency to render an opinion on your conditions.  Some IMO's state somnething like, "I have been diagnosing and treating arthritic conditions since 2003, have taught at UCLA medical school, often train other physicians in new arthritis treatments, board certified etc.."  

4.  State "when" your disabilty began.  Otherwise, the VA wants to use the exam date.  The doc can say things like..."The July 2004 xrays I viewed, showed evidence of degenerative arthritis, consistent with the patient reporting his conditions began in April, 2004"

 

      I think other exxperienced vets advocates will agree your IMO/IME needs to have all these things.  You need to tell your doctor, because many are just not familair with VA's requrements that I listed, above, including the previous post.  

A good IMO/IME will have all these things, and your doctor may charge you more than "an exam" because it is somewhite time consuming to include all these things.  You can save the doc time by reviewing your records and finding stuff and making it easy for them. 

1.  "First noticed" arthritic pain in April 04.  Exam dated April 2, 2004 by dr Kivorkian.  Arthrits present on xray per the radiologist.  

2.  Injured in an airplane jump in military service, reported to sick bay, on May, 3, 1980.  

3.  (now list significant medical exams relating to your condition for doctor to find easily). 

Edited April 29, 2021 by broncovet

[broncovet]

This is significant in the outcome:

Quote

McLendon provides that “the Secretary must provide a VA medical examination when there is,” inter alia, “an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but . . . insufficient competent medical evidence on file for the Secretary to make a decision on the claim.” 20 Vet. App. at 81 (citing, inter alia, 38 U.S.C. § 5103A(d)(2)); see Waters v. Shinseki, 601 F.3d 1274, 1277 (Fed. Cir. 2010) (noting that 38 U.S.C. § 5103A(d)(1), (2) “provide[s] th[e] guidelines for determining whether a medical examination or opinion is necessary for the Secretary to make a decision in a claim” (

Notice the term "must", this means its mandantory for the VA.

[SPO]

I have all my appointment notes, X-ray/ultrasound reports, etc.. that document symptoms and she did note my onset was in 2016 in the letter.  
what you just posted makes it sound like the VA examiners opinion was insufficient to outweigh that of a specialist in my case.

[SPO]

This is the best I’m gonna get out of this doctor.  One issue is that she says that psoriasis is secondary to psoriatic arthritis instead of the opposite.  I’m already rated for psoriasis and claim psoriatic arthritis secondary.  Should I have this sentence removed or let it fly as is?  I know they didn’t provide any medical rationale for it anyway.

I do have at least 1 other opinion written the correct way in my file for nexus.

 

Edited May 3, 2021 by SPO