Opinion on IMO

[Whodat]

Hadit family, I would like your opinion/advice from my letter that my doc had wrote for me. 

 

Dear Sir or Madam:

I have reviewed blank service records and medical history. His DD 214 documents he served in the Army from September xxxx through December xxxx. His signed July xxxx enlistment exam is negative for any medical conditions. Mr. Blank suffers from lumbar degenerative changes and lateral recess stenosis, cervical spondylosis and foraminal stenosis, bilateral knee osteoarthritis, bilateral patellofemoral syndrome and left knee meniscal tear, erectile dysfunction, and migraine headaches among other conditions. 

 

Service treatment records documented Mr Blank was involved in a motor vehicle accident on November xxxx, he complained of neck pain, lower back pain, and knee pain. According to an article published in RMD Open, the Journal of Rheumatic and Musculoskeletal Disease, injuries substantially increase the risk of osteoarthritis. A person can remain asymptomatic for a long period of time, even for decades after the trauma. It is believed that osteoarthritis development in the injured joints is marked by the initial traumatic event by intra-articular pathogenic process. Therefore, it is in my opinion that Mr Blank's lumbar degenerative changes and lateral recess stenosis, cervical spondylosis and foraminal stenosis, and bilateral knee osteoarthritis are at least as likely as not due to the motor vehicle accident while in service. 

 

Doc printed name signature and NPI

 

There is more on the letter for the other conditions but basically says the same thing. 

 

What do you all think?

 

 

[MilvetHD]

I intend to keep my comments short because I believe brevity is important and I know there are other's who will chime in who are long winded. In my opinion, your letter is too generic and fails to capture any substantive independent medical conclusions that are specific to you and your claimed conditions. The documented motor vehicle accident is a start for some of the issues, but how would this lead to ED for example? In short, for each condition your doctor needs to tie it back to a specific injury or illness and/or show that your military service caused a preexisting condition to become worse. Were you hospitalized after this accident? were you on medication? what treatment or treatments have you received thereafter? As well, what about current X-ray and MRI reports, at the risk of sounding redundant an IMO should be specific and tell the story of your injures or illness with detailed supporting records. It's okay to cite peer reviewed medical articles as supplemental information. 

 

[Whodat]

27 minutes ago, MilvetHD said:

I intend to keep my comments short because I believe brevity is important and I know there are other's who will chime in who are long winded. In my opinion, your letter is too generic and fails to capture any substantive independent medical conclusions that are specific to you and your claimed conditions. The documented motor vehicle accident is a start for some of the issues, but how would this lead to ED for example? In short, for each condition your doctor needs to tie it back to a specific injury or illness and/or show that your military service caused a preexisting condition to become worse. Were you hospitalized after this accident? were you on medication? what treatment or treatments have you received thereafter? As well, what about current X-ray and MRI reports, at the risk of sounding redundant an IMO should be specific and tell the story of your injures or illness with detailed supporting records. It's okay to cite peer reviewed medical articles as supplemental information. 

 

I understand milvet. Trust me. My skin is tough. 

There is more on the letter on each symptoms. I just didn't type it all. There is a section that explains my PTSD, meds and Ed. 

 

[MilvetHD]

3 hours ago, Whodat said:

I understand milvet. Trust me. My skin is tough. 

There is more on the letter on each symptoms. I just didn't type it all. There is a section that explains my PTSD, meds and Ed. 

 

Okay, I got you! Best of luck brother 

[broncovet]

There is a "format" for an IMO,  (or IME) which should  include all these things:

1.  The doctor needs to submit his cv to demonstrate he is competent and qualified to render an expert opinion.  Otherwise, its just another unsubstantiated opinion.  

2.  The doctor needs to specifically state, "he reviewed your medical history".   This should not be assumed.  

3.  If a nexus is desired/required, then it needs to be in the at least as likely as not format, it can not be "could be" "may be", or "may possibly be" related to service.  Best for the Veteran is if the doctor states the date symptoms began, via your history.  Ex:  "The Veterans medical history shows he has had degenerative arthritis of the spine since an exam dated May, 24, 1989.  

4.  If this is an "in person exam" it should be so stated, and, the results of any tests confirming a diagnosis should also be stated.  Example:  "In my exam dated July 22, 2022, the patients xrays confirmed the presence of degenerative arthritis of the spine".  Or, if no tests were done by the exam doctor, he can state:  "An xray dated March 19, 2004, confirms my diagnosis of degenerative arthritis of the spine", so this Veteran has obviously suffered from severe arthritic pain and loss of range of motion since that date or earlier."   "Patients medical history demonstrates severe symptoms of degnerative arthritis of the spine as far back as May 22, 1980, consistent with an auto accident injury suffered by the Veteran in military service", 2 years prior.  

5.  The examiner needs to give a medical rationale as to why he stated this opinion, consistent with medical history and medical literature.  

      I will let you decide if this opinion is sufficient, it would appear to lack thoroughness, tests, etc. etc.  If you were paying "a lot" for this IMO, I would not be happy.  If he charged you $50 for an exam, well then that's probably what you get for fifty bucks...you dont get a bunch of the docs time.  If you like this doc, you could go back, offer him more money for a more thorough exam, including a more thorough exam of the medical history.  Of course, he would need a copy of your medical history, perhaps, unless he was your family doctor since you were a child.  

      The documentation of symptoms, as well as the date symptoms began is important to you, because you need to establish "facts found" portion of your effective date.  Otherwise, if your c and p doc does an exam on July 20, 2022, that would be your effective date and your retro wouldnt be enough to buy you a cup of coffee.  

Edited July 23, 2022 by broncovet

[Whodat]

This is great advice that you all had given me. I greatly appreciate it. 

I have read some great IMO's and IME's on this site and other sites. 

Even though the VA has a standardized DBQ, I think that the VA should have a standardized IMO/IME as well. 

Most doctors that the Vet uses, know how to write a letter, but not to VA standards. 

[broncovet]

It may help to understand the rating specialist can not read 4000 pages of your medical file.  So, he or she is probably using a search engine to look for key phrases, such as "at least as likely as not", "medical history was reviewed", and those key phrases like that.  

This is an example only, Im not saying if you dont have those exact words your claim will be denied.  Google, for example, if you search for "2022 Camry hybrid reviews", will know this is a TOYOTA Camry, not a Chevrolet.  So, there is a little slack there, but, why leave your future to chance???  Why not just use terms Va is looking for?  Example:

"The patients medical file demonstrates a chronic condition."   Ok, we are smarter than a search engine.  Does this mean he reviewed your files?  Probably.  How would he know that he had a chronic condition, without reviewing the medical file? 

The answer is the doctor could be guessing, speculating, or even repeating words the Veteran used.  VA doesnt like guessing or speculation.  He wants the doctor to state he "reviewed your medical history."   So, give them what they want.  Dont give them conjecture, extrapolation, or lottery tickets instead.  

Remember military boot camp?  They wanted our clothes folded "just like we were told"..every troop inspected was expected to fold them that way, and no other.  In my boot camp, the first inspection revealed a friend of mine folded his underwear inside out.  The CC (company commander) made him make a fool of himself, by putting his undewear over his head, (with his nose out the fly)  and shouting, "skivies, I will never do this to you again".  .,all while waving his arms "like a chicken with his head cut off".  We got a laff out of that, but I dont think anyone ever folded their underwear wrong ever again.    He had to run around the whole barracks, several times, to make sure everyone saw him, like that.  

Also Remember, there are many Veterans working at VA who went through this kind of thing.  And, many dont want to accept "almost folded right".  No.  Its wrong.  And some of them expect Veterans to understand that, and use the requisite, "I reviewed your medical history".

"Reviewed" is mostly a lawyer term.  Did your doctor say, "he read your medical history".  He, also, probably did not read every word of your 4000 page history.  If he could read one page in 4 minutes, then the doctor would have spent 266 HOURS or almost 7 WEEKS reading your file word for word.  Your doctor has learned long ago, how to scan your file for key information without taking 7 weeks to read your file.  He "reviews" it looking for medical test results, and "key information".  He does not need to read your address, for example, 94 times..with each medical exam in 40 years, because that is not relevant.  The doctor is trained to review the file, and quickly find key, relevant information and summarize it so that the rating specialist does not have to read 4000 pages either.  

Edited July 24, 2022 by broncovet