Question concerning IMO or No!

[Warrenz]

I have hesitated writing this because to many it may come off as just another sniveler. Anyway, here goes! So, I am Vietnam War vet and went thru claims process starting 2008 or nine. At that time was living OCONUS. At that time I knew nothing about the process so I found on the popular ecommerce site a blue covered paperback to help me with filing my claims. I distinctly remember in the beginning of the book the guy cautioning that the process was like a full time job or something like that. IOWs...be prepared for a long process. And it was. Anyway, over the years since then we tend to go back and forth to our place overseas and stateside. I am rated 100% TDIU. But some things I suspect are related as secondary issues. For example OSA. I had a sleep study done about 3 years ago while overseas and the hospital said I had moderate OSA. Ok...got it. The issue or my perceived problem is that the sleep apnea and asthma are or at least in my opinion and from cases I have read could be tied as secondary to ptsd, tinnitus, sinusitis and whatever. I know doctors who do IMOs have to make a living and I personally feel they add value to the process of ensuring vets get rated properly. I checked into IMO to connect OSA to one of my issues. The doctor wanted $$$. I can not get paid more for my aches and pains, The value or only benefits to me would be the ability under the VA Foreign Medial Program to get reimbursed for any treatments I have while I am overseas. Medicare doesn't care about when I am overseas. So, my question is, recently have any vets been successful writing their own nexus based upon the many medical journals conclusions of OSA tied to tinnitus or ptsd; or whether my wheezing  asthma symptoms are connected to my sinusitis...or?  I am just trying to make it to the point where my wife of over 20+ years will be able to collect VA DIC when I croak. But in the interim, it would be nice to have FMP reimburse for service connected issues.  They have been a big help overseas when I do have to go to see doc... Anyone out there reached the point of diminishing returns but still have other issues tied to their other service connected issues?

[Vync]

@Warrenz Welcome to Hadit!

Writing your own IMO is tricky. If you have MD credentials/curriculum vitae, you are in a better boat than most of us to do that. If you are not medically credentialed, it is likely they would consider your IMO as a lay statement. I have read some BVA appeals where the vet was an MD and the VA denied, but it was overturned by the board because they found the vet to be competent to offer an opinion because they were deemed to be an expert.

With OSA, I believe there are three types, but I am no expert. Obstructive is common in vets who are overweight or have bad swelling. Central is neurological. Mixed is a bit of both.

If you are outside of the country, I would assume the VA might not be able to arrange an in-person C&P exam unless you happen to be close to one of our military bases. They will want copies of your medical records related to the issue. Depending on the circumstances, they may do a phone call or video C&P exam and then do the rest based on the records you provide. Keep in mind your wife can write a lay/witness statement. The VA is now "form happy" and they have a special form for that.

I have asthma, rhinitis, tinnitus (drives me nuts), and OSA. My wife wrote a lay statement stating her objective observations. 

Rhinitis is rated be blockages and/or polyps. They may tend to rely on your records, plus an opinion for that.

Tinnitus is a bit odd. The VA relies on a combo of a hearing exam and the opinion of the examiner. It can be caused by a number of things, but not something they can really put their finger on as to whether you have it or not. 

With respect to filing, I strongly recommend you contact the VA and tell them you wish to do an Intent to file. This will reserve your effective date. No evidence is needed and you have a year to formally open one (don't miss this deadline). If you do that before the end of the month, that would save your effective date if you might win.

Keep in mind that you can also file secondaries for side-effects of meds/treatments to treat your SC disabilities.

Don't forget SMC. Often, the meds to treat PTSD may cause problems when being intimate. Meds for musculoskeletal issues, like NSAIDS, can cause gastro problems. Don't forget about those. The intimacy issue might net a SMC-K award, which is about $125 or so more a month.

Look into DIC qualifications. I don't know much about it, but there is different criteria which dictates what your spouse might get.

Look into aid and attendance and/or caregiver claims depending on your circumstances.

If you file for an increase, you merely need to show records that you met the criteria of a higher rating tier within the last 12 months. Sometimes the VA may want to issue a new exam (if they feel your records are too old) or just to get a current assessment.

In my situation, nearly all of my IMO's were from private docs who were experts, did documented exams (older were C&P exam worksheets and recent were DBQs), some had the nexus and details directly in the medical records. Even with an IMO, the VA may still deny.

Expect other members to respond. Keep in mind we have been through the red tape system and may not be experts. However, good luck in your claims!

 

 

 

However, if you have sufficient medical credentials, such as being an MD, or perhaps a board certified doc in neurology/sleep science, you could definitely write your own IMO. We don't know your curriculum vitae/credentials, so I can't offer an opinion on that.

Being TDIU, you should be somewhat close to being 100% schedular, but can't work. I also have OSA and PTSD, but not SC.  I also have SC issues similar to yours like asthma, rhinitis, tinnitus, etc... The as

 

[Warrenz]

Thanks all. My apologies. I am not a medical professional. I know my lay statement would be just that. I had read a couple of those ,txt BVA decisions and I think once or twice I saw where the BVA in all its benevolence found in favor a lay statement. 

I have sc for tinnitus as well as hearing disability. It seems like a long time ago....well 10 yrs+ since they originally decided my disabilities. As a Vietnam vet I for a long time felt my hypertension and neuropathy was service connected, but back 2010 timeframe was not able to connect the dots and they were both shot down. But, I had none of the risk factors for hypertension. They basically waved it off... I knew my peripheral neuropathy and hypertension were related to my service time. I also knew at the time my tinnitus was as well. Back when I first noticed it while still in the military I honestly didn't even know it had a name. Go figure. My hypertension was SC as a result of PACT Act. I thought I would have problems with getting sc for tinnitus and hearing loss way back when, but my MOS was  11B40 and I think that was a deciding factor? I seem to recall that in the period I was awarded sc 2012 or 2013 I guess there were some changes as far as MOS played a role. I don't know though.  

My meds do have an impact. I could have maybe should have looked into SMC but at my age I feel lucky to just wake up. As for one of the SMC issues, I have had since 2015 or thereabouts had least three sinus procedures to remove polyps.  I had no sense of smell or taste for a long time. The last time a few years ago they did some ballon procedure at the time they removed polyps? So, I am thinking as a result of the continual nasal rinse meds it has changed. I now have some sense of smell and taste. It isn't all that accurate  though. But I can smell the morning coffee.

As to C&P at that time they arranged thru the embassy? Once they did the C&Ps and whatever magic they do at the VA the decisions started to come in, kind of incrementally but ratcheted up to finally 90%. It just seemed to take forever back then for it to rise to the level of them to look at my packet.

Again, my cost benefit thinking was for meds while overseas. The FMP works ok I guess? I have a sc for one eye, and the FMP folks were pretty vague about glasses. No, not vague...maybe wishy washy about an answer. But here in the states they take care of that.

Anyway,  I was just curious. One doctor gave a quote for IMO on OSA, but not the asthma. The quote  was pretty high all things considered.  Or at least that is how I felt. Anyway, I appreciate thefeed back. Years ago there was a great guy that would answer questions. Ask Jim? I think he passed away. I have friends who when they retired they had a benefits at discharge and a VA office right on the installation. My oldest son will be retiring from USMC in a couple of years and he is and I think many of the younger folks are well ahead of the power curve on that. 

[broncovet]

Welcome to hadit.  Yes, we all wish there was a "workaround" to paying for a nexus.  And, fortunately, there are.  I will get to the 2 methods to avoid paying for a nexus up front, soon.   Those may or may not work for you, as I dont know your situation, and whether those methods are practical or apply to you or not.   

The VA needs an opinion YOUR sleep apnea is related to YOUR PTSD, not people in the study in a medical journal. Those people are not applying for benefits, and, if they did, they have their own unique set of problems and circumstances, which are almost certainly different from yours.    This means you need a medical professionals opinion, and, unless you are a medical professional, this rules out "lay testimony", aka the testimony of someone other than a qualified medical professional, aka "expert witness".  This is why you can rarely succeed in writing your own DBQ or nexus.  

Now, on to the two ways of not having to pay upfront for a medical opinion, aka nexus:  

1.  Ask your VA doctor who is treating you.  Sometimes you will be surprised at how often "asking" works.  Ok, now what happens when your doctor declines?   Ask another *VA" or another private  doctor to which your private insurance will pay for it.  Most Veterans who do get full VA benefits do so with persistence, while those who give up and quit rarely do.    In my own experience, I have noticed some VA doc's have provided a nexus for me easily and without me asking, while others would not provide a Nexus if I were Warren Buffet and offered the doc a million dollars, plus all the money the doc needed for the rest of his life, and, I already had a nexus from 10 famous doctors, all of who opined that my PTSD was related to service.  People are different and, doctors are people, so their opinions vary widely.  

    Now, on to the second method:

2.  If you have been denied, "some" law firms who accept your case will "up front" the cost of the IMO, and then take that cost out of your retro.  If you dont have an attorney, you can bring these issues up to one on the NOVA advocate website, and see if they are interested in representing you knowing this.  I think Hill and Ponton may have done this, Glover Luck did it for me, and it would not hurt to ask Bergman and Moore or others.   You dont think you have a chance of retro?  Maybe, maybe not. Here is why:

Many Veterans underestimate their own potential retro.  Often, Vets who are 100 percent, for example, have been convinced, "that is as high as you can go", when, indeed its possible to get thousands and thousands more per month with SMC.  

      A common overlooked SMC is SMC S (Housebound).  There are 2 ways to get housebound, statuatory and housebound in fact:

1.   Statuatory.  SMC S should be awarded when the Veteran has a single 100 percent (tdiu counts) plus additional ratings which combine to 60 percent, seperate and distinct.  You may not be very far from this if you already are using a cpap (slepp apnea) and have PTSD, plus it will likely take another rating or two to get there.  

2.  Housebound in fact, generally requires medical evidence that you are unable to leave your home "except to go to work", that is, you are substantially confined to your home.