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I know we spoke about this not long ago, but I had an example that shows just how powerful a properly prepared "nexus" letter from an IMO can be in winning benefits.
The surviving spouse of a veteran had been seeking "DIC" benefits, claiming that the veterans cause of death was related to one of his service connected disabilities
The Death Certificate found "Acute Coronary Syndrome" as the "primary" cause of death, and "renal failure" as the secondary cause of death.
The VA Regional Office repeatedly denied the claim pointing out that the veteran only had Service Connected PTSD, Tinnitus, Hearing Loss and non-compensable residuals of Malaria. They relied upon the medical opinion of their chosen C&P examiner who went into great detail explaining how none of the Service Connected disabilities were at all related to the cause of death.
The surviving spouse contacted my office and we appealed the Regional Office denial to the BVA. I also contacted the physician I deal with exclusively in VA related claims, discussed the facts of this claim and set up a time for this “Independent Medical Examiner” to meet with the surviving spouse. I also, of course, provided the IME with a complete AND specifically organized copy of the VA Claims file for his review. Following his review of the Claims File, and his meeting with the surviving spouse, this IME provided us with a written Medical Opinion containing all the “magic language” required by the VA. His report further contained his reasoning as to why the Service Connected disabilities of PTSD and Malaria were "as likely as not", the underlying cause of death.
The BVA Judge, after receiving our IMO, correctly found that the evidence in the case was equal (in equipoise) as there was one opinion against cause of death being related to “service connected” disabilities (their C&P exam), and one opinion for cause of death being related to “service connected” disabilities (our IMO). Therefore, under the law, when all evidence is equal, THE VETERAN WINS. In our case, that means the surviving spouse wins!
This spouse will now receive DIC benefits which NEVER would have been granted without getting a well-reasoned IMO of our own.
/s/ Roger Hale
Memo To: VAWatchdog Dot Org
From: Craig N. Bash, M.D., Neuro-Radiologist
www.veteransmedadvisor.com ☎ (cell phone 240-506-1556)
Topic: The Disability Benefits Questionnaire (DBQ)
The DBQ (Disabilities Benefits Questionnaire) is an administratively organized medical history and physical (H&P) that allows the VA to input this data directly in to the rating system. But the VA only has about 70 DBQ forms for their 2000+ ratings which are based on the 65,000 medical system ICD10 codes. Thus, the DBQs are a broad-brush approach to medical problems and many DBQ questions do not pertain to each veterans medical specific medical situation.
Most veterans have been told that they need a DBQ to be successful with their VA claims but most VA physicians aren't allowed to do DBQs because they have not been “trained” how to do them. Thus the VA reserves the option to only allow the DBQ forms to be done by a select few providers.
The truth is that the DBQ alone will not lead to a successful claim because, in my experience, often the VA providers that do the DBQ now are very shallowly trained NPs (nurse practitioners) or PAs (physician assistants) who simply do not have the depth of knowledge to handle these complex medical issues that often span decades and involve many inter-related primary and secondary conditions. The axiom “You see what you look for and you look for what you know” applies here. If the NPs and Pas have a deficient knowledge base they will not look for all of the veteran’s medical problems and the veteran will lose his claim.
Furthermore, the DBQ does not have a medical nexus section. If you review enough VA records you'll see that often the VA asks specific opinion questions to the DBQ provider. These VA medical opinions are essentially Claims and Pension (C &P) service questions and potentially biased by the questions asked.
The nexus opinion is used as proof of service connection. Again since the VA providers are not randomly selected these nexus opinions have inherent selection bias. Many veterans think that the nexus opinion alone is enough proof of service connection but the truth is that for a successful case the veteran needs both a good medical H& P (DBQ) and a good nexus report to prevail.
Thus, after the DBQ has been done, the VA will often ask the provider to provide a medical opinion. The VA Comp and Pen service will the provide questions for the medical opinion provider concerning the DBQ. These questions are often somewhat biased due to the fact that the C&P service is paid by the VA.
1. Veterans should seek MD experts, which are able to do combined Independent DBQs and
2. A nexus without DBQ and a DBQ without nexus are each basically worthless.
3. Each opinion should evaluate any other DBQs and IMEs in the record and discuss any
secondary complications or CUE issues.
4. All claims should be placed on the correct forms as VA has adopted a draconian rule in 2015 of
“No form No benefits”.
/s/ Craig N. Bash M.D.
WHAT IS A MEDICAL NEXUS AND WHY IS IT IMPORTANT?
Usually, the most important part of any claim for veterans disability benefits is being able to prove that there is a “link” between your current medical conditions and your service while in the military. This is called the “nexus”. The nexus, or link, between a veteran’s current disability and something that happened to you “in-service” is often the hardest thing to prove in your claim for VA disability benefits. However, without a nexus, your disability benefits claim with the Veteran’s Administration (VA) WILL NOT WIN!
Leah Wingeart is a clinical psychologist, currently licensed in Nevada, Hawaii, and Colorado.
She has a Bachelor's of Arts degree in Psychology from the University of Maryland, a Master's
of Education degree in School Guidance and Counseling K-12 from Loyola College in
Baltimore, and a Doctorate in Clinical Psychology with a specialization in health
psychology from the University of Denver. She graduated Phi Beta Kappa and Summa Cum
Laude from the University of Maryland and was inducted into Chi Sigma Iota while at Loyola
College. She has worked in the mental health field as a school guidance counselor
and as a clinical psychologist for 18 years. She served honorably in the U.S. Navy from
2008 to 2015 and is affiliated currently with the U.S. Naval Reserves.
She lives and works primarily in Henderson, NV, but works also in
Colorado and Hawaii throughout the year.
Need more information, have questions, or want to do a free
15-minute phone or email consult?
Call 855-949-3676 or email to firstname.lastname@example.org.
2990 Sunridge Heights Pkwy #100
Henderson, NV 89052
Providing in-person therapy and psychological assessment in
Nevada. Also providing independent medical
evaluations and consulting services in Nevada, Hawaii, Colorado
PTSD Evaluations and Veteran Medical Opinions
Brett Valette, PhD
If you have served in any war from Viet Nam to Iraq and Afghanistan, and if you’ve had
any traumatic experience that is affecting you today, then you need to talk to me as
I can do a compassionate record review and Independent Veteran Medical
Opinion (IMO) based on your psychiatric issues.
I’m Dr. Brett Valette, a clinical psychologist and I’ve specialized in PTSD and
trauma evaluations for over 15 years. If it’s a combat trauma, or if you were
non-combat but experienced traumatic events, or if you were a victim of sexual trauma,
I want to help you because VA often mis-categorizes these serious PTSD
related issues as personality disorders.
If you were previously denied benefits, or you were labeled as “not fitting criteria” or if you
have not had a service connected condition, I can help you as I have 15 years
worth of experience with these types of veteran medical opinion related benefits.
Maybe you felt pressured upon your return to fill out your forms stating “I’m fine,” and now your
wife is going to leave you because you’re ‘acting crazy’ and your parents say,
“You aren’t the same person anymore.” So, in your records you have denied
any problems and there is no paper trail of treatment or symptoms.
You now feel you are ‘left out to dry’; abandoned by the military. I can help you.
Some Vets have worsening of their condition after they’re home for a few years. Suddenly
they find themselves living in isolation, sleeping with their gun, having angry outbursts at
their partners and even their children. The people who are important to you are now afraid
of you. When you leave your house you scan for danger, you plan escape routes
(even in McDonalds), ‘stupid drivers’ should be run off the road, and disrespect for
you is all around. You need to talk to me.
Maybe your service connected disability rating is too low. Things change.
Symptoms change. Stress and life pressure changes. Let me help you.
Some Vets have waited for months or years to get an evaluation. Then the doctor they see
is pressured and gets them “in and out.’ The interview was short and shallow, the final
report was incomplete and inadequate. And who has to live with the outcome? You do.
This will never happen if you want an evaluation with me.
I have been providing Independent Medical Opinions and Evaluations for over 15 years.
I specialize in PTSD, TBI, Post Concussive Disorder, Cognitive Impairments, and
Mood Disorders (depression, suicidal ideation, anxiety;
many of these symptoms are part of PTSD).
Call or email me and let’s talk. I want to help, and I can help. An effective, specialized
evaluation with a complete, compassionate, compelling, and clinically supported
report will absolutely positively impact your claim. I charge one flat fee for my
evaluation (phone, or computer), full review of your medical records, and a VA c
ompliant report that identifies the issues correctly so that the VA can rate your
benefits appropriately in the most advantageous way for you. ( n.b. The VA rules
state that the most advantageous rating is supposed to be assigned for each
patient based on the patient’s records and a veteran medical opinion.)
I also work with Dr. Bash who can also provide a collaborative and integrative
veteran medical opinion, physical exam, IME and expertly detailed report.
Thank you for your time and your trust in me,
Brett Valette, Ph.D.
Clinical Psychologist National Register Psychologist #54029
My web sites: www.globalhealthevaluations.com and www.Shrink911.net
My Email: email@example.com
Office: 303 465-3147
Dr. Craig Bash has been helping veterans with
independent medical opinions for over 20 years.
In that time, he has helped over 4000 veterans with over 40,000 claims with a high
success rate. He has hundreds of cases at the BVA, which can be searched under
the BVA search engine or found on his web site at www.veteransmedadvisor.com.
He has over 1000 name mentions at the Court of Appeals for Veterans Claims (CAVC).
He is an assistant Professor and invited lecturer at the Uniformed Services
University of the Health Sciences. He has been an expert witness for world class
medical systems such as the the VA and Johns Hopkins medical centers.
Additionally, he has 15 years of research experience at the National Institutes
of Health (NIH) where he studied experimental MRI imaging of neurologic disease.
He was previously a deputy doctor of medical services at the Paralyzed Veterans
of America (PVA) and he has done over 50 sites visits to the
VA's largest hospitals for quality of care purposes.
Dr. Bash has been 100% VA disabled since his 1984 spinal cord injury which
required a 5 month VA inpatient rehabilitation stay. Thus he is familiar with VA
care and rating system from a users prospective.
He also professional knows the private and government sector issues in quality
of care and how these care issues/diseases interface with the VA rating system.
The key to his success is his training, credentials, thoroughness and
experience with VA cases.
Craig N. Bash M.D., M.B.A.
Neuro-Radiologist and Associate Professor
Dr. Bash works hard to get veterans the Maximum Available
Benefits (MAB) for their disabilities. Some examples of his work are at the links below...
IMO/IME Independent Medical Opinions
Independent Medical Examinations
We recommend that every veteran consider seeking an Independent Medical
Examination (IME) or an Independent Medical Opinion (IMO) for their VA
disability benefits claim. The VA has become increasingly difficult to navigate.
Because of the difficulty in receiving a fair decision from VA,
we at VAWatchdog have recognized that veterans who have even the
simplest claims can no longer rely on a fair decision. Every veteran should prepare to
have expert help as they develop their claim. This includes legal representation by a
VA accredited attorney as well as expert opinions from highly skilled and well qualified physicians.
There is a difference in the IME and the IMO. The IME requires your physical presence
in front of the examining physician. The IMO is based on the opinion of the physician
after he has thoroughly reviewed your records. It is our opinion that the IMO may
be the better choice in most cases. To write an acceptable IMO is not a simple task.
The physician must first understand the law that applies to the claim.
The physician must know the details of how disabling conditions may affect the
overall quality of life of the veteran patient. Disability law is not something that most
physicians are trained in. Each of the doctors featured here is expert in the arena of
disability medicine. We urge veterans to review their claims with one of these
physicians and to seek the help of an attorney.
Dr. David Anaise is a physician and a lawyer.
In interviews with Dr. Anaise we've asked and learned much about him.
In discussions with Dr. Anaise he's told us:
"In addition to being a lawyer, I am a surgeon with almost thirty years of medical experience.
I was Clinical Associate Professor of Surgery and Attending Surgeon in Transplantation at
SUNY at Stony Brook. I served as President of the New York Transplantation Society
and as Assistant Editor of Transplantation Proceedings.
I have authored three book chapters, three patents and 106
research papers published in peer reviewed medical journals.
My background in medicine and research makes me well qualified to thoroughly
review and present your disability case. I obtain, study and analyze all your medical
records and perform independent medical research relevant to the issues of your case.
I then present an analysis presenting your medical history in a way that best supports your claim.
The submission all the medical report which does not contain an actual physical
examination or even the submission of a medical treatises requires the board to
address the reports or the medical treatises. In a decision rendered by
Judge Bartley In Bowers v Shinseki NO. 11-3022 Judge Bartley was critical of the BVA’s
failure to address a medical treatises provided by the veteran.
The BVA held that such report was merely laypersons opinion. Judge Bartley held,
'As a layperson, the Veteran is not competent generally to render a probative opinion on a
medical matter. Mr. Bowers, however, was not offering his own subjective opinion as to the
growth rate of gallstones; he was repeating the data reported in professional
medical treatises he submitted. Certainly, a layperson is competent to report information
provided by a medical professional. Cf. Jandreau v. Nicholson, 492 F.3d 1372, 1377
(Fed. Cir.2007) (holding that a veteran is competent to repeat a
medical diagnosis and report observable symptoms).
In labeling the veteran's report of the growth rate of gallstones as incompetent lay
opinion, the Board avoided addressing the substance of the medical treatise
evidence Mr. Bowers submitted, just as the Board failed to address those treatises
directly. Thus, the Board's failure to address the medical treatise evidence that
was favorable to Mr.Bowers was not harmless. See Sanders and Caluza, both supra.
As such, remand is warranted.'"
You may learn more about Dr. Anaise by visiting his web site here.