(cell phone 301-651-6392)

To: All veterans

Date: Dec 2014

From:

Topic: BVA remanded medical opinions

Craig N. Bash, M.D.

Independent Veteran Medical Opinion (IMO)

Neuro-Radiologist
www.veteransmedadvisor.com

Veteran Medical Nexus Opinion (VMNO)

Pages: 2

NPI or UPIN-1225123318- lic #--D43471

4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com

Update:
Based on my experience, with 424 BVA (Board of Veterans Appeals AKA Board) opinions since 1997
the BVA is increasingly remanding cases instead of directly granting benefits in order to get further
very detailed VA examinations that might contain up to 10 to 15 new examinations. The following is
one such case (whereby the BVA had 2 positive opinions {Drs. Bash and Sheridan} and one negative
VA CP opinion but instead of determining equipoise of the opinions and granting the case) decided to
ask for another examination. In spite of the fact that over 70% of BVA decisions are changed at the
VA court level, veterans will usually have to comply with the following example of BVA remand:
The BVA stated the following;
The May 2010 written statement from Dr. Bash conveys that "it is my opinion that his lower
extremity knee and hip and lumbar spine advanced for age degenerative disease is
due to his service-connected abnormal gait/foot disease." The October 2010 written
statement from Dr. Sheridan states the Veteran "has a history of pes planus and
surgery on both great toes, twice on the right, and has altered gait mechanics which
have led to the formation of underlying degenerative disc disease and bulging discs at
L4-5 and L5-S1." The report of the March 2011 VA joints examination states that "the
Veteran's currently diagnosed right hip and low back condition are not caused by or a
result of his service-connected bilateral pes planus with plantar fasciitis."
VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and
contemporaneous medical examination which is accurate and fully descriptive.
McLendon v. Nicholson, 20 Vet. App. 79 (2006); Floyd v. Brown, 9 Vet. App. 88, 93
(1996); Ardison v. Brown, 6 Vet. App. 405, 407-08 (1994); Green v. Derwinski, 1 Vet.
App. 121, 124 (1991). Given the apparently conflicting medical opinions, the Board
finds that further VA evaluation is necessary in resolving the issues raised by the
instant appeal.

Accordingly, the case is REMANDED for the following action:

1. Then schedule the Veteran for a VA orthopedic examination for compensation purposes in
order to assist in determining the current nature and etiology of his lumbosacral spine
disabilities. If possible, the examination should be conducted before a physician who
has not previously examined the Veteran. All indicated tests and studies should be
accomplished and the findings then reported in detail.
2. The examiner should advance an opinion as to whether it is as likely as not (i.e., probability of
50 percent or greater) that any identified lumbosacral spine disorder had its onset
during active service; otherwise originated during active service; and/or is related to
and/or increased in severity beyond its natural progression due to the Veteran's
service-connected disabilities.
3. The examiner should provide a rationale for all opinions and a discussion of the facts and
medical principles involved would be of considerable assistance to the Board.
4. The physician must explain the underlying rationale for all opinions expressed, citing to
supporting factual data/medical literature, as deemed indicated. He/She must
discuss specifically the May 2010, January 2012, and August 2012 medical
opinions from C.N. Bash, M.D. and comment on the medical literature cited in
those opinions (expressing agreement or disagreement with those opinions, and
explain in full the rationale for such agreement/disagreement).
5. The appellant has the right to submit additional evidence and argument on the matter or matters
the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999).
This remand to the RO (Regional Office) contained specific language to address my opinion, as is
highlighted in the above. The BVA stated that my opinions, [rationale] and literature must be
specifically addressed. Most physicians do not include literature references but in any RO/BVA
remand of my opinions the VA has a duty to evaluate my optionally added literature.
Recommendations:
Do:
1. Add new medical information and medical opinions to any BVA remand as per paragraph 5 above.
2. Attend any BVA remanded medical examination/s.
3. Refer my BASH Bulletin on CP examinations.
4. Get and review all copies a copy of all CP examination written reports.
5. Get a second medical opinion (Independent Veteran Medical Opinion IMO) and analysis for any CP
examinations and submit this to the VA prior to re-adjudication (rating) of the issues.
6. Consider obtaining two additional medical opinions to clarify any new medical information because
as in the above example the BVA is readily willing to add new additional VA medical opinions to files,
which already contain numerous medical opinions (3 in the above case) and thus the veteran should
also consider adding additional opinions to referee the enlarging maze of medical data. (AKA arms
race)
Craig N. Bash M.D., M.B.A.
Associate Professor drbash@doctor.com cell 240-506-1556

Independent Veteran Medical Opinion (IMO) -Veteran Medical Nexus Opinion (VMNO)