Independent Private Medical Opinion for Veterans Claims: Do They Help?
Understanding VA’s Exam Process
The most common type of medical evaluation that is completed during the VA disability claims process is a Compensation & Pension (C&P) examination. A C&P exam is a medical evaluation of a veteran’s disability, performed by a VA healthcare provider or a VA contracted examiner. VA uses C&P exams to gather more evidence on a veteran’s claimed condition before issuing a decision and assigning a rating.
Generally speaking, C&P examinations are used to:
(1) Confirm or deny service connection, and/or
(2) Establish the severity of a veteran’s disability.
After the exam, the examiner will write up a report that includes a review of their findings, any clinical test results, and any medical literature used by the examiner to determine etiology – the cause or origin of a disease or condition. If the examiner is trying to confirm or deny service connection, they will write up a medical opinion that states whether the veteran’s condition was incurred in or aggravated by service. The C&P examination is then added to the veteran’s claims file as part of the evidence VA will use to make a decision.
However, a C&P examination is not the only form of medical evaluation that veterans may undergo over the course of their claim. Instead, there are times in which veterans may want to obtain medical opinions from qualified healthcare professionals outside of VA.
What Are Independent Medical Opinions?
Independent medical opinions, or IMOS, are medical opinions typically requested by the Board of Veterans’ Appeals. When the Board of Veterans’ Appeals is reviewing a veteran’s file for adjudication, they may discover that some medical questions have been left unanswered or prior examinations were inadequate.
In this case, the Board may request an independent medical opinion (IMO) from a doctor of a specialty that is relevant to the pending appeal. Importantly, these independent medical opinions are not examinations that a veteran must attend, but rather a review of the evidence currently of record. If an independent medical opinion is conducted, the veteran or their representative will be notified and will have 60 days to respond with evidence or argument either contesting or agreeing with its findings.
How Are They Written?
When writing the independent medical opinion, the healthcare professional must be aware of the veteran’s claim. Specifically, if the opinion relates to the veteran’s claim for service connection, the doctor will need to use the “at least as likely as not” language. An independent medical opinion that uses VA’s standard of proof can be helpful in rebutting a negative C&P examination, or in providing the medical nexus element of service connection.
An independent medical opinion that uses VA’s standard of proof can help to:
- Rebut a negative C&P exam
- Establish the medical nexus element of service connection
- Show an increase in severity of your disability
How Are Independent Medical Opinions Helpful to VA Disability Claims?
The doctors issuing these opinions have specializations that relate to your condition, as opposed to a general practitioner from VA. As such, these doctors might have a better understanding of your condition and provide a more adequate explanation of the causes and/or the severity of your condition.
Veterans can obtain an independent medical opinion (IMO) on their own to help prove their claim, especially if a C&P exam did not capture the full picture of their disability.
Veterans should know that independent medical doctors are completely separate from VA. As such, their opinions can be more objective.
What if I Disagree?
If an independent medical opinion is conducted, the veteran and their representative will be notified. The veteran, or their representative, will then have 60 days to respond with evidence or argument either contesting or agreeing with its findings.
Independent Medical Opinions vs. Independent Medical Examinations
The key difference between an independent medical opinion and an independent medical examination (IME) is the fact that an IME requires attending an actual examination. This process is more involved for the veteran and goes beyond just the review of medical records. Both independent medical opinions and examinations can be very helpful. There are some cases in which one might be better than the other.
For example, if a veteran’s claim involves an orthopedic condition that deals specifically with range of motion, it might be better for a doctor to assess this matter in person, in which case an IME would be more beneficial. On the other hand, if a veteran’s claim involves an increased rating for an orthopedic condition based on its worsening progression, it would be important to assess the changes in severity over time (e.g., the last 10 years). In this case, an IMO would be more helpful in reviewing the medical evidence of record.
Getting Accredited Representation to Help Overcome Negative Exams or Medical Opinions
Accredited representation can help veterans navigate the complicated process VA has for exams and medical opinions. Specifically, accredited representatives can respond to independent medical opinions, either contesting or agreeing with them. Representatives may also gather and submit supporting evidence for independent medical opinions.
If you need accredited representation for your VA disability appeal, the experienced advocates at Chisholm Chisholm & Kilpatrick may be able to help. Contact our office today for a free case evaluation.
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