Independent Medical Opinions for Veterans Claims: Do They Help?
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 examination is a medical examination of a veteran’s disability, performed by a VA healthcare provider or a VA contracted provider. 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 the exam’s 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, he or she 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 need to obtain medical opinions from qualified healthcare professionals outside of VA.
Independent Medical Opinions
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 and his or her representative will be notified and will have 60 days to respond with evidence or argument either contesting or agreeing with its findings.
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.
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.
How Do Independent Medical Opinions Help VA Disability Claims?
As mentioned above, independent medical opinions can be helpful to your VA disability claims. Specifically, these medical opinions are completed by doctors who have specializations that relate to your condition versus a general practitioner from VA. As a result, they might have a better understanding of your condition and thereby provide a more adequate explanation of the causes and/or severity. Additionally, the independent medical doctors are completely separate from VA. Therefore, veterans may feel as though the opinion will be rendered with a higher degree of objectivity.
- BVA relied on unsubstantiated medical opinion to wrongly deny increased rating for epiphysitis of the lumbar spine
- Board erred in relying on an inadequate medical opinion to deny service connection for sarcoidosis
- Board erred in relying on inadequate medical opinion for shoulder disability
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