Independent Medical Opinions and Independent Medical Examinations: Do They Help VA Claims?

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Independent Medical Examinations and Independent Medical Opinions are not required for VA claims. However, regulations and case law require VA to consider helpful evidence, regardless of the source. Therefore, both can be highly useful during the VA claims process, especially in specific circumstances.

• Independent Medical Examinations (IMEs) are performed by a non-VA medical professional who then provides an expert medical opinion relevant to a veteran’s claim. IMEs are typically obtained to further support service connection, a higher disability rating, or an earlier effective date.
• Independent Medical Opinions (IMOs), sometimes called “nexus letters,” are written medical opinions provided by qualified, non-VA health care professionals that address specific medical questions. An IMO may not require an examination. IMOs are often used to prove a connection (“nexus”) between military service and a veteran’s disability.

What Are Independent Medical Opinions?

Independent Medical Opinions (IMOs) are written medical opinions provided by qualified, non-VA health care professionals that address specific medical questions relevant to a VA disability claim. An IMO is a form of competent private medical evidence that a veteran may submit to establish or support entitlement to VA disability benefits. Some of the questions that an IMO might answer include:

• Whether a current disability is at least as likely as not related to military service
• Whether a condition is secondary to or aggravated by a service connected disability
• Whether a disability has worsened over time or causes greater functional impairment than VA recognized
• Whether a prior VA medical opinion is inadequate or based on incorrect facts

When Are Independent Medical Opinions Most Helpful for VA Claims or Appeals?

A veteran or their representative will often arrange an IMO when:

• VA issued a negative or speculative nexus opinion
• A VA examiner failed to address lay statements or favorable evidence
• The claim involves complex causation, such as environmental exposure or aggravation
• A veteran is seeking a higher rating based on functional loss

What Makes IMOs Valuable for Veterans?

• The doctors issuing these opinions have specializations that relate to your condition, as opposed to a general practitioner from VA. Therefore, 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 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. This may mean their opinions are more objective.

How IMOs Differ from Independent Medical Examinations (IMEs)

Although the terms are sometimes used interchangeably, in VA practice they are distinct:

• Independent Medical Opinion (IMO): A records-based written opinion, often without examining the veteran in person.
• Independent Medical Examination (IME): A physical or clinical examination of the veteran that usually results in an accompanying medical opinion.

Both are private medical evidence, and either may be sufficient depending on the issue in dispute.

Key Laws About Independent Medical Opinions

VA regulations expressly allow veterans to submit IMOs:

• 38 C.F.R. § 3.159(a)(1) defines competent medical evidence to include private medical opinions.
• The Court in Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), held that the probative value of a medical opinion depends on its reasoning, not on whether it came from VA or a private provider.

What Should an IMO Include to Benefit a VA Claim?

A strong IMO typically includes:

• The examiner’s qualifications and specialty
• Identification of records reviewed
• A clear conclusion using the exact language of VA’s legal standard of proof (“at least as likely as not”)
• A well-reasoned medical rationale (e.g., research) linking facts to conclusions

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What Are Independent Medical Examinations?

An Independent Medical Examination (IME), in the context of VA disability benefits, is a medical evaluation performed by a non-VA clinician that provides an expert medical opinion relevant to a veteran’s claim. IMEs are typically obtained by veterans or their representatives to support entitlement to service connection, a higher disability rating, or an earlier effective date.

What Is the Purpose of an IME in a VA Claim?

An IME is used to address medical questions that VA must answer to decide a claim, including:

• Whether a current disability is at least as likely as not related to military service
• Whether a condition is secondary to or aggravated by a service connected disability
• The severity, functional impact, or progression of a condition
• Whether VA examination findings are inadequate, inconsistent, or unsupported

VA law permits veterans to submit competent private medical evidence, and VA may not reject such evidence solely because it was not generated by VA.

IME vs. VA Compensation and Pension (C&P) Examination

An IME is not required, but it can be critical when a VA examination is unfavorable or deficient.

Does VA Need to Consider IMEs?

Under 38 C.F.R. § 3.159(a)(1), VA must consider competent medical evidence, which includes opinions from qualified private medical professionals. The U.S. Court of Appeals for Veterans Claims has repeatedly held that VA must assess IMEs based on probative value, not source alone. Key factors include:

• Examiner’s credentials and expertise
• Review of relevant medical and service records
• Clear rationale connecting facts to conclusions

An independent medical examiner does not need to review a veteran’s entire claim file, only the relevant information. Cases such as Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), emphasize that reasoned medical analysis is more important than whether the examiner reviewed the entire claim.

When an IME Is Most Helpful for a VA Claim or Appeal

An IME is often strategically valuable when:

• VA issued a negative nexus opinion
• A VA examiner failed to address lay evidence or favorable records
• A claim involves complex medical causation, such as toxic exposure or aggravation
• A veteran seeks to challenge an underrated disability or functional limitations

In appeals before the Board of Veterans’ Appeals, well-supported IMEs frequently carry substantial evidentiary weight.

Not Sure Whether an IME or IMO is Right for Your VA Claim or Appeal?

Consider asking an experienced VA-accredited advocate for help. Initial claims assistance can be provided by a VSO. For appeals, consult with an experienced veterans law firm. Chisholm Chisholm & Kilpatrick has represented over 36,000 veterans or dependents before VA or the U.S. Court of Appeals for Veterans Claims. We have seen how and when IMEs and IMOs can be useful. Contact us at 800-544-9144 or online to request a free case evaluation.