This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits. Visit Stateside Legal (below) for assistance with legal issues.
NOTE: Letters in my Q&A columns are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers. This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits.
How important is a good Independent Medical Exam? Read this from a recent BVA hearing. This extract from BVA is clear that an Independent Medical Opinion carried significant weight for the veteran.
Board of Veterans Appeals Docket Number 08-26 895
“The Board finds the private medical opinion and conclusions of Dr. J.W.B. to be highly probative as they are definitive, based upon an interview and clinical assessment of the Veteran, a review of many service and post-service medical records, and are supported by a medical rationale. Accordingly, the opinion is found to carry significant probative weight. Among the factors for assessing probative value of a medical opinion are the physician’s access to the file and the thoroughness and detail of the opinion.”
Judge Kramer then went on to compare and contrast the IME physician's 18 page opinion to what he called a “mischaracterized” 1 and ½ page opinion by a VA doctor that overlooked several complaints by the veteran in service medical records.
If there is any doubt of your claim based on medical opinion, don't delay. Get the IME.
Jim Strickland 12/01/2010
Independent Medical Examinations
When you allege that you suffered an illness or an injury while on active duty military service and that has caused or contributed to a disabling condition today, and then make a claim for compensation, you must provide evidence to support your claim.
In some simple claims the evidence is readily available and it will be simple to evaluate.
The VA will provide evidence of the injury or illness (called a "condition" by VA) and the seriousness of that condition by demanding that you are subjected to a Compensation and Pension (C & P) medical examination. The C & P exam will usually be conducted by VA contracted health care professionals who have varying levels of expertise in the medical discipline that covers your condition.
In many cases the veteran will not agree with the results of this C & P examination. The veteran may also find the he or she may need a "nexus letter" that will provide a degree of expert medical opinion to link or connect an active duty event to a disabling condition of today.
The veteran is often told to seek an Independent Medical Examination (IME) or opinion from a neutral, unbiased, expert physician. In many cases the veteran doesn't need a complete physical examination but may need an expert physician to review existing records to offer an opinion of causality.
When the veteran finds that they need such medical expertise it's often a challenge to find such a service. Most practicing physicians aren't expert in the proper methods of conducting disability examinations and their practice isn't set up to work with patients who only seek nexus letters or records reviews.
The veteran (or advocate) who seeks an IME or records review or nexus letter must be sure that the physician is well grounded and experienced in the language used in disability examinations.
The medical doctor/examiner who will produce an opinion or any record to be used in a VA disability adjudication should be familiar with the C & P Service Clinicians Guide, the Schedule For Rating Disabilities and the Index To Disability Worksheets.
The IME examiner should understand the importance of establishing a cause and effect relationship between an event in the military and a disabling condition today. When establishing and explaining a nexus or causal relationship, such verbiage as follows here may make or break a case for you.
1. “is due to” (100% sure)
2. “more likely than not” (greater than 50%)
3. “at least as likely as not” (equal to or greater than 50%)
4. “not at least as likely as not” (less than 50%)
5. “is not due to” (0%)
The veteran or advocate who wants to obtain an IME, records review or independent nexus letter must understand some of the rules that these examinations are subject to.
The IME physician will establish a price after he or she has evaluated the amount of time involved in providing you a given service. Payment is to be made in advance of any work be done. The IME physician generally does not accept or bill for any insurance and if you believe that you have any such coverage, you must pay the examiner first and then work toward reimbursement for yourself.
The IME physician is a neutral party. You are asking the physician to provide you with an honest opinion based on the evidence you present. The IME physician is not obligated to agree with you and if such a disagreement should occur, there is no refund of any fees to be made.
There are no treatments provided during an IME. The IME doctor will not write prescriptions for you nor see you for future appointments for medical care.
You must provide legible and well organized copies of all pertinent records to the examining physician prior to any examination if you are having such. The IME physician is not responsible for retrieving any records that may support your case.
You should agree in writing exactly what work product you are paying for as you enter into the agreement. If you need a physical examination with a report about your broken hip, that's what your agreement should state.
You should ask and the doctor should advise you as to when you may expect your report. This should be written as a part of your agreement.
In the past I've had my own Independent Medical Examination and records review. I also asked the IME examiner for a nexus letter. In my opinion this was an invaluable step to gaining the benefits that I'd applied for.