The VA has their own doctors who, either employed or contracted with them, will provide a Compensation and Pension exam, otherwise known as the C&P, for anyone who files a claim for disability compensation or pension benefits. This exam is done by very specific rules that govern the legality of the exam to ensure that the VA does not make any mistakes when they decide the evaluation of the disability. First, if you do not show up, you can be denied benefits, despite the prevalence of medical records in your file or at the VA. However, we also know that C&P Exams cause a lot of anxiety and are not always favorable to the veteran (see our blog on how to prepare for a C&P). So, what can we do about it? We can get an independent medical examination (IME) to either contradict or confirm what the VA finds in its C&P exam. While these exams are often quite expensive, they are well worth the cost when it comes to providing evidence that can turn the tables on a claim that could very well be denied.
Why would the C&P be different from the IME?
Neither the C&P nor the IME doctor makes the decisions about your claim. They are only providing evidence used by the VA to make a determination as to whether you are disabled and to what degree. They are also used to provide evidence as to whether the disability is service connected or not. So let’s look at a typical C&P Exam and then see how it differs from an IME.
First, a C&P is conducted by either the VA or a contracted medical facility. Hence, the C&P examiner is not providing an independent review of the veteran. They are paid by the VA, therefore there is a determined conflict of interest in the fact that they are supposed to be providing a medical opinion. I mean, if your boss asks your opinion, aren’t you going to be swayed just a little to side with his or her view rather than be opposed to it? Even in the most non-oppressive work environments, one can’t help but be swayed by who signs their paycheck. Although, the VA looks at the paperwork your doctor submits as bias as well, favoring a paying customer they want to keep coming in for treatment.
C&P Examiners do not have to always be doctors. With the exception of mental health and audiology exams, the VA regulation states, “VA Medical facilities are responsible for ensuring that examiners are adequately qualified.” So if you are getting a C&P Exam, it may be with a physician, a physician’s assistant, a nurse practitioner, or a clinician in residence.
Who Rates the Medical Opinions that are Provided?
After the C&P is completed, the exam results and all other medical evidence are reviewed by someone who is not a doctor. Yes, not a doctor. That person, usually at the RO, has the task of determining which medical opinion holds more weight than others. A report from a specialist will usually outrank any other opinions or diagnoses from general practitioners or non-specialists. Of course, an MD’s opinion always outweighs a PA’s opinion. At least in theory, but again, this person is paid by the VA, the same organization who pays the C&P Examiner. So, it is always a good idea to have that expert’s advice to outweigh, or at least compete with any potentially negative exam results there may be.
What Exactly is an IME?
An IME is conducted by a physician who has never treated you before. They have no personal interest in you or the VA. They are presented documented facts such as treatment records, service records, lay evidence and statements, and other evidence that supports the claim, with a letter outlining the progression of the claim from injury to claim/last rating decision, by the veteran’s representative. IME trained physicians are trained to use the correct VA language and understand or are guided by attorneys who know the laws and how the report must be written and executed in order to meet all the VA standards.
While this seems like a small point, the VA is hard-pressed to accomplish this task. Between fiscal years 2006 and 2008, the last statistics available from the Office of the Inspector General, an average of 17.2% of all C&P exams were incomplete. They either weren’t signed, credentials were missing, legal language was missing, etc. This average stayed steady across all three years. In 2009, the last year of those statistics, there were 901,436 C&P Exams requested by the VA. That means that over 150,000 exams were incomplete and had to be redone or possibly resulted in an unfavorable or delayed rating for the veteran.
What Benefits are there to Getting an IME?
An IME is completed by a physician, but not just any physician. The IME providers are a select group of doctors who have specializations in the topic they are evaluating, such as an orthopedic specialist for an exam concerning a spinal injury. Another plus they have over their C&P counterparts is that they are also usually physicians who have done their own extensive research studies and have been published and/or teach. One thing, though, that sets an IME physician apart from their C&P counterparts is their Curriculum Vitae (CV). This is basically their resume and provides the VA with a record of their extensive training, any military experience, their published works, qualifications, and educational background. When a Veteran’s representative sends in an IME to the VA, it should always include the CV of the physician who conducted the exam. This alone can weigh the rating towards the veteran’s favor because often times there are no other identifying credentials listed for the C&P examiner, just those listed on the C&P Exam itself which is usually limited to MD or ARNP. By VA regulation, the VA has to determine the probative value of the evidence and rate accordingly. Therefore, the IME should always have an advantage in these situations. For more information on IMEs, see our Blog series on how Hill & Ponton prepares IMEs.