The world of the Veterans Administration is medically driven. After all, the whole purpose of the Veterans Benefits Administration is to provide compensatory relief to veterans who have medical conditions due to service. Interspersed with medical jargon is a good deal of law, which makes an-already complicated area of practice even more complicated. On the VA side, not only do the Rating Specialists and the Decision Review Officers have to be relatively familiar with medical vocabulary and conditions, but they also have to interpret them in context of the law. Understandably, then, the VA relies heavily on the exams and opinions provided by the Compensation and Pension (C&P) examiners to make some sense of the medical side and, accordingly, to figure out how to apply the law.
As practitioners of VA law, we have seen time and again that C&P examiners have bad days and misdiagnose or entirely misrepresent a veteran’s medical condition. Worse, the Rating Specialists and Decision Review Officers use those exams as a basis for their decisions, often with unfavorable outcomes. To help reverse this dilemma, Hill & Ponton has made it a practice to obtain private medical opinions for the majority of our clients. Our attorneys have found that private medical opinions significantly boost the credibility of a case and lend to the ultimate success of the claim.
To that end, we have established a process for preparing and obtaining medical opinions. The first important step in this process is obtaining the veteran’s Claims File from the VA. This file is the compilation of everything that the VA has accumulated while processing the claim(s) for compensation. The Claims File can include the veteran’s service records, service treatment records, compensation claims, VA exams, medical records (VA facilities and private), Social Security documentation (if applicable), statements from family and friends, etc. Once this file is in our possession, the attorney reviews the file to determine what has already been done on the claim, and what still needs to be done. The attorney will also determine if the claim will need a private medical opinion, and what kind of opinion we will need.
There are four basic types of opinions that an attorney can request: a nexus opinion, an opinion for increased rating, an opinion for an earlier effective date, or a vocational expert opinion.
- Nexus opinion: A nexus is a link between two separate events. For cases in which we are trying to establish service connection, we ask a doctor to provide a medical opinion that links (creates a nexus between) the veteran’s current condition(s) to an event in service—be it an injury, traumatic event, or so forth. When we prepare the medical files for this type of opinion, we pay special attention to the service medical records, taking care to point out even the smallest detail that supports a nexus. We also make sure that we have all the veteran’s current medical records, so that the doctor can observe the current conditions and symptomology. The doctor reviews the medical file as a whole, and determines if the veteran’s current condition was or could feasibly have been caused by an event in service.
- Opinion for Increased Rating: This type of opinion is needed when the VA has granted service connection for a veteran’s condition, but rated it incorrectly. This is often the result of inaccurate C&P exams. It is common for veterans to downplay their symptoms during C&P exams (which ultimately determine what rating the condition should be assigned). As a result, the exams do not accurately portray the physical or mental condition of the veteran on a day-to-day basis. The VA decision-makers therefore assign a rating that is lower than what is truly representative of the veteran’s condition. For these types of cases, we provide the doctor with the entire claims file to review (so that he/she can obtain a full picture of the disabling conditions), as well as current medical records for that condition. Ideally, the doctor would conduct an in-person examination of the veteran as a basis of the report. However, if an in-person examination is not possible, the doctor has to go by medical records alone. Current records are critical for this situation. This is why it is very important for veterans to pursue medical treatment for any conditions that were caused by service.
(Continued in Part 2)