If you applied for service-connected disability compensation for post-traumatic stress disorder (PTSD) and were denied benefits, an opinion from a private medical doctor can help increase your chances of being successful on appeal. The VA calls these opinions "Independent Medical Opinions," or IMOs. They are also sometimes called nexus opinions, since their purpose is often to link an incident in service to your current disability.
My VA Doctor Says I Will Get Benefits, so I Will, Right?
Your primary care doctor who works for the Veterans Health Administration, and disability compensation decisions are made by a separate branch of the VA, the Veterans Benefits Administration. If your doctor makes a statement about whether you should be awarded benefits for PTSD, there is no guarantee that they are correct. Even when VA doctors are willing to write a letter in support of your claim (many are not), their words do not have the force of law. The Veterans Benefits Administration will review your claim for benefits without speaking with your primary care physician or any specialists that you see.
What About a Compensation and Pension Exam?
The only time a VA doctor can write a medical opinion about your claim is when they are required to, after what's called a Compensation and Pension Exam. Often, after you apply for benefits, the VA will send you for a compensation and pension examination by a VA doctor. Chances are you will not know the doctor you are sent to. The VA will schedule a compensation and pension exam for you if the agency needs more information about your PTSD to make a decision about your application for disability compensation.
Why Do I Need a Private Medical Opinion?
A private medical opinion can help you to get your disability compensation claim approved earlier in the process, including after your first application. Or, it can help you to get benefits quicker on appeal. In some complex cases, you may not be successful at all on appeal without a private medical opinion. It is best to have an experienced disability lawyer who can advise you on whether you need a private opinion.
How Can I Get a Private Medical Opinion?
Sometimes a private psychiatrist or other doctor that you have been seeing you for some time will voluntarily support your application for benefits, or your appeal, by writing a letter for you.
If you receive all of your health care at the VA, it can be harder to get a private medical opinion. In these cases, you will have to pay a doctor to review the VA records and write a letter.
If your disability compensation will be your primary or only source of income and you have limited assets, such as your house and car, it may not be advisable to pay a doctor for an opinion. Perhaps your Veterans Service Officer will know of a doctor who can help pro bono. If you have a lawyer for an appeal, your lawyer can help you evaluate your options.
What Records Should I Give the Doctor?
If you have a doctor who will be writing a medical opinion for you, you will want to give the doctor:
- your military medical records, including your enlistment examination report
- medical records from the VA or other treatment providers
- a copy of your VA claims file, and
- any other records the doctor requests or that you feel are relevant to your claim.
What Should I Tell the Doctor to Write in the Letter
The psychiatrist or doctor should open the letter by talking about how long he or she has known you and the type of treatment he or she has provided to you. Doctors should also discuss their qualifications and credentials. A doctor who specializes in the type of disability you suffer from (such as a psychiatrist) can have more influence on the VA than a doctor who is unfamiliar with your type of condition.
The doctor should talk about any tests you've been given and what the test results have been and what type of treatment you have received. It is important that the doctor list the medical records used to develop the opinion so that the VA will give the opinion more weight. The doctor should note when your condition began, what your symptoms are, how severe your condition is, and your prognosis (meaning, whether your condition can be expected to improve).
The doctor should discuss any events or incidents that occurred while you were in service that may have caused or worsened your current disability. The main point of the letter will be for the doctor to explain if they believe your current disability was caused by your military service. It helps if the doctor can use legal language such as "as likely as not" or "more likely than not." For example, your doctor could say "it is more likely than not that the veteran's combat experiences caused her current condition of post-traumatic stress disorder." But any statement supporting a linkage between an incident in your military service and your current condition will be helpful.
Doctors should also mention that they have reviewed your VA claims file so that their opinion will be given more weight. For doctors writing the opinion that do not specialize in your type of disability, ask them to include part of their curriculum vitae (that's a fancy word for resume) that demonstrates their expertise with your type of disability. This is important because the VA will give more weight to a doctor's opinion if they are familiar with your type of disability.
To understand more about what you need to prove to be approved for disabiity compensation for PTSD, read Nolo's article on getting disability compensation for PTSD.