Getting a Private Medical Opinion for Your VA PTSD Claim

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 a successful PTSD VA claim. The VA calls these opinions "Independent Medical Opinions," or IMOs. They are also sometimes called nexus opinions because they're often used to establish a nexus (link) from an incident in service to your current disability.

My VA Doctor Says I Will Get Benefits, So I Will—Right?

Not necessarily. Your VA PTSD doctor works for the Veterans Health Administration, but disability compensation decisions are made by a separate branch of the VA called the Veterans Benefits Administration. If your VA doctor says you should be awarded benefits for PTSD, that's no guarantee that the Benefits Administration will agree.

Even when VA doctors are willing to write a letter in support of your PTSD claim (many are not), their opinion doesn't often have much sway. 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 after they conduct a Compensation and Pension (C&P) exam, where you get your disabilities evaluated. You'll have a C&P exam scheduled for you if the agency needs more information about your PTSD in order to make a decision about your VA claim. Chances are you won't know the doctor you're sent to.

How Are Independent Medical Opinions Helpful to VA Disability Claims?

Independent medical opinions—also known as private medical opinions, because they come from a private (non-VA) doctor—can help a veteran establish a nexus between their PTSD symptoms and one or more events that occurred during their military service. Establishing a nexus through medical evidence is a key step in getting your VA claim for PTSD approved.

A private medical opinion from a doctor who has treated you for PTSD and knows your specific medical history can help you get your VA claim approved earlier in the process, including after your first application. The opinion can also be used to strengthen your claim if you received an unhelpful C&P exam from a VA doctor, or can help you get benefits quicker on appeal. In some complex cases, having an independent medical opinion may be the only way to have a successful claim for PTSD.

How Can I Get an Independent Medical Opinion?

Sometimes a private psychiatrist or another doctor who has treated you for PTSD will voluntarily write a medical opinion supporting your VA claim. Or they may be willing to complete a public disability benefits questionnaire, also known as a DBQ medical opinion. (A DBQ can also help you increase your PTSD disability percentage rating after you've been approved for benefits.)

If you receive all your health care at the VA, it can be harder to get a private medical opinion for a PTSD VA claim. In these cases, you must pay a doctor to review the VA records and write a letter or DBQ opinion.

Many veterans are short on cash while they're waiting for their disability compensation to be approved. If you're stretching your dollars, you might not have the money to pay for a doctor's opinion about your PTSD. Consider asking your Veterans Service Officer if they know of a PTSD doctor who can help you for free or on a sliding payment scale.

What Records Should I Give the Doctor?

If you do have a doctor who will be writing a medical opinion for you, make sure to give the doctor the following information to review:

• 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 Ask the Doctor to Write in the Letter?

The psychiatrist or doctor should start the letter by talking about how long they've known you and what kind of treatment they've provided to you. Your doctor should also discuss their qualifications and credentials. A doctor who specializes in PTSD—such as a psychiatrist—can have more influence with the VA than a doctor who is unfamiliar with your type of condition.

Then the doctor should switch their focus to you and your medical history. Your doctor should discuss:

• any psychological, neurological, or cognitive tests you've been given and what the test results mean
• what type of treatment (such as group counseling, medication, or cognitive behavioral therapy) you've received and whether it's helped you
• when your PTSD began
• how severe your PTSD symptoms are and how they impact your daily functioning, and
• whether you're expected to improve (your prognosis).

When addressing the above topics, your doctor should refer to the medical records they used to arrive at their opinion. Doing so shows the VA that the doctor's opinion has a foundation in tests and observations.

Most importantly, the doctor should include any events or incidents that occurred during active duty that may have caused or worsened your PTSD. The VA needs to see a link between your military service and your PTSD, so the doctor should explain why they believe a connection exists.

Doctors should also mention that they have reviewed your PTSD VA claims file so that the VA knows they're familiar with your medical records (and will take their opinion seriously). For doctors that don't specialize in PTSD, ask them to include part of their curriculum vitae (resume) that demonstrates their experience with mental health. This is important because the VA will value a doctor's opinion more if they are especially knowledgeable about PTSD.

Common Reasons Why VA Rejects Private Medical Opinions

Even if you submit a private medical opinion for your PTSD claim, the VA might reject it for several common reasons:

• Insufficient medical evidence. The VA requires detailed medical evidence by the doctor to establish the existence and severity of a veteran's PTSD. The VA may reject the private medical opinion if it does not provide specific details from the doctor, like what symptoms the veteran experiences, how often they experience them, and how those symptoms impact their daily lives.
• Lack of expertise. For a PTSD claim, the VA gives special consideration ("more weight") to opinions from doctors who specialize in treating PTSD. If the private medical opinion comes from a provider without expertise in mental health (for example, a veteran gets an opinion regarding their PTSD symptoms from a doctor who specializes in cancer treatment), the VA may reject the opinion.
• Inconsistencies in the medical opinion. The VA may reject the opinion if there are discrepancies between the doctor's opinion and other medical evidence. For example, the VA can reject a private medical opinion stating that a veteran has daily severe PTSD symptoms if the veteran's own report states that their symptoms are relatively mild.
• Bias or conflicts of interest. If the VA suspects that the doctor might not be objective enough for their medical opinion to be valuable, they may reject the opinion. One example of bias is when a veteran's spouse or family member is a doctor and provides a private medical opinion favorable to the veteran's claim.

If you submit a medical opinion and the VA rejects it, the agency will provide a detailed explanation why, and you have the right to appeal the VA's decision.

How to Submit Private Medical Evidence for Your PTSD VA Claim

To submit private medical evidence for a PTSD VA benefits claim, you should first obtain your medical records from any private health care provider who has treated you for PTSD or related symptoms. There are two options for collecting and submitting this medical evidence to the VA:

• Get the records yourself by completing your health care provider's release of information form at their office. After you receive a copy of your records from your doctor, you can submit these medical records by uploading them online through the VA's eBenefits portal, by mailing them to the VA Regional Office handling your claim, or by submitting them in person at your local VA Regional Office.
• Submit VA Forms 21-4142 and 21-4142a to the VA. These forms allow the VA to request your records from your doctor on your behalf. Be aware that both VA Forms 21-4142 and 21-4142a must be completed together for the VA to get access to your private treatment records.

Carefully review all medical records before you submit them in your VA disability case and make sure they include all relevant information related to your PTSD symptoms, such as diagnostic test results, treatment plans, and progress notes.

Learning More

To understand more about what you need to prove to be approved for disability compensation for PTSD read Nolo's article on getting disability compensation for PTSD.

If you need help starting your claim for PTSD from the VA—or you've received a denial and want to appeal—consider getting help from an experienced disability attorney. For more information, see our article on hiring a VA-certified veterans disability lawyer.

_{Updated April 21, 2023}