M21-1-1mr 7. Requesting A Medical Opinion Or Examination

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M21-1-1MR

7. Requesting a Medical Opinion or Examination

Introduction

This topic contains information on requesting a medical opinion or examination to develop claims, including

VA's responsibility to provide medical examinations or obtain medical opinions for the claimant

when to request a medical opinion or examination

when to request a medical opinion versus an examination

stating requests clearly

what the opinion request needs to contain, and

the importance of identifying evidence relevant to the request.

a. VA's Responsibility

In claims for disability compensation, assist the claimant by providing a medical opinion or examination when the opinion or examination is necessary to make a decision on the claim.

b. When to Request a Medical Opinion or examination

A medical opinion or examination may be necessary when, after the development of all other relevant evidence, including the statement of the claimant, the file

contains competent medical evidence that the claimant has a current disability, or

contains competent evidence that the claimant has persistent or recurrent symptoms of disability

Note: A claimant is competent to describe symptoms of disability that he/she is experiencing, such as pain in the knee. However, because a claimant ordinarily lacks medical training and experience he/she would not be competent to diagnose his/her own medical condition or offer a medical opinion.

contains supporting evidence from service records or other sources that the claimant suffered an event(s), injury, or disease in service that may be associated with the claimant's current disability or symptoms of disability, and

does not contain sufficient medical evidence to make a decision on the claim.

c. When to Request a Medical Opinion versus an Examination

A medical opinion versus an examination should be requested when only the following is necessary to decide the claim:

Reconciliation of different diagnoses

Opinion concerning the relationship between two conditions

Opinion about functional impairment

Etiology and nexus opinions

Allen v. Brown cases (e.g., when the issue is whether a service-connected condition has aggravated a non-service connected condition)

Independent medical opinions

Opinion regarding the extent to which service-connected disabilities affect the veteran's ability to perform physical and non-physical tasks in order for VA to determine whether the veteran is unemployable.

Note: Many opinion requests require information that would be gleaned as part of the normal examination process which the physician should not be precluded from conducting, if necessary.

d. Stating Requests Clearly

When seeking a medical opinion

be very clear about what information or opinion is being requested

send the following to the medical examiner:

the claims folder, and

the opinion request

and

direct the medical examiner to

review it, and

provide a rationale for any opinion.

e. What the Medical Opinion Request Must Contain

The medical opinion request should clearly state the nature of what is needed. The requester must clearly indicate if he/she

wants an opinion on the etiology of the condition

requires the physician to reconcile differing opinions, or

wants any other medical opinion.

It is not adequate to merely refer the examiner to the claims folder containing Board of Veterans' Appeals (BVA) remand instructions. However, there is no prohibition from quoting the BVA instructions as long as the instructions are clear about whether a medical opinion is required.

f. Importance of Identifying Evidence

The requester should identify the available evidence to assist the physician in focusing his/her review. The evidence should be tagged in the claims folder, but the examiner must be advised that he/she is not limited to reviewing only this evidence.

Note: Avoid the potential problem of steering the examiner to review only the evidence pre-selected as relevant since a medical professional may have a differing opinion as to what evidence is relevant and must not be limited in the record review.

The identification of the evidence must include a general description of it, indicating the

source

approximate dates, and

subject matter.