My Light Bulb Got Turned On

[carlie]

In reading through the EVIDENCE section of M-21 I noticed something that is really working on my brain.

Evaluating evidence and weighing evidence is two totally separate things.

carlie

[Guest Morgan]

The issues we were talking about mostly are in Carlie's posting (in this topic) about evaluating and weighing medical evidence. Let me know if you are referring to something else.

[betrayed]

i AM TALKING ABOUT THIS INFO, WHERE DOES IT COME FROM? pLEASE PROVISE A LINK

5. Medical Evidence

Introduction This topic contains information about evaluating medical evidence, including· non-adversarial adjudication· weighing physicians’ opinions· evaluating medical evidence· rejecting medical evidence· supporting medical conclusions· considering the POW protocol examination report· evaluating service medical records (SMRs)· statements from physicians as acceptable evidence, and· considering information in the claims folder.

Change Date December 13, 2005

a. Non-Adversarial Adjudication VA’s system of claims adjudication is non-adversarial.Do not minimize the weight of a treating physician’s opinion based upon the idea that he/she has become an advocate for the patient, since doing so may appear adversarial and biased.

b. Weighing Physicians’ Opinions Greater weight may placed on one physician’s opinion than another’s, depending on several factors, such as · the specialty of the physician· the reasoning employed by the physician, and· the extent to which the physician reviewed prior clinical records and other evidence.An opinion may be discounted if it materially relies on a layperson’s unsupported history as the premise for the opinion.Note: Treating physician records are not necessarily dispositive of an issue and must be analyzed and discussed like all other evidence.Reference: For more information on discounting opinions based on unsupported history, see Wood v. Derwinski, 1 Vet. App. 190 (1991).

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5. Medical Evidence, Continued

c. Evaluating Medical Evidence Consider the key elements listed below when evaluating medical evidence.· Basis for the physician’s opinion, such as- theory- observation- practice- clinical testing- subjective report, and- conjecture.· Physician’s knowledge of the veteran’s accurate medical and relevant personal history.· Length of time the physician has treated the veteran.· Reason for the physician’s contact with the veteran, such as for- treatment, or- substantiation of a medical disability claim.· Physician’s expertise and experience.· Degree of specificity of the physician’s opinion.· Degree of certainty of the physician’s opinion.Reference: For more information on determining a physician’s expertise and experience, see Black v. Brown, 10 Vet. App. 279, (1997).

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5. Medical Evidence, Continued

d. Rejecting Medical Evidence Unless the historical facts upon which a medical conclusion is based are dubious or untenable, reject medical evidence only on the basis of other medical evidence.The RSVR may not rely upon his/her own unsubstantiated medical conclusions to reject expert medical evidence provided by the claimant.Reference: For more information on the basis for rejecting medical evidence, see· Shipwash v. Brown, 8 Vet. App. 218, (1995), and· Colvin v. Derwinski, Vet. App. 175 (1991).

e. Supporting Medical Conclusions Support medical conclusions with evidence in the claims folder.Cite medical information and reasoning to· link or separate two disabilities, or· establish or refute prior inception or aggravation. Cite recognized medical treatises or an independent medical opinion to support a conclusion. Note: If evidence such as medical treatises or independent medical opinions were relied upon when the rating decision was made, explain this in the rating decision.

f. Considering the POW Protocol Examination Report Carefully consider the prisoner of war (POW) protocol examination reports, because they may provide sufficient background information to relate the veteran’s current symptomatology to the POW experience.

g. Evaluating SMRs Service medical records (SMRs) are generally highly probative, but not necessarily determinative, in the resolution of service connection.

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5. Medical Evidence, Continued

h. Statements From Physicians as Acceptable Evidence A statement from any physician can be accepted for rating purposes without further examination if it· is otherwise adequate for rating purposes, and· includes clinical manifestations and substantiation of diagnosis by findings of diagnostic techniques generally accepted by medical authorities.Examples: Diagnostic techniques generally accepted by medical authorities are · pathological studies· x-rays, and· appropriate laboratory tests.

i. Considering Information in the Claims Folder The information in the claims folder must support the medical conclusions.Consider the following information in the claims folder:· applicable dates of events such as- treatment reports, and- hospitalizations· dates covered by the service medical record, identifying at least the month and year· names of- VA and private medical facilities- private physicians, and- other information sources, and· items of evidence that were requested but not received.

6. Insufficient Examinations

Introduction This topic contains information about insufficient examinations, including· improper denials, and· explaining necessary but unscheduled examinations.

Change Date December 13, 2005

a. Improper Denials Do not deny a claim or reduce an evaluation based upon an insufficient examination.

b. Explaining Necessary But Unscheduled Examinations If the rating activity decides to rate a case where a specialist exam has been recommended by the medical examiner but not scheduled by the Veterans Health Administration (VHA), explain the reason in the rating decision.

7. Reviewing Hospital Reports for Adequacy

Introduction This topic contains information about reviewing hospital reports, including· handling inadequate VA hospital reports, and· handling inadequate non-VA hospital reports.

Change Date December 13, 2005

a. Handling Inadequate VA Hospital Reports Request the original clinical records, including the nurses’ and doctors’ orders, if a VA report of hospitalization is inadequate for rating purposes in cases involving either· injury, aggravation of injury, or death as the result of - hospitalization- medical treatment- surgical treatment, or- examination, or· the death of a veteran from NSC causes if - the veteran had an SC neuropsychiatric disability that reasonably may have impeded, obstructed, or otherwise interfered with the treatment of the condition that caused death , and- the hospital report does not clarify this issue.

[carlie]

Here it is.

http://www.warms.vba.va.gov/admin21/m21_1/...v/ch05/ch05.doc

carlie