Medical Statement vs Medical Opinion

[Lavish]

Can anyone explain the difference between a C&P examiners Medical Statement vs a Medical Opinion? 

I'm reading up on Gulf War Medical Exams.  I had a Gulf War Medical C&P exam in August which lasted 4 hours; this exam consisted of many DBQs, including one for CFS.  Although, I'd already had a C&P exam a few months prior for CFS.   It took 6 weeks for the examiner to get the report to the VBA.  A few days ago, the VBA just requested another C&P exam for the CFS for "rework" and a medical opinion for CFS.   I don't know if I have to attend an exam or if this is something that the C&P examiner is going to do with what's already in the file.  I haven't gotten a call yet from VES and when I called them, they didn't really seem to know if I actually had to go in for another C&P exam or not- just said someone would be contacting me to schedule an appointment (?).  

From what I'm reading in the DMA Gulf War General Medical Examination training Sorting Symptoms Exercise (sharedfedtraining.org), certain conditions require Medical Statements and other require Medical Opinions.   

The training says for CFS, the examiner is required to provide a medical statement but not a nexus medical opinion.   For migraine headaches the examiner is required to provide a Medical Nexus Opinion.  

I'm wondering why the VBA is requesting a medical opinion if they only need a medical statement for the CFS exam report.  From my understating the medical opinion is the one where the examiner has to state the "as least as likely as not" VA language, but I don't know what the VBA wants the examiner to say in a medical statement.  

Does anyone know?

[GBArmy]

Lavish I don't know the difference between the two either, but it's part of the VA's process, and I don' think you want to address it at this point. The new exam may be a ACE exam where the reviewer needs clarification from the examiner and the answer is likely to be already in your medical records. VES should be contacting you on when it will be and probably tell you to stand by in case the examiner needs a verbal response from you. Often they don't.  Let the process unwind and then go from there IMHO.

[broncovet]

Here is the deal.  In order to determine etiology (whether your condition is related to service), the doc renders an opinion.  He was not there, so he can not establish a fact, but he can make an educated guess as to the likeliness of whether or not your condition is related to military service.  This is called a nexus.  

There are actually 3:

1.  Independent Medical exam.  This is the doc recording the facts of what he sees.  Your temperature, your blood pressure, lab results such as cholesterol levels, are not opinions, they are facts measured by a doctor.  

2.  Independent medical opinion.  An IMO need not examine the patient.  Instead, he reads the other doctors medical exams (the patients history), listens to the patient, and renders an opinion.  You see the patient IS competent to tell the doc things like: (example) 

"Yea, I fell out of a tree and broke my arm in service".  So, if the doc sees an xray of your arm, with a fracture consistent with falling out of a tree (x) years ago, he can render his opinion that its at least as likely as not your (event in service) fall out of a tree, caused your fracture which led to your current diagnosis of arthritis.  The doctor makes a "statement" in your medical records that he thinks its likely your tree fall caused your arthritis.  His statement is an opinion, but its based on other doctors statements and diagnosis.  A previous doctor, such as a military doc, makes a statment such as:  "I viewed the Xray, and it shows a fracture of the right posterior humerous about 1 cm from the elbow. "  

3.  Independent medical evaluation.  This is a combination of the two above.  The doctor examines you, does tests he feel are appropriate such as blood pressure, cholesterol, etc.  He then reads your history.  He also speaks to you, establishes your age, medical history etc.   For example, he may ask you if you have asthma.  (Some things are not included in medical records, so they simply ask you).  The doctor will likely ask you other questions, such as do you have a history of alcohol or substance abuse.  

Based on your medical history, doctors statements, your statements, what he observed on your medical tests as well as previous medical tests, and his vast medical experience, he makes an evalution of what he thinks is your medical history, and often makes a prediction of the outcome, such as you are likely to have arthritis in your arm due to the previous fracture.  

    All 3 of these, above have medical statements.  

    I will explain it this way.  A medical statement is like a motor.  You cant drive the motor, but your car is rather useless without one.  The motor is one part of many to your complete car.  

[brokensoldier244th]

27 minutes ago, broncovet said:

Here is the deal.  In order to determine etiology (whether your condition is related to service), the doc renders an opinion.  He was not there, so he can not establish a fact, but he can make an educated guess as to the likeliness of whether or not your condition is related to military service.  This is called a nexus.  

There are actually 3:

1.  Independent Medical exam.  This is the doc recording the facts of what he sees.  Your temperature, your blood pressure, lab results such as cholesterol levels, are not opinions, they are facts measured by a doctor.  

2.  Independent medical opinion.  An IMO need not examine the patient.  Instead, he reads the other doctors medical exams (the patients history), listens to the patient, and renders an opinion.  You see the patient IS competent to tell the doc things like: (example) 

"Yea, I fell out of a tree and broke my arm in service".  So, if the doc sees an xray of your arm, with a fracture consistent with falling out of a tree (x) years ago, he can render his opinion that its at least as likely as not your (event in service) fall out of a tree, caused your fracture which led to your current diagnosis of arthritis.  The doctor makes a "statement" in your medical records that he thinks its likely your tree fall caused your arthritis.  His statement is an opinion, but its based on other doctors statements and diagnosis.  A previous doctor, such as a military doc, makes a statment such as:  "I viewed the Xray, and it shows a fracture of the right posterior humerous about 1 cm from the elbow. "  

3.  Independent medical evaluation.  This is a combination of the two above.  The doctor examines you, does tests he feel are appropriate such as blood pressure, cholesterol, etc.  He then reads your history.  He also speaks to you, establishes your age, medical history etc.   For example, he may ask you if you have asthma.  (Some things are not included in medical records, so they simply ask you).  The doctor will likely ask you other questions, such as do you have a history of alcohol or substance abuse.  

Based on your medical history, doctors statements, your statements, what he observed on your medical tests as well as previous medical tests, and his vast medical experience, he makes an evalution of what he thinks is your medical history, and often makes a prediction of the outcome, such as you are likely to have arthritis in your arm due to the previous fracture.  

    All 3 of these, above have medical statements.  

    I will explain it this way.  A medical statement is like a motor.  You cant drive the motor, but your car is rather useless without one.  The motor is one part of many to your complete car.  

The site he’s pointing at is not for private providers, it is (or was) for training c&p clinicians)

the course links he’s pointing at are from 2015. (EVERONE) VA doesn’t go around sanitizing the internet of things except it’s own sites. Just because something is found out there about VA rules or exams is not ‘official’ or up to date information unless it’s in our site. Including NVSLP, Hill and Pontin, CCK, etc. and especially not links on any hired guns sites that promise to do medical exams or help you for a few. 

 

I know that this site is not using current training because I went through some of the Gulf War training set on this site this morning, and parts of it are based in FLASH, which has not been supported in current browsers to varying degrees for a few years, and was completely discontinued on 31DEC2020. 
 

I’ll look at the rest and try to post later. Time for work , and it’s been a bit stressful lately. 

Edited October 21, 2021 by brokensoldier244th

[Lavish]

2 hours ago, brokensoldier244th said:

I know that this site is not using current training because I went through some of the Gulf War training set on this site this morning, and parts of it are based in FLASH, which has not been supported in current browsers to varying degrees for a few years, and was completely discontinued on 31DEC2020.

Brokensoldier244th, can you tell me what the current training is on Gulf War (primarily regarding CFS) that is different than what's on the site?

[brokensoldier244th]

No, because I’m not a clinician or a contractor. 

Generally a statement would be on an exam within 1yr RAD- SC opinions aren’t needed for general medical exams, though a Gulf War opinion is requested for MUCMI issues on Gulf War gen meds. They are their own thing and look for specific things. 

 

Outside 1yr any claimed contention needs an SC opinion, unless it’s for an increase.
 

The opinion is a separate DBQ with rationale and answers to specific questions regarding the condition and whether it’sSC or not. The clinical dbq is just measurements and findings. 
 

 

[Lavish]

1 hour ago, brokensoldier244th said:

Generally a statement would be on an exam within 1yr RAD- SC opinions aren’t needed for general medical exams, though a Gulf War opinion is requested for MUCMI issues on Gulf War gen meds. They are their own thing and look for specific things. 
 

 

Brokensoldier244th,

What is RAD?  I googled it to find out what it means in military terms; the closest thing I could find was "Reported for Active Duty".  Is that the correct meaning?  If so, I don't really understand your response regarding an exam statement for a claim: Generally a statement would be on an exam within 1yr Reported for Active Duty.