Exams for Claims - Use Third-Party Medical Firm - VA Rules

[Top G]

I'm working on filing a new claim to raise my current ratings on a few of my disabilities.  With that, where can I file the VA rules that states the use of third-party medical firms/Doctors that can or must be used?

I'm looking at going through Ree Medical Inc to evaluate and seek amendment of my current disability rating from 90% to 100%.  From what I understand, though not read it in any VA official documentation, is that the Veteran does not need to use a VA contracted medical doctor....but would need to use a board certified Doctor.

I want to see the VA rule(s) on this in black and white for myself.  So, if any of you can help point me to whatever document this is in and if you can help narrow down the location of it within the rules "book", I'd appreciate it.  

Thank you all for your help on this.

[broncovet]

Im unaware of any regulation "in black and white" that states "the use of third party examiners can/must be used".  

To the contrary, the VA wants/needs to be very flexible since tens of thousands of exams are needed.  They pick "from the options available".  In some areas, VA docs may well be available, while in other areas, there may be no VA doc available, so a third party examiner must be hired.  

You are on the right track, tho.  

 You can go through "Ree Medical", if you so choose to pay for it.  When VA schedules an exam, they pay for it AND get to pick the examiner.  

     The VA is given a presumptive.  "If" VA hires an examiner that examiner is presumed competent absent a challenge by you or your representative.  

     However, when YOU pick the examiner, you must demonstrate the examiner is an expert witness.  This means the examiner has medical training or experience to render a professional opinion.  

You can not hire a friend who has a Phd in coaching basketball  (and no medical experience) to give an opinion your ailing knee is at least as likely as not due to service.  

Instead, when you submit an independent medical exam, You ask the doctor to submit his/her CV, detailing the examiners medical training and or experience in diagnosing and treating your type of claim.  VA can deny based on that examiner is not competent (has medical experience or training) in rendering a professional opinion.  

   A "board certified" md, would likely meet the criteria for an expert witness in the field.  

   If VA has already ordered an exam, go to that exam.  If they have not ordered an exam, and one will likely be needed, then you are free to hire Ree Medical and one or more of their board certified docs.  Dont expect VA to pay for it, tho.  

    If you buy a car, YOU get to pick the car.  However, if VA should permit you to use their vehicle(s), then they get to pick which Vehicle you use.  In other words, the guy paying the bill gets to decide.  

     For those of us who do not work for VA, we dont get to decide on the examiners..or if an exam is needed.  There are several circumstances when an exam is not needed:

1.  If you already have evidence in your file to make a determination.  

2.  If the exam can not fix your claim.  Example:  You lack a "in service event" in service.  An examiner can not turn back the clock and render an opinion that you had an in service event.  

The examiners can make diagnosis and they can render a nexus opinion, but can not create Caluza element 2, an in service event.  This needs to be shown in your military records, or, perhaps, if there is no record, a buddy can write a letter that he or she witnessed "an in service event"..such as maybe you parachuting out of an airplane, which could cause knee or ankle injuries.  

     An exam does not always require an "MD".  An audiologist, for example, may render an opinion on your hearing with or without an advanced MD degree.  

    

[Top G]

Thank you @broncovet.  

[Rivet62]

3 hours ago, broncovet said:

The examiners can make diagnosis and they can render a nexus opinion, but can not create Caluza element 2, an in service event.  This needs to be shown in your military records, or, perhaps, if there is no record, a buddy can write a letter that he or she witnessed "an in service event"..such as maybe you parachuting out of an airplane, which could cause knee or ankle injuries.  

What are your thoughts on a condition that is medically observed in-service, but denied benefits because "there were no complaints"?

My original claim decision and SOC states that while 'pelvic tilt' appears in-service there were no complaints about it therefore it is denied. "Pelvic tilt" is an analogous description for the original claim of "one hip higher than the other and/or altered gait".