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Getting a 2nd Opinion or Private Medical Opinion for PTSD Claim

Many Veterans with PTSD can benefit from a letter of support from their own private medical doctors, often referred to by the VA as an independent medical opinion. A document from a primary care physician or a psychiatrist could help some Veterans, but there can also be cases in which the VA may reject the independent evaluation.

When it comes to service-connected disability compensation for U.S. military Veterans, service-related post-traumatic stress disorder (PTSD) is one of the most common conditions – and also one of the most difficult ones to obtain benefits for.

If you are having a hard time obtaining PTSD benefits, the VA benefits lawyers at Berry Law want to help. Veterans’ disability benefits law is the primary focus of our legal practice. Our legal team brings extensive knowledge of PTSD, military service during multiple conflicts, and a strong grasp about how to successfully navigate cases through the often Veteran-unfriendly VA appeals.

Why Do I Need a Private Medical Opinion as a Disabled Veteran?

As a disabled Veteran, you often need a private medical opinion because the VA may hire a medical practitioner or psychiatrist who does not analyze your PTSD symptoms properly. In the worst-case scenarios, the VA-hired medical professional could deliberately try to downplay your symptoms due to financial incentives.

When you apply for disability benefits for PTSD or any other disability, the VA is responsible for contracting a medical professional to analyze your symptoms. You are not allowed to choose a psychiatrist or doctor for this examination. You’re required to sit through a C&P exam, during which the VA-hired medical professional will:

  • Ask you questions about your PTSD or other condition
  • Determine the severity of your symptoms
  • Make an official recommendation in a report sent to the VA

While you are required to sit through a C&P exam, you are not required to accept the hired medical professional’s word as the final statement in your case. Instead, you can pursue a private medical opinion that may disagree with the VA’s initial decision. This can be helpful when applying for disability benefits in the first place and when appealing a VA disability benefits decision.

Can an Independent Medical Opinion Help?

You could improve the chances of your disability claim getting approved much earlier in the process by supplying an independent medical opinion. Or, if your case involves an appeal of a VA decision, an independent medical opinion could be necessary to achieve any measure of success.

The ability to get an independent medical opinion for Veterans is not always easy. Private practitioners are much more likely to write such letters than doctors who are actively employed by the VA.

The VA doctors tend to come down on the government’s side, likely casting doubt on a PSTD claim. In that context, Veterans who receive their healthcare exclusively from the VA may have to pay physicians out of pocket to review VA records and conduct an examination before they are willing to author an independent medical opinion.

How Can I Get a Private Medical Opinion Regarding PTSD?

You are allowed to seek out a private medical opinion (also called a second medical opinion) regarding your PTSD diagnosis and severity. There are a few ways you can do this:

  • If you already have a psychiatrist or doctor who you regularly see, you can request a session with them for an independent medical opinion.
  • You can seek out another doctor or psychiatrist for a private medical opinion. If you choose this path, make sure that the professional you pick is qualified and a specialist in mental health. This will maximize their understanding of your condition.

To enable a doctor to write an independent medical opinion for the VA, the doctor will generally need the following:

  • Your military medical records, including your enlistment examination report
  • Medical records from the VA or any other treatment providers
  • A copy of your VA claims file

A doctor may request other kinds of records that they believe are relevant to your claim to provide a link between military service and PTSD.

An experienced PTSD lawyer can guide you through disability claim process, including whether you need an independent medical opinion and how to get a second opinion from a credible private doctor.

What Medical Records Are Needed for a Private Medical Option for a PTSD Claim?

When doctors are reviewing your possible PTSD claim, they will be looking for medical records relating to events or incidents that occurred while you were actively engaged in military service. This usually harkens back to intense and prolonged combat, but it also could include sexual or physical assault, terrorist attacks, or natural disasters, among other causes.

Establishing a service connection for PTSD usually requires a Veteran to demonstrate proof of a “stressor” (traumatic event) during service, a PTSD diagnosis, and an opinion from a VA psychologist or psychiatrist that the stressor caused or aggravated the PTSD.

To establish this service connection, a medical professional or therapist will require documents such as:

  • Documentation of your military service. This should break down when you were on active duty in the military and help to establish that your military service directly correlates with the beginning or exacerbation of your PTSD symptoms.
  • Documentation of your PTSD symptoms. This can be medical records, such as official prescriptions for medication or medical procedures from your therapist/psychiatrist, or it can be personal documentation, like journal entries, the written testimonies of friends, family members, coworkers, and more.

It’s a wise idea to gather all relevant medical records and documents related to your PTSD and the treatment of this condition ahead of time. Contact your medical professional or psychiatrist who diagnosed you with PTSD and ask for documentation to be mailed or emailed to you.

Once you have these documents, you can provide them to another independent medical professional (if you are seeking a second medical opinion from another doctor) or the VA. Both entities will require these documents to make an accurate decision regarding your PTSD rating

Common Reasons Why VA Rejects Private Medical Opinions

The VA is not obligated to accept all independent medical opinions, and it may even reject the opinions of VA doctors in some cases. Independent medical opinions can be rejected for a variety of reasons, including cases in which doctors based their opinions solely on the testimony of the PTSD claimant.

The VA could also determine that an independent medical opinion was uninformed and based on an incomplete review of a Veteran’s medical history. In other cases, the doctor may have provided insufficient reasons to justify their conclusion that the Veteran suffers from PTSD.

Doctors could also be penalized for using speculative language such as “could be” or “may be” in their independent medical opinion. The VA could reject an independent medical opinion when a physician fails to address unfavorable evidence.

Another reason for rejecting the findings of independent medical opinions includes a doctor’s failure to address a significant period of time between a Veteran’s discharge and a PTSD diagnosis. The VA could also reject an independent medical opinion when the agency feels that the doctor is relying on inaccurate facts in the PTSD analysis.

However, you are the only one who knows the severity of your symptoms as they truly are. If you believe the VA has rejected a private medical opinion on a poor basis, or if you believe another private medical opinion is necessary, you can contact Veterans law attorneys for further assistance.

How Berry Law Can Help

Berry Law represents Veterans nationwide. Our firm has been providing legal counsel to fellow Veterans since 1965.

Firm founder John S. Berry Sr. is a Vietnam War Veteran and Bronze Star recipient. John S. Berry was a company commander in Iraq during Operation Iraqi Freedom and a platoon leader in Operation Joint Forge in Bosnia. 11 other attorneys in our firm have served in the U.S. military.

If you are struggling to obtain VA disability benefits for PTSD, you do not have to deal with all the challenges by yourself. Contact Berry Law and let us handle all of the complex legal legwork so you can focus on your health and well-being.

Our firm understands the many complications to PTSD claims. We handle appeals before all VA Regional Offices, the Board of Veterans’ Appeals, and the U.S. Court of Appeals for Veterans Claims.

We will provide an honest and thorough evaluation of your case when you schedule a free case evaluation.

Sources:

VA Claim Exam (C&P Exam) | Veterans Affairs

About VA Disability Ratings | Veterans Affairs

NIMH » Post-Traumatic Stress Disorder

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

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