Independent Medical Exam (IME) and Disability Claims

When Veterans seek disability benefits for service-related conditions, the accuracy and thoroughness of medical examinations play a crucial role in the claims process. The Department of Veterans Affairs (VA) relies on Compensation and Pension (C&P) exams to assess a Veteran’s eligibility for benefits. However, if a Veteran feels that the C&P exam results are inadequate or unfair, they have the right to seek a second opinion through an Independent Medical Exam (IME).

Understanding the VA Disability Claims Process

The VA provides several ways to file a VA disability claim, including online through the VA website, by mail, or in person at a regional VA office. When applying, Veterans must submit the claim along with supporting evidence, such as medical records, service records, and lay statements. By providing as much relevant information as possible, the Veteran can help the VA make an accurate decision on the claim.

To qualify for VA disability benefits, Veterans must demonstrate three key elements:

  • A current disability
  • An in-service event, injury, or illness, that caused the disability
  • A medical link or nexus between the disability and the in-service event 

After submitting a claim, the VA will review the evidence and may schedule a C&P exam to assess the Veteran’s condition. The VA may also request additional information or evidence if needed. Once all necessary information has been gathered, the VA will decide the claim and notify the Veteran of the decision.

If the VA determines a Veteran’s condition is service-related, it will establish service connection and assign a disability rating based on the severity of the condition, using a scale from 0% to 100%. The rating is reflective of the impact of the condition on the Veteran’s ability to work and function in daily life.

If a Veteran disagrees with the VA’s decision, or if their claim is denied, they have the right to appeal and provide additional evidence, such as an IME, to support their claim.

About the C&P Exam

The VA must assist Veterans in proving the elements of their claim, and often this is by providing a C&P exam. VA-contracted providers conduct these exams to evaluate the Veteran’s condition and provide a medical opinion. 

The purpose of a C&P exam is to:

  • Confirm the presence of the claimed condition (diagnosis) 
  • Evaluate the severity of the condition
  • Opine whether the condition is more or less likely than not service-related.

During the C&P exam, a VA-contracted provider will:

  • Review the Veteran’s medical history
  • Conduct a physical examination
  • Ask questions about the Veteran’s condition and its impact on daily life
  • Complete a Disability Benefits Questionnaire (DBQ) to document their findings 

After the exam, the provider submits their report to the VA.VA adjudicators then review the medical and other evidence of record to determine the Veteran’s eligibility for benefits, disability rating, and effective date.

About the Independent Medical Exam

An Independent Medical Exam, on the other hand, is a separate evaluation conducted by a healthcare professional who is not affiliated with the VA. Veterans may seek an IME if they believe that their C&P exam results were inadequate, inaccurate, or unfairly underrated or denied their claim.

Key differences between IMEs and C&P exams include:

  • Choice of doctor: Veterans can choose their own doctor for an IME, whereas the VA assigns a provider for the C&P exam.
  • Cost: IMEs are paid for by the Veteran, while C&P exams are free 
  • Scope: IMEs provide a medical  opinion and supplemental evidence to support a Veteran’s claim

Advantages of an IME

An IME offers several advantages compared to a C&P exam.

  • Impartiality: An IME doctor may not have a prior relationship with the Veteran or the VA, increasing the likelihood of an objective opinion. However, Veterans can seek an IME from any provider with whom they already have a history.
  • Consideration by the VA: The VA must consider any outside medical evidence, including IME reports, when addressing appeals of disability claims.
  • Supplemental evidence: An IME can provide crucial evidence to counter the VA’s findings and help Veterans receive the maximum benefits they are entitled to.

Challenges in Obtaining an IME

Despite the potential benefits of an IME, Veterans may face some challenges in the process:

  • Cost: Unlike VA C&P exams, which are free, Veterans typically have to pay for an IME.
  • VA’s preference for C&P opinions: If a Veteran has already attended a VA-approved C&P exam, the VA may give more weight to that opinion compared to an IME.
  • Finding a qualified IME doctor: Not all doctors are familiar with VA requirements and standards for disability assessments.The inclusion of a DBQ is helpful, but providers may also write a letter.

Incorporating IME Evidence in the Claims Process

If a Veteran obtains an IME, they can submit the report as additional evidence to support their initial disability claim or supplemental claim. The VA is required to consider this evidence when deciding on the claim. However, it’s the VA may still give more weight to the C&P exam.

Working with experienced VA disability benefit lawyers can help Veterans effectively incorporate IME evidence into their claims and appeals and build strong legal arguments to support their case.

How an Experienced Veterans Disability Benefits Lawyer Can Help

Veterans struggling to obtain the disability benefits they deserve for their service-connected conditions, or who believe that their claims have been unfairly denied or underrated, need to take action. That’s where the dedicated team at Berry Law comes in. 

With decades of experience fighting for Veterans’ rights, Berry Law has helped countless Veterans across the United States secure the benefits they deserve. Their team is committed to providing personalized, compassionate representation and will work tirelessly to ensure that Veterans’ voices are heard and their cases are presented in the strongest possible light.

Many of the attorneys at Berry Law are  Veterans themselves, so they uniquely understand the challenges Veterans face when navigating the VA disability system. Many have firsthand experience with the claims process, and know how to effectively incorporate IME evidence into appeals to build strong legal arguments on behalf of their clients.

Contact Berry Law

Veterans should not let an unfair denial or an inadequate disability rating stand in the way of obtaining the support they need and deserve. Contact Berry Law today to schedule a consultation and learn more about how their experienced VA disability lawyers can help with an IME and disability benefits claim.

Call the firm toll-free at 888-883-2483 or fill out our online contact form to speak with Veterans disability lawyers at Berry Law and learn more about the VA’s disability options. The firm represents Veterans in all 50 states, and their legal team is available 24/7 to answer questions and provide the assistance.

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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