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An Independent Medical Opinion (IMO) increases the success rate of a VA disability claim by providing three critical elements often missed in standard C&P exams: a formal DSM-5 diagnosis, detailed evidence of occupational and social impairment under 38 CFR § 4.130, and a clear medical nexus statement. This comprehensive clinical documentation prevents denials by legally linking the veteran’s mental health condition directly to their military service.
Many veterans file claims based on self-diagnosis or a brief checklist, only to be denied when the VA finds insufficient evidence of service connection. Submitting a robust IMO from a licensed doctoral-level psychologist ensures that the Department of Veterans Affairs has the exact clinical terminology, functional impact data, and professional medical rationale required to grant service connection and assign an accurate disability rating.
The way the current system is set up, a veteran can file a claim for any mental health diagnosis they choose. The problem with this freedom of choice is that most veterans (and the individuals helping them) are not mental health clinicians. They are not trained in assessment and diagnosis. These individuals have no way of knowing whether the diagnosis they are claiming is accurate or way off the mark. They shouldn’t be expected to.
This is the first reason it is extremely important for veterans filing an initial claim to submit verification from a licensed mental health provider that they actually have the diagnosis they are claiming. Without this, you are risking having your claim denied. With a claimed diagnosis that is only a guess and not a professional opinion, the C & P exam may find that the veteran does not meet criteria for that diagnosis, may or may not be thorough enough to figure out what diagnosis is correct, and may ultimately lead to an unfavorable result for the veteran.
Does this process sometimes work in favor of the veteran who does not submit an independent medical opinion with their claim? Sure. But many more are denied, and the ramifications for those that are denied because their diagnosis is inaccurate are great. Your claim process starts over. You lose time. And your compensation is delayed, if you’re lucky. If you’re unlucky, you don’t receive that compensation at all.
But let’s say your claim does get approved after the C & P exam, without an independent medical opinion. Unfortunately, there is another hurdle to jump. When your disability is determined to be service-connected, it is given a rating. This rating corresponds with the level of impairment or impact on your daily functioning. It corresponds with the level of benefits you will receive (0-100%). This determination is made through evidence that the C & P examiner has access to.
Ultimately, the VA is looking for very specific information that corresponds with their various rating levels to make their determinations. Veterans usually do not come to the C & P exam knowing what information the VA needs to know. Unfortunately, we have heard many stories of veterans not being asked the right questions in their exams or being matched with an examiner who lacks empathy. This hinders the veteran’s comfort level in sharing, ultimately leading to the veteran holding back and not revealing information necessary to determine an appropriate rating.
Unfortunately, if you seek a mental health assessment from a professional outside of the VA, success is not guaranteed. To be successful, your evaluation needs to provide the relevant information for your claim. Many well-intentioned providers do not understand the VA claims process. As a result, they lack knowledge of what the VA is looking for in an independent medical opinion.
Instead, you need a provider who is intimately familiar with the information required by the VA and who can perform your assessment with care and compassion. This creates a safe environment for you to share aspects of your life that you may have never shared with anyone else. These factors combined will enable you to receive an accurate rating from the VA.
Additionally, with a quality mental health assessment, you may not need a C & P exam at all. The VA is moving toward accepting assessments and evidence such as those provided by VMHA as all of the evidence needed to make a claim determination. As a result, this can cut down on your processing time and enable you to receive your benefits faster.
The third reason our Independent Medical Opinions benefit your claim is that we provide a Nexus statement. The VA weighs these heavily in determining service connection. A Nexus statement is the provider’s official stated opinion linking your mental health condition to your military service. The link between your mental health distress and your military service is critical for your claim to be accepted. The VA could agree that you have depression, for example, but may determine that your depression was caused by factors outside of service. Essentially, this will result in you not receiving benefits for that disability.
Veterans receiving mental health treatment for at least 12 weeks can receive a Nexus letter from their provider. Accordingly, this letter, done correctly, can establish service connection. This can be the most cost effective option for you. But if you do not fall into that category, an independent medical opinion with a Nexus statement is the best option to fulfill this need. Without a Nexus, you will have to trust the VA to draw the right conclusions and attempt to link your mental health condition with your military service. In both initial claims and appeals, an appropriate Nexus, combined with sufficient evidence, can make or break your claim.
We recommend receiving an independent medical opinion that fulfills three needs:
VMHA specializes in providing independent medical opinions that meet these needs. Our experienced psychologists can strengthen your claim and increase your chances of success.
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Want more information? Email us at info@vmhaforvets.com or call us at 214-307-2198.
Disclaimer
This blog post is for informational purposes only and should not be construed as legal or medical advice.
Dwayne Edwards is a Marine Corps Veteran and Founder of VMHA. He served in the infantry and intelligence, deployed to Iraq, and served as the suicide awareness officer for his last command. He holds a BA from Binghamton University and an MBA from Yale School of Management.
After experiencing the difference a high-quality psychologist can make for his own mental health journey, he founded VMHA to provide high-quality, ethical, and transparent mental health evaluations to fellow service members and veterans.
At VMHA, we hold our educational content to the same high standards as our clinical assessments. This article has been reviewed and fact-checked by our Internal Quality Assurance Team, led by licensed, doctoral-level psychologists (Ph.D. / Psy.D.) to ensure it adheres to our editorial and clinical standards.
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