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If you received a bad C&P exam, there’s a strong chance you also received an unfavorable VA medical opinion for service-connection, which could result in your VA disability claim being denied.
The good news?
You have options to fight back—legally and ethically!
In this short article from VA disability expert Brian Reese, we’ll explain specific action steps you can take to address a negative VA medical opinion.
Let’s get started!
Summary of Key Points
- Unfavorable VA Medical Opinions: An unfavorable VA medical opinion includes a negative nexus statement such as “less likely than not,” indicating the examiner did not find a connection between your condition and your military service. This type of negative medical opinion usually stems from a bad C&P exam and can lead to a denial of VA disability benefits unless appropriately challenged.
- How to Request a New C&P Exam: If your C&P exam was inadequate or inaccurate, requesting a new exam is mission critical, especially before the VA denies your claim. Reporting the issues to the VA hotline phone number and documenting the experience in a detailed Memorandum for Record (MFR) ensures the problems are officially recorded and your case gets reassessed.
- Why Get a Private Independent Medical Opinion (IMO): A private Independent Medical Opinion (IMO), or Nexus Letter, can effectively challenge a negative VA medical opinion. This detailed medical document provides evidence linking your condition to your military service and is instrumental when filing a Supplemental Claim to introduce new and relevant evidence not previously considered.
- When to Submit a Private Rebuttal Letter: If the C&P examiner discredits your private Nexus Letter, a rebuttal letter from the original provider can address and counter the examiner’s critique. The letter should provide additional evidence-based rationale, clarify misinterpretations, and reinforce the original Nexus Letter’s validity, ensuring the VA Rater reconsiders your claim with all relevant evidence.
What Is an Unfavorable VA Medical Opinion?
An unfavorable VA medical opinion stems from a bad C&P exam and contains a negative nexus statement that will likely lead to a claim denial.
The nexus statement addresses whether your disability is “at least as likely as not” (50/50) related to your military service.
If you see phrases like “less likely than not” or “not due to” in your medical opinion, it means the VA examiner did not find a connection between your condition and your service, making a denial of benefits likely.
Example: You file a VA claim for back pain, and the C&P examiner writes: “It is less likely than not that the veteran’s back pain is related to their military service, as there is no evidence of a documented in-service event, injury, or illness. The veteran’s back pain is likely due to their civilian employment as a construction worker.” This negative nexus statement and explanation will probably lead to a claim denial unless you challenge the C&P examiner’s findings.
How to Challenge an Unfavorable VA Medical Opinion
If you receive a negative VA medical opinion, here are specific steps to take to challenge and discredit it depending on your situation:
#1. Request a New C&P Exam
If your C&P exam was inadequate or inaccurate and the VA hasn’t yet denied your claim, you can always request a new exam.
Acting quickly is mission critical!
- Call the VA Hotline Immediately: Dial 1-800-827-1000 to report the issues with your exam. Explain what went wrong and request that the VA schedule a new C&P exam.
- Write a Detailed Memorandum for Record (MFR): Document your experience in detail, just like in the military. Include facts such as the examiner’s name, what was said, and why the exam was inadequate or inaccurate. For example, if the C&P examiner pencil-whipped your exam and spent only five minutes assessing your condition or dismissed your statements, note that in the MFR. Upload this to your VA.gov account under the claim in question to ensure it’s included in your file.
- Example: If you attended a C&P exam for PTSD and the examiner failed to ask about your in-service stressor event(s) or mischaracterized your mental health symptoms, you should call the VA hotline, document this in an MFR, and immediately request a new C&P exam.
#2. Get a Private Independent Medical Opinion (IMO)
A private Independent Medical Opinion (IMO), also called a Nexus Letter, can effectively challenge and discredit a bad C&P exam and a negative medical opinion.
- How to Use a Nexus Letter: A private healthcare provider can write a detailed IMO that explains why your condition is “at least as likely as not” caused or made worse by your military service. This document can counteract a negative medical opinion and nexus statement from a VA C&P examiner.
- VA Appeal Options: If your claim has already been denied, submit the IMO with a Supplemental Claim to introduce new evidence. If you’re challenging a denial without new evidence, file a Higher-Level Review (HLR) for a fresh look at your file from a more senior VA claims adjudicator.
- Example: If you were denied service-connection for migraines because the VA examiner claimed they were unrelated to service, a private neurologist could write an IMO linking your condition to in-service events, such as exposure to loud noises or head trauma.
#3. Obtain a Private Rebuttal Letter
If the VA discredits a private Nexus Letter you’ve submitted with your claim, a rebuttal letter from the same private provider who wrote the letter can address the issues raised by the VA C&P examiner.
- What to Include: A rebuttal letter should explain why the initial Nexus Letter remains valid, provide additional evidence-based rationale, and clarify any misinterpretations or issues cited by the VA examiner.
- When to Use: A rebuttal letter is particularly useful when submitting a Supplemental Claim after a VA claim denial based on a bad C&P examiner discrediting the probative value of a private Nexus Letter.
- Example: If you were denied service connection for bilateral severe flat feet because the VA C&P examiner discredited the probative value of your private Nexus Letter solely on the basis that you paid for it, the private provider could write a rebuttal letter addressing this issue. The rebuttal could clarify that the Nexus Letter was based on an independent, evidence-based medical evaluation, not influenced by payment, and supported by specific facts, such as diagnostic imaging and a detailed review of your in-service physical demands. The provider could also explain that there is no prohibition against paid medical evidence for a VA claim and mention the fact that the VA-contracted C&P examiner is also a paid examiner receiving a fee for conducting the exam.
Conclusion & Wrap-Up
An unfavorable VA medical opinion from a bad C&P exam doesn’t mean the end of the road for your claim.
By requesting a new exam, obtaining an Independent Medical Opinion, or submitting a private rebuttal letter, you can counteract the negative findings and build a stronger case for your service connection.
Remember, the VA disability claims process isn’t over until you quit!
Stay proactive, keep fighting, and secure the benefits you’ve earned through your service.
You’ve got this!
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
