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The VA updated regulations regarding requests for medical opinions. Here's what you need to know

What are the VA's regulations regarding requests for medical opinions? A quick visit to the VA's 38 CFR section 3.159 – the code of federal regulations relating to VA disability – might leave you more confused than clarified. This long webpage is filled with technical definitions and details, making it hard to find the simple information that you need.

We'll be posting several blogs to break this down into simpler explanations, but for now, we'll start with the three elements that need to be met in order to determine if a condition is service-connected (and if a medical opinion is necessary).

Here are three elements that must be met before you can request a medical opinion or evaluation from the VA:

Element 1: A current chronic disability 38 CFR 3.159(c)(4)(i)(A)

  • The VA defines Element 1 as: "The presence of competent evidence of a current disability or persistent or recurring symptoms of disability." You must establish that you are currently suffering from a condition/symptom. We will break down what “competent evidence” means in a future blog.

Element 2: Service event 38 CFR 3.159(c)(4)(i)(B)

  • The VA defines Element 2 as: "Establishment of one of the following in service: 1) An event, 2) An injury, 3) A disease." In short, this means there must be objective evidence of something occuring in service.

Element 3: A medical nexus 38 CFR 3.159(c)(4)(i)(C)

  • The VA defines Element 3 as: "An indication that the diagnosis or symptoms may be associated with the established event, injury or disease in service." The VA requires that your current condition/disability is connected to service or a service connected condition.

Is a C&P exam (compensation and pension) or medical opinion always necessary?

No! In fact, recent reports have even revealed that the VA has wasted a lot of time on unnecessary appointments. After an internal review, the Office of the Inspector General (OIG) released a report on September 7th, 2022 that revealed 68% of the time the VA Board of Appeals failed to follow required procedures in Veterans claims.

We covered the entire event in our blog The VA Gets an "F" – so check it out if you haven't already. The results are appalling. What we're trying to say here is: This entire process can be a lot simpler than you may have been led to believe (IF you know where to look for information, and what the regulation is asking of you). Your military life was governed by regulation, and things are no different with the VA and disability. We will be breaking down the key elements one by one so you understand this important piece of the regulation.

Need help getting medical evidence for your VA disability claim? We're your people.

No more guessing and hoping for the best – filing for VA disability benefits doesn't have to feel like such a mission. We help Veterans with nexus letters and DBQ’s for their medical conditions which enhance their VA disability claim. Save time, money, and frustration with us.

Take a look at our services page here to review all of the ways we can support you. When you're ready to get started, sign up for an expert chart review here.

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