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Independent Medical Opinion (IMO) / Nexus Letter

This hot little ticket is the key to turning your Claim or Appeal from a dud to a stud. It provides your claim with one of the key elements that all claims need to be successful. Which is a medical opinion that your disability is a result of your military service or an already service-connected disability.

NOTE:

  • An IMO is NOT a DBQ and a DBQ is NOT an IMO! For more information about DBQs click HERE.

IMPORTANT NOTES:

  • An IMO is NOT required for your claim or appeal to be successful, so please do not feel obligated to include one! This is more for Veterans who's claims may be more complex, be it due to time since separation, controversy, confounding factors, etc.

  • As an IMO is primarily a records review and the application of medical knowledge/expertise, it is NOT necessary for the Veteran to meet face to face with the doctor who prepares the IMO.

Who Should Write an IMO

For an IMO to have any weight it should be completed by a medical expert. The more experienced and specialized the expert, the better.

This medical expert should be:

Currently Board Certified in their field of study and their expertise should be relevant to the Veteran's focus. For example:

  • Audiologist - Hearing loss or Tinnitus.

  • Cancers - an oncologist.

  • Disabilities relating to old bone injuries - an orthopedic surgeon.

  • Traumatic Brain Injuries:

    • Psychiatrists;

    • Physiatrists;

    • Neurologists; or

    • Neurosurgeons.

  • Mental health:

    • Board-certified or board-eligible psychiatrists;

    • Licensed doctorate-level psychologists; OR

One of the following other mental health professionals, under the CLOSE supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist:

  • Doctorate-level mental health providers

  • Psychiatry residents; and

  • Clinical/Counseling psychologists completing a one-year internship or residency.

NOTE:

  • “Close supervision” means that the supervising psychiatrist or psychologist met with the Veteran and conferred with the examining mental health professional in providing the diagnosis and the final assessment. The supervising psychiatrist or psychologist must co-sign the examination report.

SPECIAL NOTE:

  • For PTSD, the examining psychiatrist or psychologist should comment on whether the Veteran has experienced other traumatic events and, if so, indicate the relevance of these events to the current symptoms.

Where to get an IMO

Ideally, you should get your treating physician to prepare it for you.

Unfortunately, if your treating physician is from the VA, you are kinda out of luck. The Veteran Health Administration (VHA) is primary concerned with treating Veterans. And as such, helping Veterans with their claims is generally outside of the scope of their job.

Your VA Physician is permitted but not required to assist you with an IMO, and many would rather focus their efforts on treatment.

So you may have to search out a private physician.

IMPORTANT NOTE:

  • PLEASE DO NOT GO ONLINE AND USE SOME SITE THAT PEDDLES IMOs and DBQS! You'd be best served going through your own treating physician or someone else who is local.

Important Things an IMO Should Include

Here are a few things that your physician should be sure to include in their IMO:

  • Letter should only be the length needed. It should be direct and stick to the facts.

  • Statement that the physician has reviewed all of the Veteran's relevant/available pre/post medical records as well as of course the Veteran's military medical records.

  • Statement regarding their opinion* as to if the Veteran's current disability is service-connected/or related to a Veteran's service-connected disability.

*This statement does not need to be absolute, as it can be really hard to be absolute with the origin of things.

The language the VA uses and understands regarding statements of service connection are as follows:

  • Is not related: 0% chance disability is service-connected.

  • Less likely than not: Less than 50% chance disability is service-connected.

  • As likely as not: 50% chance disability is service-connected.

  • More likely than not: More than a 50% chance disability is service connected.

  • Is related: 100% chance disability is service-connected.

Importantly, for the purposes of the VA, if the likelihood is at least 50% then the VA considers it a positive opinion for the purposes of establishing service-connection.

Nexus Letter Example

Here is an example that you can show your doctor to give them more of an idea of what you are looking for:

DATE _________________

Reference: (Veteran's name) _________

SS# ________ VA File # _______________

To Whom It May Concern,

I am Dr. _________ I am board certified in my specialty. My credentials are included. I have been asked to write a statement in support of the aforementioned Veteran's disability claim.

I have personally reviewed their medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of their military service in the years ____________ (Event or Events claims as the cause of the condition) while they served during their military service (List dates of service).

Mr/MR/MRS. ________ is a patient under my care since (enter date). Their diagnosis is ___________ (Name the Condition).

I am familiar with their history and have examined Mr/MR/MRS. ________ often while they were under my care. (Specify Lab Work, X-rays, Etc.)

Mr/MR/MRS. ________ has no other known risk factors that may have precipitated their current condition.

After a review of the pertinent records it is in my professional opinion that it is at least as likely as not that MS/MR/MRS. ________'s condition is a direct result of their (Event) as due to their military service.

In my personal experience and in the medical literature it is known (Provide a rationale AND references to medical literature).

Signed,

Dr. ______

(List credentials and contact information)

Final Words

Let there be no confusion here. Please do NOT go IMO shopping!

If the physician determines that your disability is less likely than not due to your military service/service-connected disability then you should generally accept this. If you do disagree with them you are of course free to get a second opinion - just don't keep trying to find the one doc that will go along with you.

Frequently Asked Questions

    • The tie principle is NOT applicable here. Because the two are not equal. If for instance the C&P examiner was more experienced, specialized, etc. Their opinion may have carried more weight than your IMO. However, you should have your claim reviewed by a VSO. So they may help guide your through the Appeals process. Since the VA may not have properly considered your IMO.

    • It is kind of a misnomer. It is independent with respect to the VBA. IE it is an opinion from someone not affiliated with the VBA.

    • While it may be a matter of personal/professional policy for them, it may also be that want to be properly compensated for their work and time. As such, you should make it clear that you will compensate them appropriately. It will take them time to go through your records, do any relevant research, type up the opinion, etc. and physician time isn't cheap - this will cost you at least a thousand dollars, possibly quite a bit more.

      • If they are still unwilling, you will then have to seek out another physician.

References