{ "version": "1.0.0", "segments": [ { "speaker": "Leah Bucholz", "startTime": "7.12", "endTime": "19.975", "body": "Hey, guys. It's Leah b. So can a private medical opinion beat a VA C and P exam? This is probably one of the most common questions that I hear from veterans. And the short answer is yes." }, { "speaker": "Leah Bucholz", "startTime": "19.975", "endTime": "54.234997", "body": "Of course. In some situations, a strong private medical opinion can absolutely carry significant probative value and outweigh a negative VA C and P exam. But there is a lot of misunderstanding online about how this actually works, and there's really no black and white answer. Okay? So today, wanted to break down what VA is supposed to look at when weighing medical evidence, what makes private medical opinions persuasive, and why not every opinion private medical opinion is automatically strong because it disagreed with with the VA opinion." }, { "speaker": "Leah Bucholz", "startTime": "54.394997", "endTime": "89.1", "body": "Right? So before we jump in, I wanna make something very clear. VA is not automatically just wrong simply because they did not, decide your issue with service connected or there was a negative opinion. Sometimes the VA examiner's conclusions are medically reasonable based on the evidence available. But there are also situations where a C and P exam clearly, contains incomplete rationale, factual inaccuracies, unsupported medical conclusions, or failure to address important medical evidence." }, { "speaker": "Leah Bucholz", "startTime": "89.1", "endTime": "126.950005", "body": "Right? So this is where private medical evidence can sometimes be very beneficial and can become extremely important. So one of the biggest misconceptions that I see online is veterans believing that the VA is automatically required to favor its own examiner over a private provider or even that a VA examiner is somehow biased because they do contract v VA exam. So I don't think that's fair. I think that, any medical professional in, you know, in the most, kind of ethical way should just do what the records support." }, { "speaker": "Leah Bucholz", "startTime": "126.950005", "endTime": "143.95999", "body": "It it really shouldn't matter if it's a private medical opinion or if it's the VA. It it shouldn't matter where their paycheck is coming from. Right? That would be extremely unethical, and I would hope that no medical provider would put their own license and their morals on the line for something like like that. Right?" }, { "speaker": "Leah Bucholz", "startTime": "143.95999", "endTime": "160.175", "body": "It should be based on what they're reviewing. They you know, the Hippocratic oath says that they they will do no you know, shall do no harm, and it should be based on what the evidence supports. Okay? That's that's just not how the system is supposed to work. Right?" }, { "speaker": "Leah Bucholz", "startTime": "160.175", "endTime": "186.68999", "body": "So VA is supposed to weigh all competent, medical evidence of record. So that includes a well supported, basically means a well supported VA, or a well supported private medical opinion can absolutely be highly persuasive if it is thorough medically reasoned and supported by the evidence. So honestly, this is where rationale becomes incredibly important. And we've discussed this on a number of videos in the past. Right?" }, { "speaker": "Leah Bucholz", "startTime": "186.68999", "endTime": "201.785", "body": "So a medical opinion is not persuasive or or helpful simply because a provider checked a box saying at least as likely as not. The provider needs to explain the medicine and the rationale. Alright? Why is the condition related? So it shouldn't be just because Leah b says so." }, { "speaker": "Leah Bucholz", "startTime": "201.785", "endTime": "213.69", "body": "No. It should be, excuse me. Here's all the medical peer reviewed medical literature that supports my opinion. How did the record support the conclusion? Does the timeline make medical sense?" }, { "speaker": "Leah Bucholz", "startTime": "214.17", "endTime": "231.985", "body": "Were alternative risk factors considered? Does current medical literature support that opinion or that relationship where applicable? Those are things that tend to give an opinion probative value. So let me give you a hypothetical example. Okay?" }, { "speaker": "Leah Bucholz", "startTime": "232.33", "endTime": "291.19", "body": "So let's say a veteran files a claim for obstructive sleep apnea secondary to their service connected PTSD. This is very common. Right? So the veteran receives a negative CMP exam where the examiner states there is no medical literature that supports a relationship between PTSD and obstructive sleep apnea. Now imagine the veteran obtains a private medical opinion from a qualified provider, maybe it's their treating provider, maybe it's a medical expert company or whatever, who thoroughly reviews the records, discusses the veteran's documented symptom progression, addresses weight gain or weight fluctuations, discusses aggravation if, relevant, references current medical literature, and explains why the veteran's PTSD, related sleep impairment and associated factors may have contributed to that worsening sleep apnea or causing the sleep apnea, whether it's through know, whatever." }, { "speaker": "Leah Bucholz", "startTime": "291.27", "endTime": "310.29498", "body": "Those are two very different levels of medical analysis. The issue the issue is not simply which doctor said yes and which said no. The issue is which opinion is more thorough, more medically reasoned, and more consistent with the evidence. Right? That discussion matters tremendously." }, { "speaker": "Leah Bucholz", "startTime": "311.095", "endTime": "347.65", "body": "So now another thing I think veterans really need to consider or to really need to understand is that not all medical opinions are per are going to be considered persuasive. I know that people like to throw the word rebuttal around, and that can sound powerful online. But a rebuttal opinion is not supposed to be an emotional against an examiner. I don't even like the word rebuttal opinion because that implies that we're rebutting something, and I really believe legal professionals should be the ones rebutting anything. If there's a medical opinion to give and it contains some sort of response to evidence of record, I think that's just a medical opinion." }, { "speaker": "Leah Bucholz", "startTime": "347.88998", "endTime": "370.665", "body": "So a strong opinion should specifically identify any, medical deficiencies. For example, did your CMP examiner overlook documented complaints? Now a medical opinion, if I'm going to address someone else's medical opinion, I'm not going to attack their character, right, or their profession or or anything like that. I'm gonna just look at the facts. Did that examiner and I'm not gonna point out a bunch of legal discrepancies." }, { "speaker": "Leah Bucholz", "startTime": "370.665", "endTime": "378.1", "body": "Right? That's for the attorneys to do. So did the examiner overlook documented complaints? K. Did they fail to discuss aggravation?" }, { "speaker": "Leah Bucholz", "startTime": "379.13998", "endTime": "389.215", "body": "Did they rely on inaccurate facts? Did they ignore relevant literature? Did they fail to explain their rationale adequately? Did they just say it's because I said so? Right?" }, { "speaker": "Leah Bucholz", "startTime": "389.215", "endTime": "407.19", "body": "Those are legitimate medical criticisms. A weak opinion is usually one a weak, like, response, in a medical opinion is usually one that says, I just disagree with this examiner. That is just that just is really flat. Right? We want something powerful that says, hey." }, { "speaker": "Leah Bucholz", "startTime": "407.43", "endTime": "432.255", "body": "This is the literature, and this is how this is supported, and this doesn't make medical sense. So, honestly, one of the biggest mistakes I see veterans make is focusing entirely on conclusions instead of the credibility. Okay? So a credit a credible opinion is usually objective, balanced, and evidence based. If a provider appears, willing to connect every condition to service regardless of the records, that can actually hurt you." }, { "speaker": "Leah Bucholz", "startTime": "432.255", "endTime": "452.035", "body": "Right? That can hurt the credibility if they just anything you throw at the wall, say yes to. Strong medical opinion should not read like ad, advertisements or legal arguments. They should read like professional medical analysis. I know veterans like it when medical professionals get riled up and write a bunch of crazy stuff in the reports." }, { "speaker": "Leah Bucholz", "startTime": "452.035", "endTime": "488.43002", "body": "Okay? I've said this time and again, and I think there are some very either uneducated, inexperienced, or just medical professionals that like to pander to that emotional side of veterans sometimes. And they and veterans feel, like, val valued and supported when a medical professional just rips into somebody in a in a letter. But that's really, in my opinion, Leah's be Leah Bead's opinion, that is not helpful to you long run because adjudicators don't wanna see me sassing people. That's not that is, like, very, low quality." }, { "speaker": "Leah Bucholz", "startTime": "489.23", "endTime": "494.99002", "body": "We should be scientific and objective. Okay? Let the attorneys and the VSOs tear. K? Let them do that." }, { "speaker": "Leah Bucholz", "startTime": "494.99002", "endTime": "513.545", "body": "That's their job. It immediately discredit somebody when I start reading that emotional communication in a in a medical opinion. K? So, again, this is a very important point. Medical professionals and legal professionals serve very different roles in this process." }, { "speaker": "Leah Bucholz", "startTime": "514.05", "endTime": "525.57", "body": "Do I read opinions like that and and just sit here at my desk and say, what the f? You know, this is crazy. I can't believe I'm reading this. Of course. But we have to maintain that that professional scope in line." }, { "speaker": "Leah Bucholz", "startTime": "525.57", "endTime": "542.22003", "body": "K? As medical providers, our role is to analyze diagnoses, causation, aggravation, symptoms, that functional impact, the medical rationale. K? There are situations where the issue may be more legal than medical, of course. K?" }, { "speaker": "Leah Bucholz", "startTime": "542.78", "endTime": "574.83", "body": "For example, maybe VA failed to properly weigh favorable evidence that's already in the file. Maybe there are procedural issues. Maybe there are duty to assist concerns. Maybe the issue involves effective dates or legal interpretation of presumptive service connection. Those are situations where veterans should strongly consider you know, you don't have to, but you should strongly consider consulting an accredited attorney or a BSO or an accredited claims agent because the issue may be, beyond just medical analysis." }, { "speaker": "Leah Bucholz", "startTime": "575.55", "endTime": "587.31", "body": "Another misconception that I often see online is veterans believing that a long opinion automatically means a better opinion. Okay? Don't get me wrong. Sometimes we write 20 page opinions. K?" }, { "speaker": "Leah Bucholz", "startTime": "587.705", "endTime": "605.96", "body": "That's just not necessary all of the time. Right? I've seen very short opinions that were extremely fact filled, persuasive, and just great because they were medically logical, clear, and evidence based. K? I've seen very long opinions that contain very little actual medical reasoning and just were not that great." }, { "speaker": "Leah Bucholz", "startTime": "605.96", "endTime": "622.395", "body": "Length does not always equal quality. What matters is that substance. What matters is whether the provider clearly explains medical rationale and the medical basis for the opinion, and whether that rationale is supported by the evidence. And it's very fact based. Okay?" }, { "speaker": "Leah Bucholz", "startTime": "622.395", "endTime": "650.025", "body": "Finally, probably the most important thing veterans should understand regarding this topic is this, is that a private medical opinion is not about beating the VA. K? It's about providing competent, credible medical analysis that helps clarify the medical evidence within the claim. Sometimes VA the VA examiner's opinion will ultimately be more persuasive. Sometimes the private medical opinion will be more persuasive." }, { "speaker": "Leah Bucholz", "startTime": "650.025", "endTime": "678.625", "body": "And sometimes the truth is that additional development or clarification is still needed. So at the end of the day, the strongest claims are usually supported by organized record you know, things like organized records, consistent histories, credible medical evidence, and clear rationale, not hype, emotion, promises, all that drama. K? Because persuasive medical evidence is not built on who is louder. It's just not." }, { "speaker": "Leah Bucholz", "startTime": "678.625", "endTime": "696.76", "body": "It's built on who explains the medicine more clearly and more credibly, who is more tactical in their approach to really nailing that analysis. Okay? So I hope you guys enjoyed this. Please like and subscribe. I'm always so happy to see you guys, tuning in, and, thank you as always for your support." }, { "speaker": "Leah Bucholz", "startTime": "696.76", "endTime": "699.88", "body": "And please drop some comments if you have any questions. Alright. See y'all later." } ] }