The purpose of this consultation is to discuss relevant medical history and determine what medical documentation may be required for further independent medical evaluation or opinion services.

An Independent Medical Examination is a comprehensive, objective evaluation performed by a qualified medical professional.
A focused in-office physical examination is conducted to assess the Veteran’s current medical condition. When clinically indicated, additional testing such as range-of-motion measurement using a goniometer, diagnostic imaging, pulmonary function testing, and EKG may be performed on site at the time of the examination.

Findings and conclusions are based on current medical evidence, clinical judgment, applicable VA standards, and are documented in the Disability Benefits Questionnaire (DBQ).

In depth review of medical records: Service Treatment Records, VA Medical Records, Private Medical Records related to the condition(s), Imaging Reports (X-ray, MRI, CT-reports only are acceptable), Prior VA rating decisions related to the condition (s).  

Common Toxic Exposure Risk Activity (TERA) Reviewed Include:

Vietnam (Agent Orange)

Gulfwar (BurnPits)

Camp Lejune Contaminated Water

Radiation Exposure

Asbestos

Deployment and Non Deployment Environmental Exposure

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An Independent Medical Opinion (IMO), commonly referred to as a Nexus Letter, requires a comprehensive and independent medical review. A Nexus opinion cannot be issued without first reviewing relevant medical records and, when clinically necessary, performing an independent medical examination.

A valid Nexus opinion must establish a medical connection between a diagnosed condition and military service. This requires both confirmation of the condition (through examination documented on DBQ) and medical reasoning supporting causation or aggravation.

Nexus letters written without an independent evaluation or records review lack medical foundation and frequently result in  denial. For this reason, Nexus opinions are only provided following appropriate examination and record review to ensure accuracy, objectivity, and medical defensibility.

Toxic Exposure Medical Opinions are independent medical evaluations addressing whether a diagnosed condition is related to documented toxic exposure risk activities during military service. These opinions are rendered in accordance with VA Toxic Exposure Risk Activity (TERA) guidelines and applicable PACT Act provisions.

Each opinion is based on a comprehensive review of service records, deployment history, exposure documentation, medical records, and current medical literature. When clinically necessary, an independent medical examination is performed to confirm diagnosis and assess severity.

The medical opinion evaluates the likelihood of a causal or contributory relationship between the claimed condition and identified toxic exposures, using accepted medical principles and VA standards. Conclusions are documented (through examination documented on DBQ).

Toxic exposure and complex Independent Medical Opinions require a higher level of medical analysis.
These opinions involve detailed review of service records, exposure history, medical literature, and risk assessment, and often require synthesis of multiple medical conditions, timelines, and potential contributing factors. Due to their complexity, these evaluations are more in-depth than standard medical opinions and require additional time, documentation review, and clinical judgment