Source: https://veteranclaims.net/2009/03/14/criteria-for-expert-witness/
Timestamp: 2019-04-25 13:01:27+00:00

Document:
(holding that the Board may reject a medical opinion that is based on facts provided by the veteran that have previously been found to be inaccurate); Swann v. Brown, 5 Vet.App. 229, 233 (1993)(same); Wilson v. Derwinski, 2 Vet.App. 614, 618 (1992) (stating that the Board must evaluate the credibility and weight of the history upon which a medical opinion is predicated).
Both VA medical examiners and private physicians offering medical opinions in veterans benefits cases are nothing more or less than expert witnesses. While the Federal Rules of Evidence are not binding in this Court, nor on the Board, the rules on expert witness testimony provide useful guidance that has been exhaustively vetted by both the Rules Advisory Committee and by the U.S. Congress. In U.S. district courts, expert testimony may be received from a suitably qualified expert under the following conditions: (1) The testimony is based upon sufficient facts or data; (2) the testimony is the product of reliable principles and methods; and (3) the expert witness has applied the principles and methods reliably to the facts of the case. See FED. R. EVID. 702. The Court agrees that these are important, guiding factors to be used by the Board in evaluating the probative value of medical opinion evidence, and that this Court’s review of the Board’s evaluation of competing medical opinions will be enhanced by their application. Notwithstanding that medical professionals offering medical opinions in veterans benefits cases do not typically testify subject to crossexamination, the Court believes that these criteria are important indicators of the probity of medical opinions. Therefore, where the Board favors one medical opinion over another, the Court will review the Board’s decision to determine whether these criteria have been met or properly applied.
It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion.
Therefore, a private medical opinion may not be discounted solely because the opining physician did not review the claims file. Likewise, the Court holds that the Board may not prefer a VA medical opinion over a private medical opinion solely because the VA examiner reviewed the claims file.
That the medical expert is suitably qualified and sufficiently informed are threshold considerations; most of the probative value of a medical opinion comes from its reasoning. Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a serviceconnection or rating context if it contains only data and conclusions. See Stefl, 21 Vet.App. at 125(holding that “a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor’s opinion”); Miller v. West, 11 Vet.App. 345, 348 (1998) (“A bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record.”); see also Dennis v. Nicholson, 21 Vet.App. 18, 22 (2007)(“The Court has long held that merely listing evidence before stating a conclusion does not constitute an adequate statement of reasons and bases.” (citing Abernathy v. Principi, 3 Vet.App. 461, 465(1992))); but see McLendon, supra, (holding that a conclusory opinion may furnish enough evidence of current disability or medical nexus so as to call for a VA medical examination).
Guillain-Barre syndrome: acute idiopathic polyneuritis; 1 idiopathic: of unknown cause or spontaneous origin; polyneuritis: inflammation of several peripheral nerves at once. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 803, 905, 1482 (30th ed. 2003).
Mark R. Lippman, of La Jolla, California, was on the brief for the appellant.
Paul J. Hutter, General Counsel; R. Randall Campbell, Assistant General Counsel; Joan E. Moriarty, Deputy Assistant General Counsel; and Savitri D. Persaud, Appellate Attorney, all of Washington, D.C., were on the brief for the appellee.
Before HAGEL, DAVIS, and SCHOELEN, Judges.
matter for readjudication consistent with this decision.
appeal with respect to this issue abandoned. See Ford v. Gober, 10 Vet.App. 531, 535 (1997).
relies, and argues for affirmance of the Board decision.
The appellant served on active duty in the U.S. Army from November 1954 to October 1956.
syndrome. The appellant perfected an appeal of the November 1998 rating decision in June 2000.
Major Depression, secondary to Guill[ain-] Barre condition.” Record (R.) at 305. In July 2000, Dr.
of his physical ailment service[-]con[n]ected condition.” R. at 452.
Dr. Juarbe Ortiz replied that he had not.
The appellant underwent VA psychiatric examinations in December 2000 and April 2004.
dysthymic disorder, and sequelae of service-connected Guillain-Barre syndrome.
the Board gave for discounting the evidence in the medical opinions from Dr. Pellot Moran and Dr.
specific duty is not at issue in this case. See 38 U.S.C. § 5103A(b), (c).
in[-]depth claims file review as are the assessments of the VA psychiatrist.” R. at 9.
to assist a claimant in obtaining evidence necessary to substantiate the claimant’s claim.” 38 U.S.C.
decide how much development is necessary. See Shoffner v. Principi, 16 Vet.App. 208, 213 (2002).
such an examination or opinion is necessary to make a decision on the claim,” 38 U.S.C.
the examinations was to develop negative evidence, in violation of Mariano v. Principi, 17 Vet.App.
development reasonably could be construed as obtaining additional evidence for that purpose.”).
appellant’s claim. In short, VA fulfilled its duty to assist.
raised or briefed to the Court.
should offer to furnish the claims file to that physician in order to render a more complete opinion.
In the appellant’s view, this offer should be made before any merits determination.
The appellant cites Watai v. Brown, 9 Vet.App. 441, 444 (1996), in support of his argument.
of the claims file, but incompletely reviewed it.
evidence received by VA may require an appropriate response, consistent with the duty to assist.
necessary in the particular case to render a thorough opinion.
We next turn to the question whether the Board erred in discounting the opinions of Dr.
opinions or examination reports is more probative of the medical question at issue.
a veteran’s claim or appeal.” Understanding the Appeal Process (VA Pamphlet 01-95-1) at 27 (Apr. 1995).
necessarily reduces the probative value of a medical opinion submitted on behalf of a claimant.
the report or opinion is fully cognizant of the claimant’s past medical history.
632 (1992) (“The [VA] examiner should have the veteran’s full claims file available for review.”).
Board decisions disposing of earlier claims.
familiar with the claimant’s extensive medical history).
The claimant may submit his own medical evidence from private physicians. 38 U.S.C.
review the Board’s decision to determine whether these criteria have been met or properly applied.
medical literature may also furnish information relevant to diagnostic and nexus issues.
medical history, is of primary concern).
never imposed a burden of claims file review on all private physicians furnishing medical evidence.
entitled to probative weight because the examiner did not have the veteran’s claims file to review).
that the Board will defer action on an appeal pending such a request. See 38 C.F.R. §§ 1.577; 20.1200 (2008).
assist in a direction that seems to countenance, and even institutionalize, such practices.
examination. Many times those facts can be found in the information contained in the claims file.
the medical expert who considers them and detract from the medical opinions of experts who do not.
considerations; most of the probative value of a medical opinion comes from its reasoning. Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a serviceconnection or rating context if it contains only data and conclusions. See Stefl, 21 Vet.App. at 125(holding that “a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor’s opinion”); Miller v. West, 11 Vet.App.
(1992))); but see McLendon, supra, (holding that a conclusory opinion may furnish enough evidence of current disability or medical nexus so as to call for a VA medical examination).
reasoned analysis required in a medical opinion. It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion. The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion. See Stefl, supra. These significant facts may or may not include matters evident from a review of the claims file, given the nature of the issue under consideration.
records. Her opinion is persuasive and supported by the medical evidence.
some 39 years after separation from service, and after a productive working life. See Maxon v.
after service can be considered as a factor in determining a service-connection claim).
opinion in accordance with the procedures set forth in this decision.
with Kutscherousky v. West, 12 Vet.App. 369, 372-73 (1999) (per curiam order). See Kay v.
entail a critical examination of the justification for the decision.” Fletcher v. Derwinski, 1 Vet.App.
394, 397 (1991). In addition, the Board shall proceed expeditiously, in accordance with 38 U.S.C.
§ 7112 (expedited treatment of remanded claims).
readjudication consistent with this decision.

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