b. Definition: Credibility Credibility is a blanket term for the fact finding of whether evidence is believable or not believable. Except in the case of claims to reopen, there is generally not a formal presumption of credibility. However, as a matter of policy, VA decision makers should accept evidence at face value unless called into question by other evidence of record or sound medical or legal principles. VA decision makers are expected to make credibility determinations when credibility is raised by the evidence available. Factors to consider in making a fact finding of credibility include facial plausibility consistency with other evidence submitted internal consistency demeanor of a witness (who is offering in person testimonial evidence), and interest/bias. Example: Veteran submits a statement as part of his claim for service connection that he injured his low back in the Air Force while loading cargo onto a C-130 aircraft during an exercise in July 2002. Personnel records reveal the Veteran served in the Air Force as a loadmaster and participated in a military exercise in the Philippines in July 2002. Analysis: The Veteran’s statement, when viewed along with the evidence of record, appears believable. Therefore, the statement is credible. Example: Veteran submits a statement along with his claim indicating he injured his low back during multiple parachute jumps in the Army from 1980 through 1983. Personnel records reveal Veteran’s occupation during service was “clerk.” There were no records indicating that the Veteran was involved in parachuting operations. Analysis: The Veteran’s statement, when viewed with other evidence, is not believable. Therefore, the statement is not credible. Reference: For more information on findings of credibility, see 7 Vet.App. 508 (1995). c. Definition: Competent Evidence Competent evidence refers generally to evidence offered from a qualified source. A determination of evidentiary competency involves analysis of whether a person offering evidence is qualified to establish a matter. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings
a. Treating Physician’s Treatment Background and Probative Value VA does not apply the “treating physician rule,” whereby the evidence of a treating physician is generally entitled to more weight than evaluations made by consulting physicians or expert witnesses. However, a treating physician’s familiarity with the history of a disability may increase the probative value of any medical evidence/opinion. Reference: For more information on determining a physician’s expertise and experience, see , 10 Vet.App. 279 (1997). b. Definitions: Types of Medical Assessments The main types of medical assessments for VA purposes are diagnoses, opinions, examination, and history. Diagnoses are medical assessments made typically to identify injury or disease. They are typically the end result of an examination and involve the application of the physician or examiner’s knowledge, experience, and judgment to a set of facts. Opinions are medical assessments on questions such as etiology or onset. They may or may not be accompanied by a contemporaneous examination. However, like an examination, opinions involve the application of the examiner’s knowledge, experience, and judgment to a set of facts. An examination for VA purposes involves the collection of relevant medical facts (history, clinical observations, or measurements and potentially lab testing) by a medical professional. History is a verbal recounting or written record of relevant life events, habits, routine, symptoms, and/or treatment. It most often comes from the patient’s oral report and/or review of medical records. Other materials could also be relevant to a physician’s or examiner’s understanding of relevant medical or psychological history. c. Medical Assessments – History and Policy Applications A key evidentiary concern in many VA claims is evaluating the probative value and weight of a diagnosis or opinion that relies upon a claimant’s history. The claimant’s self-interest in the outcome of a medical assessment and his or her ability to recollect facts over time both raise concerns about whether history is accurate and, therefore, whether medical assessments are valid. However, as a general principle, unless the historical facts upon which a medical conclusion is based are dubious or untenable, the medical conclusion should be accepted as credible. The probative value of this medical evidence may be considered and weighed relative to other evidence of record. In most cases, medical diagnoses and opinions are based to some degree on history provided by the patient or examinee. Medical assessments based on
e. Basis for Rejecting Medical Evidence The RSVR may not rely upon his/her own unsubstantiated medical conclusions to reject expert medical evidence provided by the claimant. Reference: For more information on the basis for rejecting medical evidence, see , 8 Vet.App. 218 (1995), and , Vet.App. 175 (1991). f. Supporting Medical Conclusions With Evidence in the Claims Folder Support medical conclusions with evidence in the claims folder. Cite medical information and reasoning to link or separate two disabilities, or establish or refute prior inception or aggravation. Note: If evidence such as medical treatises or independent medical opinions were relied upon when the rating decision was made, explain this in the rating decision. g. Considering FPOW Protocol Examination Reports Carefully consider former prisoner of war (FPOW) protocol examination reports because they may provide sufficient background information to relate the Veteran’s current symptomatology to the FPOW experience. h. Evaluating STRs Service treatment records (STRs) are generally highly probative, but not necessarily determinative, in the resolution of service connection. A current disability and, in some cases, a nexus between the current disability and an injury or disease shown in service will be required to award service connection. i. Statements From Physicians as Acceptable Evidence for Rating Purposes Without Further Examination A statement from any physician can be accepted for rating purposes without further examination if it is otherwise sufficient for rating purposes, and includes clinical manifestations and substantiation of diagnosis by findings of diagnostic techniques generally accepted by medical authorities. Examples: Diagnostic techniques generally accepted by medical authorities include pathological studies x-rays, and appropriate laboratory tests. j. Considering Information in The information in the claims folder must support the medical conclusions.