What Goes into a Dr. Howard IMO
The VA is not obligated to accept a medical opinion just because it exists. To carry weight, an opinion has to be thorough, well-reasoned, and grounded in the evidence. It also has to come from someone whose credentials are hard to dismiss.
Here is how Dr. Howard builds each opinion, from the first review of records to the final written report.
A Full Records Review
Every opinion starts with a careful review of the available record. That typically includes:
- Service records, including personnel file, deployment history, and documented incidents or injuries
- Military Occupational Specialty and unit history where relevant to the stressor
- VA treatment records and prior C&P examination reports
- Private mental health and medical treatment records
- Prior rating decisions and VA correspondence
- Statements in support of claim from the veteran or supporting witnesses
Dr. Howard does not issue opinions from an incomplete record. If something is missing that matters, that gets addressed before the evaluation moves forward.
The Clinical Interview
After reviewing the records, Dr. Howard conducts a structured clinical interview with the veteran. This is a forensic evaluation, not a routine intake. The interview covers:
- Military history, deployment experiences, and identified stressors in depth
- Current symptoms across all relevant diagnostic areas
- How symptoms affect work, relationships, daily activities, and self-care
- Secondary conditions that may warrant separate documentation
- The timeline of symptom onset relative to service
Diagnosis Under DSM-5 Standards
Every diagnosis in a Dr. Howard opinion is based on the DSM-5, the diagnostic standard the VA uses. The report documents which criteria are met so the VA cannot challenge the diagnostic foundation of the opinion.
Where it matters, Dr. Howard also addresses:
- Differential diagnosis, such as distinguishing PTSD from Adjustment Disorder or separating PTSD from TBI-related changes
- Co-occurring conditions that warrant separate documentation
- Alternative explanations that the evidence rules out
The Nexus Opinion
The heart of any IMO or nexus letter is the medical opinion itself. Dr. Howard’s opinions are written to meet the VA’s legal standard: that the condition is “at least as likely as not” related to military service.
That conclusion is supported by:
- A summary of the clinical findings from the records review and interview
- Reference to relevant medical and psychological literature where it applies
- A clear explanation of the reasoning behind the conclusion
- Explicit use of the legally recognized standard of proof
Where it applies, Dr. Howard also addresses secondary service connection, aggravation of pre-existing conditions, and continuity of symptomatology.
Functional Assessment
A diagnosis alone does not determine a rating. What matters is how the condition actually affects the veteran’s ability to work and function. Dr. Howard’s evaluations include a detailed functional assessment covering:
- Work performance: attendance, reliability, concentration, task completion, ability to handle stress and supervision
- Social functioning: relationships, withdrawal, family conflict, and community participation
- Daily living: self-care, household management, finances, and independent functioning
- Symptom pattern: frequency, severity, and how functioning looks on both average days and the worst days
This assessment maps directly onto the VA’s General Rating Formula for Mental Disorders, giving the rating authority a clear picture of what an accurate rating should reflect.
What You Receive
Each completed opinion includes:
- A formal written report on professional letterhead, signed by Dr. Howard
- A nexus opinion section stating the medical conclusion in VA-recognized language
- DSM-5 diagnoses with supporting criteria
- A functional assessment documenting occupational and social impairment
- A summary of all records reviewed
- Dr. Howard’s current curriculum vitae for submission alongside the opinion
Reports are written to be understood by rating officers, VSO representatives, attorneys, and the Board of Veterans’ Appeals. No unnecessary jargon. No ambiguity about what the opinion says.
Turnaround
Completed opinions are delivered within 10 business days of receiving all records and finishing the evaluation. If your case has a hard deadline, contact the office to discuss whether a faster turnaround is possible.
Questions Before You Refer?
If you want to talk through a case before committing to a referral, that is a normal part of the process. Call or email the office and Dr. Howard or his staff will be glad to help you figure out the right next step for your client.