Medical Evidence for Permanent & Total Disability

P&T Opinion Letter + Record Review

An independent medical record review focused on whether your service-connected condition or conditions are medically expected to remain permanent and continue causing total disability over time.

Comprehensive Record Review
Permanence Analysis
Qualified Medical Provider
Evidence-Based Opinion

Veteran meeting with a healthcare professional to review medical records

Important

A P&T medical opinion is only provided when supported by the reviewing provider’s independent professional judgment and the available medical evidence.

A Thorough, Evidence-Based Process

More Than Just a Letter

A strong P&T medical opinion begins with the evidence. The review focuses on the nature of your service-connected conditions, treatment history, prognosis, stability over time, and whether meaningful improvement is medically expected.

Submit Your Records

Provide relevant VA and private medical records, rating information, C&P examinations, DBQs, treatment history, and other available supporting documentation.

Professional Record Review

A qualified medical provider reviews the evidence to evaluate chronicity, severity, prognosis, treatment response, and the expected future course of your service-connected conditions.

Medical Opinion

When medically supported, the provider prepares a detailed opinion addressing whether the documented disabilities are reasonably expected to remain permanent and totally disabling.

Our Services

P&T Opinion Letter + Record Review

Our P&T Opinion Letter service begins with a comprehensive review of your service-connected conditions, medical history, treatment history, prior examinations, current severity, and available evidence regarding prognosis and expected improvement.

The purpose of the review is to determine whether the medical evidence supports an opinion that your service-connected condition or conditions are reasonably expected to remain permanent and continue causing total disability.

The initial Record Review is included as part of the service and helps ensure that any medical opinion provided is grounded in credible, documented evidence.

Your service includes:

Review of relevant VA and private medical records
Review of current service-connected conditions and ratings
Evaluation of treatment history and response to treatment
Review of prior C&P examinations and DBQs when available
Assessment of chronicity and stability over time
Evaluation of prognosis and likelihood of meaningful improvement
Independent determination of whether a P&T opinion is supportable
Detailed P&T medical opinion letter when medically appropriate
Evidence-based rationale explaining the provider’s conclusions
Relevant medical literature when applicable

Individualized Review

What the Provider Evaluates

P&T is not simply about having a 100% disability rating. The medical question is whether the service-connected disability picture is reasonably expected to remain permanent, with little or no meaningful improvement anticipated over time.

Chronicity

How long the condition has existed, whether symptoms have persisted, and whether the disability has remained significant despite treatment.

Stability Over Time

Whether examinations, treatment records, and medical findings show a stable or consistently severe disability picture over an extended period.

Treatment Response

Whether appropriate treatment has produced meaningful and sustained improvement, or whether significant limitations continue despite care.

Prognosis

The medically expected future course of the condition, including whether substantial improvement is reasonably anticipated.

Functional Impact

The ongoing effect of service-connected conditions on physical, mental, occupational, and everyday functioning.

Overall Disability Picture

How the service-connected conditions interact and whether the combined medical evidence supports a permanent total disability picture.

Medical provider reviewing Veteran medical records and disability documentation

Connecting the Evidence

Documenting Why Improvement Is Not Reasonably Expected

A current disability rating alone does not necessarily establish that a condition is permanent.

Medical evidence can help explain the long-term course of the condition, treatment response, stability of symptoms, objective findings, prognosis, and whether meaningful improvement is medically expected.

The provider’s role is to evaluate the available evidence and explain, when medically supportable, why the service-connected disability picture is expected to remain permanent.

Preparing for Your Review

Medical Evidence Supports the Request. VA Makes the Decision.

Valor Health’s role is limited to providing an independent medical record review and, when medically supported, a professional medical opinion regarding permanence and the expected future course of service-connected conditions.

Clinical Independence

The reviewing provider does not determine whether VA will assign or recognize Permanent & Total status and does not make a legal determination regarding entitlement to VA benefits.

Every medical opinion is based on the provider’s independent professional judgment and the evidence available for review.

A P&T opinion is issued only when the medical record supports the conclusion that the relevant service-connected disability picture is reasonably expected to remain permanent.

Clinical Integrity

Important Disclaimer

This service provides an independent medical record review and, when medically supported, a professional medical opinion addressing whether the Veteran’s service-connected condition or conditions are reasonably expected to remain permanent and continue causing total disability.

Valor Health does not provide legal advice, representation before the Department of Veterans Affairs, or assistance preparing or filing a claim for VA benefits.

A medical opinion does not guarantee Permanent & Total status, an increased disability evaluation, protection from future examinations, or any other VA benefit. The U.S. Department of Veterans Affairs makes all decisions regarding disability ratings, permanence, total disability, eligibility, and entitlement to benefits.

Medical conclusions are based solely on the records reviewed, the available clinical evidence, and the independent professional judgment of the reviewing provider.

If, after the record review, the reviewing provider determines that the available evidence does not support a P&T medical opinion letter, the paid service fee will be refunded less a $299 record review and administrative fee.