The opinion explains why

A DBQ records findings. A medical opinion addresses the connection — why a condition is, or is not, related to service or to another service-connected disability. On most denied claims, this is the missing piece.

What makes one persuasive

Not the conclusion. The reasoning. An opinion that carries weight identifies the question, the relevant history and findings, which records were considered, any competing explanation that matters, and the path from those facts to the answer.

A favorable phrase with nothing behind it — a box ticked, a sentence asserting a relationship — leaves the adjudicator with nothing to weigh. It can be discounted without much difficulty, and frequently is.

Causation and aggravation are two questions

For a secondary claim, 38 C.F.R. §3.310 addresses both separately:

• (a) Causation — did the service-connected condition bring this one about?
• (b) Aggravation — did it worsen a condition that would otherwise exist?

An opinion answering only causation leaves aggravation open, and "A did not cause B" is not an answer about whether A worsened B.

An opinion that uses the same rationale for both has also not answered the second. That is what sent Atencio v. O'Rourke back: the examiner answered causation and aggravation in one merged paragraph, and the court said aggravation "is independent of direct causation" and must not be handled "in an almost slapdash manner by both examiners and the Board."

Aggravation also carries its own arithmetic: the regulation works from a baseline severity, established from medical evidence predating the aggravation or the earliest evidence showing when it began, and then deducts both that baseline and any worsening from the natural progress of the disease. An opinion that says only "it got worse" has not addressed what the rule asks.

Two limits on that arithmetic are worth knowing before an opinion gets written, because an examiner told the wrong standard will write to the wrong standard:

• The worsening does not have to be permanent. Ward v. Wilkie set aside Board instructions that told examiners it did.
• Worsening because a service-connected condition made treatment impossible is compensable. Spicer v. McDonough held §1110 covers "a worsening of functionality — whether through an inability to treat or a more direct, etiological cause," and that §3.310(b) is unlawful as inconsistent with §1110 to the extent it was used to reject that theory. The regulation still says otherwise on its face; it has not been amended.

What makes an opinion carry weight

Not the letterhead. Three precedential decisions say so, and they are the reason a short, well-reasoned letter can beat a confident one.

• Reasoning, not conclusion. Stefl v. Nicholson: an opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions," and "a mere conclusion by a medical doctor is insufficient."
• Your doctor is not second-class. Nieves-Rodriguez v. Peake: VA may not prefer its own examiner solely because that examiner read the claims file, nor discount yours solely because they did not. "Most of the probative value of a medical opinion comes from its reasoning." What matters is whether the clinician knew the facts that mattered — and treating you for years is one way of knowing them.
• Equivocal language costs you. Courts have repeatedly found opinions saying a link "could" exist, or is "certainly plausible," too speculative to carry weight. A clinician who is genuinely uncertain should say so; one who holds a view should state it in the terms the system uses.

What follows from all three: give the clinician the facts, and ask that the opinion recite the records and history it relies on. An opinion that shows its foundation can be weighed. One that does not, cannot.

There is no public Medical Opinion form, and that is not a barrier

VA lists a Medical Opinion DBQ among questionnaires it does not release publicly. That does not mean a qualified clinician cannot write a reasoned opinion — a letter or clinical statement in an appropriate format does the same work. Treating the absence of a form as a prohibition costs veterans the exact evidence these claims turn on.

Your part

Give an accurate history, including the parts that do not help you, and the records that let the clinician reason from something. Do not supply the conclusion. For which theory your own record actually supports, talk to an accredited representative.

Reviewed October 6, 2026