The attorney defines the assignment. The physician owns the medical conclusion. Feedback improves completeness; it does not purchase a result.
1. Optional preliminary screen
A firm can ask a narrow consulting question before ordering a signed opinion: does this theory appear medically supportable, is another explanation stronger, is important development missing, or does the question belong with a specialist? Screening is useful when counsel wants to avoid spending money on a full opinion before the medical problem is clear.
2. Assignment and scope
For a formal review, counsel identifies the condition, the medical question, the relevant theory or theories, and any specific issues that must be addressed. The assignment can involve nexus, secondary causation, aggravation, C&P reasoning, severity, functional loss, work capacity, or a broader forensic reconstruction of the medical record.
The goal is not to tell the physician what answer to reach. It is to make sure the physician knows exactly what question counsel needs answered.
3. Secure transfer and complete record review
Records are exchanged after professional contact using an agreed secure method, ordinarily PageAI or Dropbox unless firm policy requires something else. The public website and ordinary email are not used for C-files or protected health information.
Dr. Townsend then reviews the complete available material relevant to the assignment, reconstructs the timeline, returns to original sources when summaries conflict, tests the proposed mechanism, and weighs the strongest contrary evidence and competing causes.
4. Clarification or development when the record leaves a real gap
If a material fact can reasonably be supplied by the Veteran, a focused clarification call may be appropriate. If the missing piece is diagnostic testing, a specialty examination, an unavailable source record, or another form of development, the physician identifies that limit instead of speculating past it.
5. Draft medical analysis
The draft addresses the assignment in plain language, identifies the controlling chronology, explains the medical mechanism when one is supported, deals with contrary evidence, and states the physician's best-supported conclusion. A defensible answer may be favorable, unfavorable, mixed, or unresolved.
6. Counsel review and feedback
Counsel reviews the draft for the things counsel is uniquely positioned to catch: an assignment question that was not answered, a factual mistake, a missing record, an overlooked adjudicative issue that changes the medical question, or wording that is unclear to the intended reader.
Counsel may also send additional evidence. The physician then decides whether the new information changes the reasoning or conclusion.
7. Physician revision and final opinion
Dr. Townsend independently evaluates the feedback, revises the report where medically warranted, rechecks the important source support and causal links, and approves the final signed opinion. The physician remains accountable for the final medical judgment.
8. Recurring and batch assignments
Single cases and recurring work can be coordinated with attorneys, paralegals, or case managers. Capacity, expected turnaround, and fee terms are confirmed before the assignment begins. Large or multi-condition files are scoped according to the work actually required rather than forced into a one-size-fits-all process.
Where the process should stop
Some files are not ready for an opinion. Some need a specialist. Some contain a stronger competing explanation than the theory counsel initially proposed. The workflow is designed to surface those issues early enough to be useful rather than hide them inside a signed report.