Why Is a C&P Exam Important to Your VA Disability claim?
A Compensation and Pension exam can be the difference between an award and a denial. It can mean the difference between a 10% rating and a 60% or greater rating. It is a final discovery and assessment of evidence proving you are disabled due to your military service. In this light, the C&P exam is of the utmost importance.
Not all, but most claims for disability compensation will require a C&P medical exam.
Getting Ready for Your C&P Exam
The medical exam is part of the VA’s duty to assist you as a veteran. Because the C&P exam has weight, we cannot stress enough the importance of preparing for it ahead of time. Take a moment and read the 6 essential steps you can take to prepare for the C&P exam.
Either a VA doctor or a contracted non-VA doctor will do the examination. You can also have your own doctor examine you and fill out the appropriate Disability Benefits Questionnaire (DBQ) forms.
These medical reports, along with your service medical records and other lay evidence, are used by VA to decide your eligibility for benefits and the level of compensation.
Without question, the best approach is to file a VA disability claim that is fully developed and try to avoid the need for any further exam.
What’s the VA Looking For?
To quality for disability compensation, every veteran’s claim must eventually give the VA competent evidence supporting:
- Current Diagnosis. No diagnosis, no service connection.
- Service connection. Your claimed disability was caused or made worse by your military service.
- Proof of nexus (evidence of the link tying your disability to your service). A common source is your doctor’s nexus statement or nexus letter stating that your disabling condition is “as least as likely as not” connected to military service.
When Is a C&P Required?
The initial claim review is handled by the Rating Veterans Service Representative (RVSR). If any of these components are not part of your claim file during review or are lacking in some way, the RVSR will request one or more C&P exams.
Whereas a fairly straightforward condition would call for a general physician, more specialized conditions necessitate physicians with proper advanced medical training to perform the exam.
If you are claiming more than one disabling condition, the VA may ask that you attend multiple exams specifically for those impairments.
In summary, the VA relies on the C&P exam to resolve any of the following:
- diagnose a condition;
- substantiate if your disability is service connected/establish medical nexus;
- furnish the VA rater additional medical information about your disability for rating purposes.
Can I Get a VA Rating without a C&P Exam?
Yes, you can. A C&P is not required in every case. For the sake of cost containment, VA has specific guidelines in place to determine if an exam is really needed.
As mentioned, if your initial application for benefits contains all of the required medical and lay evidence for a favorable decision and rating, the VA will likely rate your claim without a C&P.
What Can I Expect in the C&P Exam?
The doctor must keep the exam within the bounds as stated in the C&P order requested by either the Veterans Benefits Administration (VBA) or the Board of Veterans’ Appeals (BVA). This may include specific remarks, questions, directions, or requested opinions regarding your claimed disability, which the doctor must follow.
Expect and prepare for questions the examining doctor will ask. These questions are all part of the DBQ forms and are sorted by condition (i.e. Amputations, PTSD, Diabetes Mellitus, Sleep Apnea).
The examples below offer a simplified picture of various VA C&P scenarios:
Example 1: You have diagnosed knee instability and knee joint ankyloses. The C&P examiner is only asked to assess the degree of joint function.
For this examination, the doctor does not need your entire medical records; instead, the doctor is asked only to examine the joint for limitation of motion, weakness, tissue abnormalities and other physical findings, and record those findings for comparison to the norm. You want to be prepared to tell the examiner exactly how that particular impairment is affecting your day to day life.
Example 2: There is no letter of nexus in your file. So VA needs to determine whether your disability is service connected.
In this case, the C&P’s orders would ask the examiner to give an opinion as to whether a condition is related to a specific incident during military service. This would require a thorough review of your records: medical evidence, buddy statements, inconsistencies or gaps in the record, and other data in your claim file.
The examining doctor will then write an opinion stating whether the veteran’s disability can or cannot be linked to military service. The opinion should be stated in this manner:
- “is due to” (100% sure)
- “more likely than not” (greater than 50%)
- “at least as likely as not” (equal to or greater than 50%)
- “not at least as likely as not” (less than 50%)
- “is not due to” (0%)
Example 3: You have been denied VA benefits for PTSD and have appealed the denial. Now your disability appeal is remanded by the Board of Veterans Appeals (BVA).
In this case, the problem is that no definite diagnosis has been given. Your civilian doctor has diagnosed PTSD, yet the VA’s C&P examining doctor did not arrive at the same diagnosis. The BVA has requested an additional C&P exam to address this specifically, wherein the C&P examiner is asked to review your claims folder and any BVA remand instructions carefully before examining you. All instructions and findings must be explicitly spelled out in the written summary report.
What Authority Do C&P Examiners Have?
C&P examiners do not make the final determination of “disabled.” But clearly, their opinions and findings play a major role in the VA’s final determination of disability, and the degree of disability.
Examiners have the power to agree that, yes, your condition is just like you claim it is. For example, the VA’s doctor finds that your spinal impairment is connected to your military service, and provides critical medical information about the level of disability for rating purposes. That medical statement will go a long way toward an award of disability benefits and the appropriate entitlement, including possible total disability based on unemployability.
Likewise, VA examiners’ findings can work against you. Suppose the examiner concludes there are no occupational factors associated with your service duties that were more likely than not to cause the development of your disabling condition. This, of course, can be a devastating blow to your claim.
Veterans Benefits Lawyers Fighting for You
When dealing with the VA, it can seem next to impossible to keep track of the VA red tape and evidence required to obtain the VA rating you deserve.
C&P exams are part of the VA’s duty to assist. Even so, as veterans’ attorneys we review countless adverse decisions based on inadequate VA exams. They can be deficient for various reasons, the front runners being:
- Decisions are based upon incorrect facts
- Examiner was not qualified to evaluate the condition
- Examiner inadequately portrayed or ignored the condition’s symptoms and characteristics
- No distinct medical decision or opinion supported by evidence
- Findings are not based on sound clinical judgment
We are veterans′ claim lawyers who proudly assist U.S. military men and women in their fight for benefits.
If you are a veteran whose claim for disability compensation was denied or underrated, don’t give up. If you need an advocate to fight for your rights, contact us today to set up a free consultation.
To learn more about the process, download our free Veterans Disability eBook.