What To Expect at a Compensation and Pension (C&P) Exam for Anxiety and Depression

CCK Law: Our Vital Role in Veterans Law

Mental health disorders are common among military veterans, with some studies claiming as many as 16 percent of service members deployed to Iraq and Afghanistan have been affected by post-traumatic stress disorder (PTSD) and depression. Unfortunately, many veterans are not sure how best to pursue VA benefits for these serious disabilities.

If you are a veteran suffering from anxiety or depression related to your military service, you may be wondering how to prepare for a Compensation and Pension (C&P) exam for these conditions. This article will guide you through what a C&P exam for anxiety and depression looks like, so you can feel ready on the day of the exam.

Key points of this article include:

• C&P exams are a critical part of the disability claims process, as they help VA determine both the severity of a veteran’s disability and whether that disability is service connected.
• When it comes to C&P exams for anxiety and depression, the Disability Benefits Questionnaire (DBQ) will likely play a significant role. DBQs help to organize and standardize certain C&P exams, allowing them to proceed more smoothly.
• If a C&P exam goes unfavorably for a veteran, they have the right to submit evidence of their own to counter the exam’s findings, potentially leading to a more positive outcome.

What Are Depression and Anxiety?

Depression is a serious mental health condition that affects the way someone thinks, feels, and acts. Symptoms of depression tend to vary from person to person; however, common symptoms include the following:

• Persistent feelings of sadness, worthlessness, and hopelessness
• Lack of motivation or interest in activities that usually derive pleasure
• Difficulty sleeping and concentrating
• Change in appetite resulting in weight loss or weight gain
• Irritability
• Decreased energy/fatigue
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Anxiety is a mental disorder characterized by ongoing feelings of worry, fear, or unease that are intense, disproportionate, and difficult to control in everyday situations. People with anxiety disorders may experience a range of common symptoms, such as the following:

• Feelings of restlessness or tension
• Difficulty concentrating
• Having a sense of impending danger or panic
• Avoidance of situations that trigger anxiety
• Increased heart rate
• Chest pain or tightness

What Are Compensation and Pension Examinations?

Compensation and Pension (C&P) exams are medical exams ordered by VA to evaluate the conditions that a veteran is claiming for disability compensation. Typically, either a VA medical professional or a third-party medical professional contracted by VA will conduct the exam.

C&P exams are often crucial to the disability claims process, as they help determine both the seriousness of a veteran’s disability, and whether that disability is service connected.

“It is important to know what is being evaluated at your C&P exam for depression,” says one accredited claims agent with CCK Law. “Some questions you may want to ask are: Is the examiner attempting to determine the etiology — or cause — of your depression in order to establish service connection? Or are they helping to establish the severity of your depression in order to determine your rating? It’s also possible that it’s a combination of the two, as well.”

The results of a C&P exam for anxiety and depression will go a long way toward determining a veteran’s overall disability rating and the compensation they will receive.

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What To Expect at a C&P Exam for Anxiety and Depression

While a C&P exam for anxiety and depression can take several different forms, veterans can generally expect the following steps in the process to take place:

• Before the C&P exam, the VA examiner should review the veteran’s entire claims file and look for evidence related to the condition. Once the veteran arrives, then the exam itself will begin.
• During the exam, one of the first things the examiner will do is confirm the veteran’s diagnosis of anxiety, depression, or both. They will likely do this by asking questions that determine how the veteran’s symptoms align with the criteria for either of these mental disorders.
• After confirming the disorder, the examiner may then ask the veteran questions about their medical history to determine whether their mental conditions are service connected. If they determine the condition is service connected, their medical opinion could potentially be used as a nexus opinion.
• The examiner will also ask the veteran how seriously their symptoms affect them on a day-to-day basis, in order to assess the severity of the veteran’s mental disorder, which will be important for the final disability rating.
• Throughout the exam, the examiner will likely take notes in a document called the Disability Benefits Questionnaire, or DBQ. The DBQ is intended to standardize certain aspects of C&P exams to ensure the exams run accurately and smoothly.
• After the exam, the examiner will pass the results along to VA, and depending on the conclusions they come to, the exam will likely play a key role in how much disability compensation the veteran receives.

Further details about each of these steps can be found in the sections below.

How Does VA Diagnose Anxiety and Depression During a C&P Exam?

Generally speaking, VA uses criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) to evaluate whether there is a valid diagnosis of depression or anxiety.

The DSM-5-TR criteria for Major Depressive Disorder, the most common type of depressive disorder, involves the following:

Five (or more) of the following symptoms must be present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

• Depressed mood most of the day, nearly every day
• Anhedonia (i.e., loss of pleasure), nearly every day
• Significant weight loss, or decrease in appetite nearly every day
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day
• Feelings of loss of energy nearly every day
• Feelings of worthlessness or excessiveness nearly every day
• Diminished ability to think or concentrate nearly every day
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The depression is not attributable to the physiological effects of a substance or to another medical condition.

On the other hand, the DSM-5-TR criteria for Generalized Anxiety Disorder (GAD) include:

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
• The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past six months).
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
• The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Assuming a veteran meets all of the criteria from the DSM-5-TR necessary for a diagnosis of depression or anxiety, the VA examiner will note their symptoms down in the corresponding section of the Disability Benefits Questionnaire (DBQ) to help determine their disability rating.

What Is the VA Anxiety and Depression Disability Benefits Questionnaire (DBQ)?

During a C&P exam, VA medical examiners will often complete a Disability Benefits Questionnaire (DBQ). This is a medical document that can be used to organize observations, notes, symptoms, and other aspects of a veteran’s disability.

“Most of the time the examination will be following a Disability Benefits Questionnaire, also called a DBQ,” says Michelle DeTore, supervising agent at CCK Law. “The DBQ contains check boxes for certain symptoms of depression and is used to standardize language to evaluate the disability in accordance with its rating criteria, resulting in a faster review of the condition.”

There is a specific DBQ that pertains to mental conditions called the Mental Disorders DBQ, which covers many of the questions asked in C&P exams for depression and anxiety. This contains several important sections, including:

Occupational and Social Impairment

One central concept the anxiety and depression DBQ addresses is the veteran’s overall level of social and occupational impairment, seeing it as a critical part of the diagnostic criteria. Here, the level of impairment due to depression or anxiety ranges from no diagnosis to total occupational and social impairment, with various levels in between.

Some questions that the examiner might ask to cover this section of the DBQ include:

• How does your disorder affect your ability to work? Does it prevent you from working?
• Does your anxiety or depression affect your ability to establish or maintain relationships?
• Have any past medications worked to counteract your social or occupational impairment?

Medical History

Medical history is crucial for the VA examiner to determine how long a veteran has suffered from their condition and whether that condition could be connected to their military service.

For this section of the anxiety and depression DBQ, the examiner may ask questions like:

• How long have you suffered from anxiety and depression? Has it become worse over time?
• Do any of your family members also suffer from anxiety and depression?
• What was your mental health like before entering into military service? Was there a particular event or period of time that you believe contributed to your current disorder?

Symptom Checklist

The symptom checklist of the DBQ provides a reliable way for examiners to confirm a veteran’s diagnosis, as well as make note of the severity of their symptoms. Some DBQ questions asked in a C&P exam for depression to gauge a veteran’s symptoms include:

• Have you lost interest in activities you previously found pleasurable?
• How many hours of sleep do you get each night? Do you awaken well rested?
• Do you have trouble controlling how much you worry?
• How easy or difficult is it to concentrate on a task you have at hand?

Behavioral Observations

It is important for veterans to be aware that their behavior before, during, and after their C&P exam is likely to be noticed by their VA examiner and potentially other staff at the exam location. The examiner may even take notes of any behavior they find relevant to the veteran’s condition in the Behavioral Observations section of the DBQ.

Some questions examiners may ask veterans about their behavior and appearance could be:

• Are you feeling fatigued or tired today?
• Have you often found yourself irritable or impatient with others, lately?
• Does your disorder at all affect your ability to groom or bathe yourself?

Competency

The Mental Disorder DBQ also has a section on competency, which is the veteran’s apparent mental capacity and ability to handle their own financial affairs. The examiner may make note of the veteran’s overall competency, since it is possible for certain disorders to present so severely that the veteran could be deemed mentally incompetent.

If an examiner has concerns about a veteran’s mental competence, they may ask questions like:

• Do you know what day of the week it is?
• Who is the current president?
• Can you count backward from 50 for me?

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How VA Assigns Disability Ratings for Anxiety and Depression

After the C&P exam is complete, VA adjudicators will review it along with all of the other evidence in the veteran’s claims file. Specifically, VA rates depression under 38 CFR § 4.130, Diagnostic Code 9434, and anxiety under various potential codes, including DCs 9400, 9403, and 9410.

Though depression and anxiety are distinct conditions, VA rates them using the same General Rating Formula for Mental Disorders. Under this rating formula, veterans may receive an anxiety and depression disability rating ranging from 0 to 100 percent, using the following criteria:

• 100 percent–Total occupational and social impairment
• 70 percent–Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood
• 50 percent–Occupational and social impairment with reduced reliability and productivity
• 30 percent–Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal)
• 10 percent–Occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication
• 0 percent–A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication

It is important to note that mental disorders like anxiety or depression can sometimes be caused or worsened by a separate, already service-connected condition. In situations like this, it is possible to have these disorders rated on a secondary basis.

What To Do After an Unfavorable C&P Exam

If a veteran receives an unfavorable C&P exam, they have the option to submit evidence and arguments to counter such findings.

Specifically, veterans may obtain a private medical opinion assessing the etiology and/or severity of their depression. Additionally, veterans can submit lay statements outlining the onset and progression of their psychiatric symptoms along with an argument explaining why the C&P examination was inadequate.

If the veteran argues successfully, there is a chance VA will overturn the results of the C&P exam and order a new one to be conducted.

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Tips for Attending a C&P Exam for Anxiety and Depression

The following are important tips for veterans to keep in mind in order to get as much as possible out of their C&P exam:

• Always attend your C&P examination–Missing your exam might result in your claim being automatically denied.
• Do not hide or downplay your symptoms–Be honest and upfront about your condition. Talk about how your symptoms affect you on a daily basis, as well as the impact they have on your worst days.
• Consider taking someone with you for the exam–The presence of a friend, family member, or other loved one can provide both emotional support and potential testimony as to the severity of your condition. If you do this, however, you should ensure your companion is prepared to contribute and is not caught by surprise by any questions they might be asked.
• Know that you will likely be observed after arrival–It is not uncommon for VA examiners to keep an eye out ahead of time for the patients they will be examining. Be aware that your behavior or interactions with others at the testing location may be noted by your examiner before the exam even begins.
• Obtain a copy of your exam results–Veterans can, and should, obtain a copy of their C&P exam results by requesting it from their local regional office. VA will not automatically provide veterans with copies of their exams. Therefore, it is necessary that veterans follow up on their own accord. Veterans can also have their representatives access a copy of the exam results through VA’s electronic database system (i.e., VBMS).

VA Deny Your Depression and Anxiety Claim? Call CCK Law

If an unfavorable C&P exam led to your disability claim being denied, then the representatives at Chisholm Chisholm & Kilpatrick may be able to help. Our accredited attorneys have extensive experience in appealing VA decisions and have secured favorable outcomes for 99 percent of our past clients before VA. (Past results do not guarantee future outcomes.)

Call CCK Law today at (800) 544-9144 or contact us online for a free evaluation of your disability claim.