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Compensation and Pension (C&P) Exams for PTSD

September 17, 2019
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VA Disability Compensation for Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a psychiatric condition commonly experienced by veterans as a result of their military service.  Nonetheless, veterans must show a link between their PTSD and military service in order to receive disability compensation.  To establish service connection, the following elements must be present: (1) a current diagnosis of PTSD; (2) an in-service stressor; and (3) a medical nexus between your PTSD and in-service stressor.  When it comes to a medical nexus opinion, VA will likely order a Compensation and Pension examination (C&P exam) in order to have a doctor opine on whether your PTSD is related to your service.

Compensation and Pension Examinations

C&P exams are medical exams ordered by the Department of Veterans Affairs to evaluate the conditions that a veteran is claiming for disability compensation.  These exams are meant to assess the etiology and/or severity of a veteran’s condition and are part of VA’s duty to assist veterans in obtaining evidence to support their disability claims.  Either a VA medical professional or a third-party medical professional contracted by VA will conduct the exam.  Before a C&P exam for PTSD, the examiner will review the veteran’s entire claims file and look for any evidence that may be related to the condition.

How Does VA Evaluate PTSD During the C&P Exam?

During a C&P exam for PTSD, the medical examiner will likely complete a Disability Benefits Questionnaire (DBQ).  A DBQ uses check boxes and standardized language so that the disability evaluation can be made quickly and correctly.  Specifically, healthcare providers will “check a box” next to a description that most accurately depicts the disability in question – in this case, PTSD.  However, it is important to note that a DBQ will not be used if the veteran is undergoing an initial exam for PTSD.

Diagnosing PTSD During a C&P Exam

VA uses criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) to evaluate whether there is a valid diagnosis of PTSD.  This diagnostic criteria section of the DBQ is broken down into six categories (Criteria A-F).  The subsequent section lists additional symptoms related to PTSD.  Assuming a veteran meets all of the criteria from the DSM-V necessary for a PTSD diagnosis, the symptoms section of the DBQ will then help determine an appropriate disability evaluation.

Another important section of the DBQ addresses the veteran’s level of occupational and social impairment.  Here, the level of impairment due to PTSD ranges from no diagnosis to total occupational and social impairment, with various levels in between.  Veterans should be honest and forthcoming about how their PTSD affects their everyday life.  Doing so will further help the examiner see the full extent of the condition.

How VA Assigns Disability Ratings Following C&P Exams for PTSD

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 PTSD under 38 CFR § 4.130, Diagnostic Code 9411, and assigns a disability rating ranging from 0 to 100 percent.  The rating assigned is based on the level of social and occupational impairment, and the frequency, duration, and severity of symptoms.  However, there are many times in which veterans believe their PTSD warrants a higher disability rating than the one assigned by VA.  In this case, veterans have the right to appeal for a higher rating.  When a veteran files for an increased rating for their PTSD, VA will likely send them to another C&P exam that will focus mainly on the severity of the condition.

What to Do If You Disagree with Your PTSD C&P Exam Results

If you disagree with your PTSD C&P exam results, you may submit private treatment notes and medical records to provide more favorable evidence.  Such medical records should also be given consideration during the adjudication process.  Veterans are entitled to go to outside doctors and obtain opinions to be weighed against VA examinations.  Therefore, if you have additional evidence in support of your PTSD claim, it may be beneficial to submit it to VA following your C&P exam. Veterans are able to challenge their C&P exam for PTSD.

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