C&P exams: Compensation and Pension examinations and the role they play in your VA disability case
What is a C&P Exam?
A Compensation and Pension (C&P) exam, is a medical examination of a veteran’s disability, performed by a VA healthcare provider, or a VA contracted provider. VA uses C&P exams to gather more evidence on a veteran’s claimed condition before issuing a decision and assigning a rating. Most commonly, C&P exams are used to 1) confirm or deny service connection, and/or 2) establish the severity of a veteran’s disability. Before the exam, the examiner will review your entire claims file, which contains previously submitted evidence and medical treatment records. The exam itself usually only lasts about 15-20 minutes, but can range anywhere from 5 minutes to several hours.
When veterans go through the disability claims and appeals process, VA has a “duty to assist” them in obtaining evidence to support their claim. Since medical evidence is crucial to a veteran’s disability case, C&P Exams are provided by the VA at no cost to the veteran in order to fulfill its duty to assist.
When Will You Attend a C&P Exam?
A C&P exam is typically the first step in the VA disability claims process after a claim has been filed. Namely, VA has a “duty to assist” veterans in obtaining evidence to support their claims. Since medical evidence is crucial to a veteran’s disability case, C&P exams are provided by VA at no cost to the veteran. After applying for service-connected compensation, VA will send a notice either informing you that an exam has been scheduled, or indicating that you will need to schedule one on your own behalf. If an exam is already scheduled for you, VA will provide the date, time, and location that it will take place. If you are responsible for scheduling the exam, you must respond promptly by reaching out to the Compensation and Pension Department at the VA in order to do so. Either way, it is very important to attend a C&P exam once it is scheduled. If you do not attend, your claim will likely get denied.
How Do I Schedule a C&P Exam?
After applying for disability compensation, the VA sends applicants a notice informing them of the need to schedule a C&P exam. You should respond to this notice as promptly as possible by reaching out to the Compensation and Pension Department at the VA to schedule your exam. It is very important to attend your C&P examination; if you do not attend, your claim will likely be denied.
What Will Happen During the C&P Exam?
During the C&P exam, the examiners will ask questions about your disability and how it affects aspects of daily functioning. VA examiners might complete a Disability Benefits Questionnaire (DBQ) as well. Each DBQ is drafted to correspond with a specific condition, and is formatted for examiners to “check a box” next to descriptions that most accurately depict the disability in question. It is important for you to be honest about your symptoms so that they can be properly documented. This method may not always allow for a complete and thorough medical analysis due to its format; this lack of information could potentially result in a denial of benefits.
C&P exams can last anywhere from 10 minutes to one hour. If the exam is very brief, you may not have been able to present the examiner with a complete picture of your condition. We encourage note-taking during your C&P exam to document its brevity, and to note whether you were able to sufficiently describe your condition.
During your C&P examination, be honest about your symptoms so that they can be properly documented. Bringing a friend or family member to your exam may be beneficial so that they may serve as a witness to the symptoms that impact your daily life.
Who Will Conduct My Exam?
C&P exams are not always performed by doctors. Often times, VA will have other medical professionals such as physician’s assistants, nurse practitioners, or third party medical contractors conduct your exam. It is likely that you have never met your examiner prior to your C&P exam. For a second opinion, you are able to ask your treating physician at the VA, or in the private sector, to conduct a supplemental examination. DBQ’s are available on VA’s website to be printed, and can be completed by your own doctor. A medical opinion from a doctor who has been continuously treating you and that understands your condition may carry more evidentiary weight when your claim is being reviewed by the Board or a judge at the CAVC.
How Does VA Use C&P Exams?
After the exam, the examiner will write up a report that includes a review of the exam’s findings, any clinical test results, and any medical literature used by the examiner to determine etiology – the cause or origin of a disease or condition. If the examiner is trying to confirm or deny service connection, he or she will write up a medical opinion that states whether it is “at least as likely as not” (a 50% chance) that your disability was incurred in or aggravated by service. The C&P exam is then added to your claims file as part of the evidence VA will use to make a decision.
Can You Get a Copy of Your C&P Exam?
You have the right to request and obtain a copy of your C&P exams by contacting the VA medical center where the exam was conducted, or your VA Regional Office. VA decision makers often place significant weight on C&P exams when deciding claims. Therefore, it is important for you to review the exam to determine if the results are favorable. Furthermore, you can ensure that the exam was filled out completely and thoroughly, reflecting the most accurate information possible.
Requesting to see your examiner’s credentials from the VA may also be helpful, as it can reveal whether he or she was qualified to issue a medical opinion on your disability. For example, if a nurse practitioner conducts an examination of a veteran with a complex neurological disorder, he or she may not be considered qualified enough to evaluate that condition.
C&P exams are often considered to be the most important piece of evidence in a veteran’s claim file. If an exam is incomplete or not conducted, VA is not fulfilling its duty to assist the veteran in developing his or her case. If you are a veteran who filed a claim but has not had an examination yet, we recommend insisting on an examination at every stage of the claims and appeals process until you get one; if no examination is performed, it can be very difficult to prove service connection.
What Will a Veterans’ Law Judge Look For When Reviewing My C&P Exam?
We asked CCK’s Bradley Hennings, a former Veterans Law Judge at the U.S. Department of Veterans Affairs, Board of Veterans’ Appeals (BVA), to weigh-in on how he went about evaluating C&P exams during his time as a judge.
He put emphasis on the inclusion of accurate factual history. While reviewing a claim, the questions Mr. Hennings would ask himself include: Did the doctor ask the right questions? Did they know what actually happened during the veteran’s time in service that led to the disability? Did they gather a current and complete list of symptoms? Was enough detail provided in the report to be fully informed of the veteran’s disability?
If a Veterans’ Law Judge feels as though your C&P exam is lacking the adequate amount of information required to make an informed decision, they will remand, or send back, your case to the Regional Office with specific instructions for additional development. The Regional Office will then order a new C&P examination, and the veteran will have to repeat the process. It is important to review your C&P examination and provide as much additional objective evidence as possible during your claims process, so that you can avoid this cycle in which veterans often get caught.
What If You Disagree with Your C&P Exam Results?
If you disagree with your C&P exam results, consider disputing or countering the examiner’s report by doing the following:
Gather “buddy statements”
Buddy statements are written statements from people who know you, your symptoms, and how your disability affects your life. Your “buddies” might include your spouse, children, other relatives, fellow veterans from your unit, co-workers, etc.
Request a hearing with the Board of Veterans’ Appeals
When submitting a Substantive Appeal (VA Form 9) in the appeals process, you have the option to request a Board of Veterans’ Appeals (BVA) hearing with a Veterans Law Judge. Attending a hearing allows you and your attorney to point out the specific problems with your C&P exam and present evidence that may counter or weaken the exam results. If a Veterans Law Judge feels as though your C&P exam is lacking the adequate amount of information required to make an informed decision, they will remand, or send back your case to the Regional Office with specific instructions for additional development. The Regional Office will then order a new C&P exam, and you will have to repeat this process. After the proceeding, the transcript of your BVA hearing is added to your claims file.
Have your doctor complete a DBQ
In theory, the DBQ allows you to submit a medical exam performed by a private physician who knows the history of your disability and can spend more than 15 minutes with you. However, there are several downfalls that make the DBQ option potentially less effective. For example, the DBQ form your doctor would complete is different than the evaluation guidelines for C&P exams. Specifically, the DBQ forms do not ask your doctor to provide descriptions or rationales for any symptoms listed or conclusions drawn during the exam. This often leads VA adjudicators to give DBQs less weight in making a decision on your claim. Therefore, if you choose to pursue this option, let your doctor know that they should support their answers with a written explanation even if the form does not require it.
Common Problems with C&P Exams
It is beneficial to gather information about your C&P exam in order to highlight the exam’s weaknesses. For example, there are several common issues that come up in C&P exam reports that may be helpful to your case.
The examiner was not qualified to examine your disability
Unfortunately, it is not uncommon that C&P exams are performed by non-physicians. You may be evaluated by a nurse, a nurse practitioner, a physician’s assistant, or internist rather than a licensed doctor. Some veterans have even been assigned a physician whose specialty is unrelated to their disability. If this is the case, you can make a strong argument that the exam results should not be considered valid. The name of your examiner will appear on your copy of the exam report. By searching the internet, you will likely be able to find your examiner’s level of training, specialty, and perhaps even their CV or resume.
The examiner provides irrelevant or outdated medical research as rationale
On C&P exams where service connection or etiology are being established, the VA examiner is required to reference medical research that supports his or her medical opinion. Take a look at the medical literature they list on the report. If the evidence referenced was published more than five or ten years ago, this could help you case. Or, if the evidence referenced is regarding a different type of disability or does not discuss a connection between the type of in-service event or injury you experienced and your current disability, you should address this.
The examiner ignores favorable medical information
Examiners must provide a rationale for any medical opinions they provide. If in the report, the examiner lists only medical treatment records or medical research that do not support your claim, an argument can be made that they ignored more favorable information. For example, if you are claiming a back condition, an examiner might cite two doctor’s appointments in which you said your back pain was the worst pain you ever felt you have ever felt and you couldn’t walk for more than 2 blocks.
The examiner misreports what you said or suggests you are “malingering”
Does the exam report match what you said in-person? The examiner may have misstated or misinterpreted what you said. It could also be possible that you did not understand the examiner’s question. For example, if an examiner asks if you experience “radiculopathy” without explaining that it means “numbness and tingling”, you may have unintentionally answered incorrectly. Additionally, an examiner might suggest that you are “malingering”, meaning you are exaggerating or faking your symptoms. An assumption like this could undermine the C&P exam report and even other parts of your claims file, so it’s important to address this as well. Buddy statements are particularly effective in this case if your “buddy” has witnessed your symptoms and can provide specific examples of how they affect your life.
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