Mental Health Compensation and Pension (C&P) Exams
What are C&P Exams?
Compensation and Pension, or C&P, exams are medical exams ordered by VA to evaluate the conditions that a veteran is claiming for disability compensation.
These exams are meant to assess the cause and severity of a veteran’s condition and are part of VA’s duty to assist veterans in obtaining evidence to support their disability claims.
It is important to know what is being evaluated at your C&P exam. Whether examiner is attempting to determine the etiology (cause of the condition) to establish service connection, or severity to help determine your rating, or both.
These exams are typically conducted by a VA examiner or a VA-contracted third-party medical professional. Prior to the exam, the examiner will review the veteran’s c-file so they are familiar with the veteran’s case.
C&P exams play an incredibly important role in the disability claims process. VA will almost always give more weight to the opinion of the C&P examiner than that of the veteran’s treating doctor.
How Are Mental Health Conditions Evaluated?
Generally speaking, VA uses criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to evaluate whether there is a valid diagnosis of a mental health condition during the C&P exam.
Common conditions include:
- Anxiety disorders (e.g., panic disorder)
- Trauma and stress-related disorders (e.g., post-traumatic stress disorder)
- Psychotic disorders (e.g., schizophrenia)
- Cognitive disorders (e.g., dementia)
- Eating disorders (e.g., anorexia or bulimia)
- Mood disorders (e.g., major depressive disorder)
- Residual effects of traumatic brain injuries (TBI)
What to Expect During a C&P Exam
As mentioned above, the examiner should review the veteran’s entire claims file before the exam and look for any evidence that may be related to the claimed condition. The medical examiner will typically ask the veteran questions about how their condition affects them on a daily basis. The questions the examiner asks will vary based on your claim (service connection vs. increased rating).
The examiner or a treating physician may also complete a Disability Benefits Questionnaire (DBQ). The form allows the user to use checkboxes and standardized language to evaluate the veteran’s disability quickly and correctly. Specifically, healthcare providers will “check a box” next to a description that most accurately depicts the disability in question
The DBQ also addresses the veteran’s level of social and occupational impairment. For example, the level of impairment due to depression ranges from no diagnosis to total occupational and social impairment, with various levels in between. Assuming a veteran meets all the criteria from the DSM-5 necessary for a diagnosis of their specific condition, the symptoms section of the DBQ will then help determine the appropriate disability rating.
It is important that veterans be honest and upfront with the C&P examiner about their symptoms and the way the condition impacts their life.
In some instances, the examiner may physically examine the veteran. With mental health conditions, a physical examination may occur if the veteran’s metal health condition is linked to another condition. For example, if the veteran suffers from debilitating back pain which has caused them to experience depression, they may file a claim for depression secondary to back pain. At the C&P exam, the examiner could physically examine the veteran’s back and ask questions regarding the connection between the back condition and the veteran’s depression.
How Does VA Rate Mental Health Conditions?
After the C&P exam is complete, VA adjudicators will review it along with all the other evidence in the veteran’s claims file.
Aside from eating disorders, VA rates all mental health conditions using the same diagnostic criteria. Specifically, VA rates mental health conditions under 38 CFR § 4.130.
Ratings range from 0, 10, 30, 50, 70, and 100% based on:
- The level of social and occupational impairment, and
- The frequency, duration, and severity of the symptoms listed in the criteria.
However, the symptoms listed are not exhaustive. They are meant to serve as a guide for the level of impairment at each rating.
Do I Need to Meet all Criteria in VA’s Mental Health Rating Formula?
No, veterans do not need to exhibit every single symptom listed in the rating criteria to receive that particular disability evaluation. Since mental health conditions can manifest differently per individual, VA’s rating formula for mental health conditions is not binding.
Symptoms listed in each level of the rating formula are simply examples meant to demonstrate the types and levels of impairment commonly found at that assigned percentage rating.
For example, a veteran may be so anxious that they pick at their skin, causing physical harm to themselves. In this case, skin picking can be considered as both self-injurious behavior and an obsessive ritual that interferes with routine functioning, thereby warranting a 70 percent disability rating. It should be noted that even though skin picking is not a symptom that is listed in the rating criteria, it is similar to other symptoms that are listed.
What If I Have Multiple Mental Health Conditions?
Psychiatric disorders can sometimes be difficult to tell apart as many disorders have overlapping symptoms. Similarly, many mental health conditions are connected.
For example, it is common for veterans to develop depression or anxiety as a result of their PTSD. However, VA does not rate each condition separately under its General Rating Formula. Instead, veterans with multiple mental health conditions will likely be assigned one combined rating.
VA exams will typically address this directly, as the DBQ form requires the veteran to specify if they have more than one mental health condition.
Veterans can only be rated for a symptom’s functional limitations once.
An example would be a veteran who suffers from PTSD that might also have a diagnosis of major depressive disorder. If VA has conceded that both of those conditions are attributed to the veteran’s service, the veteran is not going to receive a 50 percent rating for PTSD and a separate 30 percent rating for major depressive disorder. Rather, the veteran may receive a combined 70 percent rating under the diagnostic code for one condition.
To have the same symptom considered under more than one diagnostic code is called pyramiding, which VA regulations strictly prohibit. Veterans may not receive an overlapping rating for the same condition or the same symptoms.
Tips for Attending Mental Health C&P Exams
- Attend your exam!
- Failure to do so without providing good cause can result in VA denying your claim without looking into further evidence.
- Be as honest as possible. Do not under- or over-report your symptomology. Instead, make sure to carefully explain to VA what you are experiencing on a daily basis and how your condition affects your ability to function both at work and at home.
- Be aware that you can bring somebody with you to the exam if you feel as though they can offer additional information, or if you do not feel comfortable attending alone.
- VA examiners are likely to observe you from the very beginning. This means that from the moment you walk into the waiting room, examiners may observe your interactions with other patients and the staff.
- You have the right to challenge an unfavorable exam.
- Each examiner must provide a detailed explanation for their conclusions.
- VA must provide adequate rationale for deciding a certain medical opinion has more probative value. If VA does not do so, the veteran can rebut VA’s determinations.
Need Help Overcoming a Negative C&P Exam?
If you received a negative C&P exam, there are ways to challenge it. Often, accredited representation is one of the best tools a veteran can have when fighting a negative C&P exam. If you need accredited representation, the skilled veterans’ advocates at Chisholm Chisholm & Kilpatrick may be able to help you. Contact our office today for a free case evaluation.
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