CCK’s Robert Chisholm, Bradley Hennings, Rachel Foster, and Alyse Galoski discuss the critical role that Compensation and Pension (C&P) Exams play in the VA disability claims and appeals process. Our experts share their knowledge of C&P exams from the viewpoints of a veteran’s representative before the Department of Veterans Affairs and the Board of Veterans’ Appeals, and as a representative before the Court of Appeals for Veterans Claims.
In order to fully understand the significance of Compensation and Pension (C&P) Exams in the Veterans Benefits Administration’s (VBA) disability claims and appeals process, it is important to first establish the basic elements required for a VA disability claim to be successful:
- The veteran must have the correct type of discharge: honorable or general;
- An incident, injury, or illness occurred while in service;
- A medical ‘nexus’, or connection, linking the incident in service with a current disability.
What are C&P exams?
A Compensation and Pension Exam is typically the first step in the VA disability claims process after a claim has been filed. This examination is used to establish a connection to service and to evaluate the severity of a veteran’s condition, or to increase a veteran’s current VA disability rating. 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.
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 my C&P exam?
To evaluate your condition, VA examiners complete a Disability Benefits Questionnaire (DBQ). 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. 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.
What should I expect after my C&P exam is complete?
After undergoing a C&P exam, we recommend exercising your right to request a copy of the results; this can be obtained directly from the VA medical center where the exam was performed, or from the VA Regional Office. Reviewing this information may help you understand how your claim will be judged. If your examination did not yield favorable results due to inconsistencies (e.g. omission of a previously established diagnosis), you may introduce new evidence into your case file detailing this.
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?
CCK’s Bradley Hennings, a former Veterans Law Judge at the U.S. Department of Veterans Affairs, Board of Veterans’ Appeals (BVA), was able 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.