C&P exams: Compensation and Pension examinations and the role they play in your VA disability case

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 & Pension (C&P) Exam, also known as a VA claim exam, is a medical examination of your disability performed by a VA doctor – or a VA contracted doctor. VA uses C&P Exams to gather more evidence on your claim before making a rating decision. Typically, VA examiners are looking to 1) confirm or deny service connection, and/or 2) establish the severity of your disability.

Before the exam, the examiner should review your claims file, or c-file, which contains all the evidence you have submitted with your claim as well as any medical treatment notes that VA has requested from your healthcare provider(s). The exam itself usually only lasts about 15-20 minutes. Exams may be as short as 5 minutes or as long as a few hours.

How does VA use C&P Exams?

After your exam, the examiner will write up a report that includes a review of the exam 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 determine whether your disability is service connected, they will write up a medical opinion that states whether, based on their review of your c-file and the in-person exam, it is “at least as likely as not” (a 50% chance) that your condition was incurred in or aggravated by service. The exam report is then added to your c-file as part of the evidence VA will use to decide your claim.

Can you get a copy of your C&P Exam report?

Yes! You have the right to request and obtain a copy of your test results by contacting your VA Regional Office. You should request a copy of your exams because VA decision makers often place significant weight on C&P Exams when deciding claims and exam reports are not always as thorough as they should be.

So you disagree with your C&P Exam results…

VA has a limited number of examiners and a substantial backlog of claims to process. Because of this, VA examiners are often rushed and may even be assigned to evaluate disabilities that are beyond their expertise or training. If your C&P Exam results are not favorable, it’s not over. But it helps to know what issues to look for and how to dispute or counter the C&P report.

What can you do?

There are a few routes you can take to dispute a C&P Report. Because VA adjudicators use your entire c-file (which includes your C&P Exam, but also any evidence you submit, hearing transcripts, etc.) to make their rating decision, the goal is to get evidence into your c-file that specifically counters the inadequate C&P report.

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. After the proceeding, the transcript of your hearing is added to your c-file.

Have your doctor complete a DBQ.

This option has pros and cons. A DBQ, or Disability Benefits Questionnaire, is a form created by VA to help physicians and adjudicators evaluate your disability. In theory, it allows you to submit a medical exam performed by your private physician (or VA doctor) who knows the history of your illness and can spend more than 15 minutes with you. However, there are a few downfalls that make the DBQ option potentially less effective. First, VA doctors almost never agree to complete DBQs. Second, the DBQ form your doctor would complete is different than the evaluation guidelines for C&P Exams.  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. So, if you choose to pursue this option, let your doctor know that they should not just check off symptoms on the form, but should support their answers with a written explanation even if the form does not require it.

Common Problems with C&P Exams and Examiners

If you choose to pursue the buddy statement or hearing options above, it is helpful to gather specific evidence about your C&P Exam that could be used to highlight the exam’s weakness(es). There are some common issues that come up in C&P Exam reports or with C&P examiners that may help your case. Remember that you can and should obtain a copy of your C&P Exam report in order to identify these issues.

The examiner was not qualified to examine your disability – due to their level or area of training.

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 an internist rather than a licensed doctor. Some veterans have even been assigned a physician whose specialty is unrelated to their disability. If an Occupational Therapist is evaluating your bladder cancer, for example, you can make a strong case that the exam results should not be considered valid. The name of your examiner will appear on your copy of the exam report. A quick internet search will likely lead you to the examiner’s level of training, specialty or area of training, 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/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 your case. Or, if the evidence referenced is about 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 make this clear in your c-file or during a hearing.           

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 did not get in the way of working without mentioning the ten doctor’s appointment in which you said your back pain was the worst pain you’d ever felt and you couldn’t walk 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 c-file, so it’s important to address through a hearing or through buddy statements. 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.

Category: Veterans Law