How Do I Know If My C&P Exam Went Well?
Emma Peterson: Hello, and welcome to another edition of CCK Live. My name is Emma Peterson, and today I’m joined by Kevin Medeiros and Rachel Foster. And we are going to be discussing how you can tell if your VA C&P examination went well. So, let’s jump right in.
So, what is a C&P examination, or a compensation and pension exam? It’s a medical examination of your disability that’s going to be performed by a VA health care professional or sometimes, VA will contract with a third-party provider to perform that examination.
VA uses the C&P exams to gather more evidence about your claimed conditions before making a decision and either assigning a service connection or granting you a specific rating.
So, C&P exams are used to confirm or deny service connection, that important nexus element that veterans need to get their disability service-connected, or to establish the severity of your disability. What rating are you going to get in light of the symptoms and impairment your disability causes?
Now, prior to the exam, the C&P examiner should review your entire claim file. Sometimes they will review it electronically. Sometimes, if it’s around some paper copies, it should probably be electronic by now, but they’re supposed to look at everything in the file. And that should contain previously submitted evidence and the arguments you’ve made, your prior treatment records, your service records, the whole shebang.
But they should look at everything ahead of time. And it is extremely, I cannot stress this enough, extremely important that you attend your C&P examination. If VA schedules something for you, you’re going to have to go most likely. Failure to do so often results in VA denying whatever benefit you’re seeking. If you’re unable to attend and that certainly does happen, you need to reach out to the VA right away and attempt to reschedule that examination.
So, let’s get to what everyone is here for. Kevin, how can veterans out there know if their VA examination went well?
Kevin Medeiros: Sure, there are a few ways and the first is to request a copy of the examination report. The VA examiner is not going to complete it and hand it to you on your way out the door. They’re going to complete it and probably at some point later and get it over to the VA adjudicators. So, the way to request a copy is to contact your local Regional Office. There’s a VA hotline that you can call and request an appointment to review your file. Or if you’re working with a representative, you can ask them to request a copy on your behalf.
So, once you have the copy of the examination report, you’ll be able to review it and see whether or not it turned out well. It’s important to do this to see if the results are favorable. So, in a service connection case, you will know if it’s favorable if the examiner provided a positive nexus opinion. Or you’ll know if it’s unfavorable and get an idea of what you can do to maybe respond to that and submit favorable evidence of your own on the question on service connection.
So, you want to take a look at the report, make sure it’s filled out thoroughly and has accurate information. So, in terms of increased ratings for orthopedic disabilities, for example, if you experience flare-ups, you’ll want to make sure that the examiner adequately described your reports about your flare-ups and how they affect your functioning during those times.
You want to see if the examiner accurately reflected the severity of your condition overall, whether they were familiar with your medical history, if they took a look at X-rays and accurately described them in the examination report.
And in terms of the ultimate medical opinion, like I was referring to in service connection cases, the examiner is required to provide an opinion. So, you’ll know it’s favorable if they include language that it’s “at least as likely as not” that the claimed condition is related to service or other service-connected conditions. And if they use the phrase “less likely than not” or “not at least as likely as not”, then it’s an unfavorable nexus opinion and your claim will probably be denied.
So, you’ll want to take a close look at that if you’re seeking a service connection. See what reasoning the examiner might have provided for the negative nexus opinion as it’s known. And if it is a negative opinion, see if the reasoning is accurate or something that you might be able to respond to either with lay reports or with medical evidence of your own.
And the last thing to look for or the examiner’s credentials. VA does have certain conditions that require specialists to conduct the examination. So, if you want to look to make sure, for example, for a psychiatric condition that someone with our psychiatric specialty conducted the examination. And if not, that might be something to bring up to the adjudicator either before or after they make their decision based on the opinion.
Emma: Thanks, Kevin. And just for everyone out there that wants to know that number to call the VA to get a copy of your exam, is 1-800-827-1000. And we’ll post that in the comments, in case you missed it. But once again, 1-800-827-1000, and you can request an appointment to review your file or ask for a copy of that examination.
Now, just for people out there jumping off what Kevin said, sometimes VA is going to schedule you an exam with not that precise drill down a specialist that might be the perfect person for your condition. And that’s okay. A lot of times internists or general doctors or nurse practitioners may be the ones conducting the exam. So, just because it’s not with the specialist you thought, it doesn’t mean that VA is going to immediately get you a new exam. But, as Kevin mentioned, there are specific conditions that require specialists. So, reach out to your VSO, your accredited rep, an attorney, or whoever you work with on these claims just to get a sense of whether or not your condition requires some sort of special treatment when getting the exam.
So Rachel, what can you do if you disagree with your C&P exam results? What are the next steps?
Rachel Foster: Sure. So, there are a few different options that you can consider. The first of which is gathering buddy statements. So, buddy statements are written statements from people who know you, they’ve observed your symptoms and they have directly seen how your disability affects your everyday life. These people might include your spouse, children, other relatives, fellow veterans from your unit, co-workers, anyone who can speak directly about the issue.
Another option is to request a hearing with the Board of Veterans’ Appeals. So, when appealing a decision to the Board, you have the option to request a hearing with the veterans’ law judge on the hearing docket. Attending a hearing can allow 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.
Because we also know that there is a long delay with Board hearings, an alternative option is to submit something in writing to the Board raising the issues found in the exam in lieu of the hearing.
If the veterans’ law judge feels as though your C&P exam is lacking the adequate amount of information required to make an informed decision, they can remand or send your case back to the Regional Office with specific instructions for additional development.
Sometimes, this can include very specific instructions for the VA examiner, such as asking them to pay attention to evidence they missed using the correct legal standard. Or for a specific kind of specialized examiner to review your case, similar to what Emma was describing. The Regional Office will then order a new C&P examination and you will have an opportunity to attend a new and hopefully more adequate exam.
A third option is to ask your own medical provider to complete a DBQ. So, the Disability Benefits Questionnaire, or DBQ for short, is a survey-style form that gathers relevant information for a given disability, and most of them are publicly available.
A DBQ form allows you to submit a medical exam affirmed by a private physician who’s very familiar with the medical history of your disability. Most VA examiners also use DBQ forms. However, something to keep in mind is that the examiners are often responding to a very specific question from the Regional Office. And maybe asked by them to provide a medical opinion or to make sure that they are including reasoning and rationale.
The DBQ form that your doctor would complete does not automatically have this requested information from the Regional Office. 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. If this isn’t included, it could leave VA adjudicators to give that DBQ less weight in making a decision on your claim.
Emma: Thanks, Rachel. And to get that new exam ordered from the Board, it is really important that you attack your previous examinations. So, let’s say, how do they exam, and the Regional Office issues you a rating decision. For whatever reason, another exam is scheduled in between the time you get that rating decision and you go to the Board. In this new system under the AMA, the exam that happened prior to the rating decision that you appeal to the Board must be the one that causes the problem. In the new system, there’s no automatic duty to assist that the Board’s going to just keep remanding for new exams. So, it’s important that the first exam the RO used is something that you bring up and counteract with either your own DBQ or with an argument or explanation as to why you need a new exam.
Kevin, any final thoughts for those out there watching this and wondering how can I make sure I have a good exam or what to do if they end up with a less than favorable exam?
Kevin: Sure. I just think it’s important for veterans to be as descriptive as possible when they are in an examination describing their disability. And in the case of seeking a higher rating, describing how the disability operates, how it affects the daily functioning, how flare-ups might further impact regular activities of daily life or even work. And in terms of service connection, describing the history of the condition how it developed in or ever since service, so that, when you get the examination report and you review it, you can ensure that it’s accurately reflected in there and that the examiner has fully described everything that you explain to them. And if not then, the Board’s not going to have information that might entitle you to a higher rating or would has changed the examiner’s opinion.
So, I think it’s important to be very as descriptive as possible. A lot of the time, we see very bare-bones descriptions from examiners. So, if what they have in the report is not fully complete, then that’s something you can deal with a representative or an attorney in addressing after you review the report.
Emma: Yeah, I couldn’t agree more. And also it can be difficult to be as open and honest with this new person that you’ve never interacted with, describing a personal medical condition. And so that’s certainly understandable that it’s not exactly the same as seeing your treating provider.
But if you can take notes, bring a journal, think about it ahead of time before you go in there, and have some thoughts prepared, it certainly will help you in that process. Rachel, do you have any final thoughts or suggestions for those out there wondering what they can do before a C&P exam or how to know what to do after?
Rachel: Yeah, so I second everything that Kevin said. If there isn’t evidence or additional evidence that you can submit, it is so very important to at least get it in writing or one of the options is to present it at a hearing to raise those issues that occurred at the VA exam.
Sometimes, a veterans’ law judge, if it gets to the Board, might miss those inadequacies, if they aren’t raised previously.
Emma: Thanks, Rachel. So, for more information about C&P examinations, including tips on exam do’s and don’ts, please be sure to visit our blog and you can check out our other videos on YouTube.
If you have any questions, please be sure to post them in the comments. And thanks to everyone for tuning in. And please be sure to subscribe to our channel to make sure you stay in the know about VA topics. Once again, I’m Emma Peterson with Kevin Medeiros and Rachel Foster.
Thank you so much.
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