How Much Weight Does a C&P Exam Have for VA Claims?

Video Transcription

Alyse Phillips: Welcome to CCK Live. I’m Alyse and I’m joined here by Matt and Frank, two of my colleagues who are accredited claims agents at CCK. Today, we will be discussing how much weight C&P exams, also known as compensation and pension exams, have in the VA disability claims process. So, let’s just start off with a general overview of what a C&P exam actually is.

Essentially, it’s a medical examination of a veteran’s disability. So, it’s going to be performed by a healthcare provider or a VA contracted provider. They use these exams to gather more information on a veteran’s claims conditions before issuing a decision and assigning a rating.

So, most commonly, the C&P exams are going to be used for one of two purposes. The first is to confirm or deny service connection. So, to see if something is related to service. And the second will be to establish the severity of veterans’ disability. So, that’s going to be important when they’re actually determining your rating for a service-connected condition.

Before the examination, an examiner should be reviewing your entire claims file, which is going to contain previously submitted evidence. So, it’s going to both include lay evidence and also medical evidence. And also, especially if it’s something related to service connection, it will also include anything related to your time and service.

When a veteran goes to a VA exam, the VA does have a duty to assist them in supporting their claim. So, what this means is that VA has to ensure that exams are adequate and that they’re actually provided in the first place. So, what that is going to end up with you being basically provided an exam at no cost in order to fulfill this duty to assist.

Frank, can we talk a little bit about if a veteran can get a rating without a C&P exam?

Frank Padula: Yes. So C&P exams are technically not required in every case. If a veteran’s initial claim for benefits is submitted with all of the required information, documentation, or other evidence necessary for a favorable decision, then VA may not need to schedule the C&P exam for issuing that rating. But it is important to understand that once VA requests that a veteran goes to a C&P exam, they should be certain to attend.

If a veteran does fail to attend an exam once it has been scheduled or even fails to follow up on the scheduling of that exam, their claim could be denied outright on that basis. However, if a veteran does miss an exam unintentionally, they can and they should contact VA as soon as possible to see if they can reschedule. Similarly, if the veteran can’t go to the exam whether because of an illness, maybe a transportation issue, or another scheduling conflict, they can and they should contact VA to reschedule that appointment.

And I know it’s frustrating. Even though many C&P exams may seem unwarranted, it can be detrimental to miss them. And with that being said, attendance is a crucial component of a C&P exam once it has been requested.

Alyse: Absolutely. Matt, could you tell us why C&P exams are so important?

Matt Fusco: Sure. So, VA decision-makers will often place significant weight on C&P exams when deciding claims. Without competing for medical evidence, the results of the C&P exam are often considered to be one of the most important pieces of evidence in a veteran’s claims file. A negative C&P exam could potentially result in the denial of your claim. And as Frank was alluding to, that’s why it’s important to not only attend the examinations when you can, it’s also important to request a copy of your exam and review it carefully yourself to determine if the results of the exam are favorable.

There are a few things to be on the lookout for after you have participated in a C&P exam. First, you should make sure that the exam itself was filled out completely and thoroughly, reflecting the most accurate information possible and reflecting what was discussed during the course of the examination with the examiner. And second, it’s a good idea to take a look at your examiner’s credentials, and make sure that they are the type of specialist qualified to evaluate the condition for which you had the examination completed.

Alyse: Absolutely, thank you. So, let’s talk a little bit about how much power examiners actually have. After an exam, an examiner is going to write up a report and is going to include a review of the findings and the clinical tests results, and any medical literature that might be used to determine etiology in a service connection case.

However, with that said, it is a common misconception that C&P examiners make the final determination as to whether a veteran’s condition is service-connected or even what rating veterans should be receiving. In fact, those two questions are both purely adjudicatory functions that are going to rest with both either the rating office or the Board, depending on what stage your case is at.

So, while an examiner is going to be finding the actual, they’re going to be making those medical determinations, they’re not making the final decision in your case as to whether one gets service-connected, or alternatively if you are warranted, for example, 30 percent for your PTSD or 50 percent for your PTSD. Those are going to be something that’s going to rest with both, or either rather, the RO or the Board.

C&P examiners, however, do have the power to agree with the veterans’ descriptions of their conditions and symptomatology. So, they do have some ability to determine credibility. And they also have the power to just disagree with the veterans’ descriptions on the other side of the same point.

And with that said, the language that a C&P examiner uses is going to be very significant. For example, to support a claim for service connection, they’re going to be using language like “at least as likely as not” caused by service connection. They might also be using language that matches up with different ratings in the rating criteria if we’re talking about an increased rating claim.

Frank, could you tell us what happens if you do disagree with the C&P exam?

Frank: Definitely. So, if you do disagree with your C&P exam results, you can consider disputing or countering the examiner’s report by doing a number of the following. So first, you could gather buddy statements from friends, family members, other veterans, or people who know you, your symptoms, and how your disability affects your own life. You could have your own doctor complete a Disability Benefits Questionnaire, or DBQ to provide VA with a more comprehensive picture of your disability and how it impacts your life.

You could even request the examiners’ credentials to ensure that they were qualified to conduct your exam. And if not, you can challenge that as well, or something you can consider doing is requesting a hearing with the Board of Veterans’ Appeals, and attending that hearing allows you to point out specific problems with your C&P exam and present evidence at the same time that may counter or weaken the exam results.

And if that veteran’s law judge feels as though your C&P exam is lacking the adequate amount of information required to make an informed decision on your claim, what they’ll do is remand or send back your case to the VA Regional Office with specific instructions for additional development to include a new C&P exam. And after that proceeding, it’s worth mentioning that the transcript of the Board hearing is added to your claims file as well. So, at that point, the Regional Office will then need to order a new C&P exam and the process will be repeated after that.

Alyse: Thank you. So, that will pretty much wrap up what we have for you today on C&P exams. We have done several blog posts and other YouTube videos about this topic including other tips and best practices. So, please be sure to check those out on our website and our YouTube channel. Also, please be sure to subscribe to our YouTube channel. Thanks for watching.