Compensation and Pension Exams (C&P) are one of the most critical components of the VA claims process and often central to the success or failure of a claim when seeking to establish service connection for a disability.
As a VA examiner who performs these types of exams, I often encounter veterans who have been on the receiving end of a poorly-conducted exam or examiner’s report.
While you won’t really know how your exam went until you either see the completed exam report or receive a Veterans Affairs disability letter, there are a few tell-tale signs to clue you in to the successfulness of the visit… even while you’re in the middle of one!
Understanding these factors can help you best prepare for your C&P exam or ask for another one if things really went sour.
What is a Compensation and Pension Exam?
Compensation and Pension (C&P) Exams are assessments conducted by medical providers to determine the clinical status of your disability, document it in a Disability Benefits Questionnaire (DBQ), and oftentimes produce a Medical Opinion as to whether or not your disability was caused by military service.
While the VA itself officially makes that call, this provider’s report carries significant weight in affecting it one way or the other.
Here’s a few general items that are helpful to know about your C&P exam:
1. The VA claims process consists of a lot of “hurry up and wait.”
Months may go by after veterans initially submit a VA disability claim before a C&P exam is suddenly scheduled, sometimes only with a few days’ notice.
Please note you may not always receive a notification in time.
2. The VA or contracted VA doctor will not call you to determine a preferred date/time.
They will simply notify you of your appointment time via mail/email/phone, with the option to reschedule if the appointment coincides with a life event.
3. C&P exams tend to feel unusual.
After discussing all your disability symptoms, the provider will not recommend treatment since the purpose of the exam is purely to assess rather than to treat.
4. Multiple C&P exams are often ordered for the same claim.
This can lead to some justifiable puzzlement on why you need to be seen again.
Just know that the VA often likes to see multiple opinions and exam results from different providers to evaluate your claim.
5. Don’t be surprised if your disability exam was not conducted at a VA Medical Center
Your VA regional office often hires outside contractors to help furnish exam results more rapidly and meet the high volume of claims in the system (especially after passage of the recent PACT Act).
Here are some signs your VA C&P Exam went well:
1. Your entire claims file was available for the exam.
Your claims file (aka C-File) is a large record containing all the claims you’ve made, service treatment records (STR’s), military records, civilian medical records (if you’ve submitted them to the record), all the decisions that have been made in the past for your claims, internal VA memos about your case, any DD-214’s on file, appeals documents, etc.
If that sounds like a lot of paperwork, it is. Almost all C-Files I encounter have 3,000 – 12,000 pages, which brings me to my next point…
2. You directed the examiner to the relevant medical evidence.
A large part of your disability examiner’s job is to comb the entire record searching for information relevant to your claim.
However, the C-File is basically just a giant, searchable PDF thousands of pages long, making it oftentimes difficult to review and find contextual information in handwritten documents and redundant text.
Doing anything to get on the examiner’s good side helps, and one of the best ways to do this is to save them some work.
Before your visit, prepare by going through your records, finding all the documents relevant to your claim, and bringing a hard copy of these in.
3. The VA ordered the right Disability Benefits Questionnaire for service connection for a specific diagnosis.
For the VA, almost all disabilities fall into distinct categories.
For example, there are many different types of knee issues you could be diagnosed with, but they all must be assessed using the Knee DBQ.
That may sound like a no-brainer, but as an examiner, I often see the wrong assessment ordered.
A common one I encounter is an Arthritis DBQ being ordered for arthritis in a specific joint.
This is problematic because the Arthritis DBQ is only intended for system-wide arthritic conditions (like rheumatoid arthritis), rather than for arthritis or degenerative changes in a localized area.
This matters – since the DBQ’s are filled with specific questions about your condition, getting the wrong DBQ can lead to insufficient information for determining your VA disability rating.
It’s usually obvious which DBQ is the right one, so a good way to approach this is to simply ask your examiner what DBQ was ordered.
You can say something like, “I’ve heard the wrong DBQ sometimes gets ordered – can you clarify which one we have for my claim today?”
If you’ve received appointment paperwork prior to the visit, the DBQ’s are often listed there as well. For a full list of downloadable DBQ’s, visit our DBQ resource center.
4. Your examiner took enough time to assess your disability.
Many of the veterans I’ve seen mention how previous C&P exams they’ve attended felt too short, with not too many questions asked about their condition and symptoms.
While some exams are indeed very short in nature, this is often a legitimate concern – consider the fact that during your examination, the doctor is expected to:
Conduct a thorough medical history.
This includes onset of the condition, treatment you’ve received through the years, current symptoms related to your illness, specific examples of functional limitations caused by your condition and how your illness affects daily life, identifying any assistive devices you may be using, asking about recent medical testing, etc.
Review other conditions you have that are relevant.
Some conditions may be relevant to the one being claimed (especially if you’re claiming secondary service connection).
Perform a focused, but thorough, physical exam.
If one is indicated for the condition (including the use of a goniometer anytime range of motion testing is required).
If you’re filing for an increased rating, they should ask what’s changed since the last time you filed.
As you can tell, there’s a lot to cover even for just one claim. Understanding this can help you get a feeling for whether or not the examiner progressed too rapidly, didn’t ask enough questions, or skipped parts of the examination.
5. Your provider was specialized to administer your exam.
In some circumstances, you may encounter an examiner who doesn’t have the right credentials to administer your C&P exam.
For example, you will need specialty providers for hearing loss, mental illness, or dental/vision issues – these cannot be performed by a general provider.
Most other claims can be seen by a general doctor, so don’t be surprised if the examiner assigned to review your lower back injury isn’t an orthopedic spine surgeon.
You may also be seen by an Advanced Practice Provider (APP) rather than a doctor – a Nurse Practitioner (like me!) or a Physician’s Assistant.
Can I challenge a bad C&P exam?
Yes! If you suspect your C&P exam was inappropriately performed for any of the above reasons, you may request another C&P exam from the VA.
Please note that you are not guaranteed to receive one, so it may help to write down a list of reasons why you believe your C&P exam was not performed appropriately or if it was performed by the wrong specialist.
How do I challenge a bad C&P exam and request a new one?
In order to report issues with the Compensation and Pension exam you’ve received and request a new one, document the reasons you think it went poorly in a formal Memorandum for Record (MFR).
Then, call the VA, use your MFR to guide your explanation of why you think a new exam is warranted, and then upload the MFR with the rest of your claim paperwork.
Private medical opinions can also help support your case. Keep in mind that the appeals process is also in place should you receive a claim denial letter.
C&P exams are one of the critical pivot points when pursuing VA disability compensation and establishing a service connected disability for VA benefits, but it is also one that veterans tend to understand the least.
Hopefully this knowledge will help you skillfully navigate your C&P and secure the veterans benefits you are entitled to!
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