When you file a claim for disability with the VA, often times they will schedule what is known as a Compensation and Pension Exam, or C&P Exam. This exam is used for by the VA for three main reasons;
To Diagnose a condition- To Determine a Nexus for a condition
- To Determine the Level of Severity for a condition
The exam will often be utilized for at least two if not all three of these reasons. We are going to review what the purpose of each of these points is and what you need to do to ensure the most favorable exam for your claim.
Diagnosis of a Condition
You have filed a claim for a condition and you are notified by the VA that they have scheduled a C&P Exam for you. You may already be being treated by a VA doctor for the condition, but the exam will not be conducted by your treating physician. It will be either a physician at the VA who specializes in C&P examinations or a contracted private physician. The point of this is to ensure the physician has no monetary or personal interest in the exam. You are not their patient; they will never probably see you again so they have no reason to provide a biased exam result. However, remember this point, they are being paid by the VA, so providing an exam result favorable to the VA is in their best interest. So be prepared to ensure you get a fair exam.
If you have a diagnosis already from your treating physician, have copies of that paperwork available for the examiner as well as sent into the VA with your claim, especially if you are being treated by a specialist. If the C&P Exam is not done by a specialist, a diagnosis by a specialist is supposed to outweigh any other opinion, including that of a non-specialized C&P examiner.
Even if they diagnose you with a different condition that does not mean your claim is invalid. For example, if you filed a claim for depression and the C&P Examiner stated you do not have depression, you have PTSD. You do not have to start a new claim; the claim for depression is still valid because diagnoses can change based on what doctor you are seeing and what symptoms you have described at that interview. In addition, if you had filed a claim without an official diagnosis, then having an official diagnosis just changes the claim, it does not stop it. After all, you are not qualified to diagnose yourself (unless you are a doctor) according to the VA. Therefore, if you said you had depression and a doctor said you had PTSD, well, you have PTSD, but your effective date is still the date you filed the claim for the depression. This applies to any condition with similar symptoms such as gastro problems, respiratory problems, heart problems, etc.
Determine a Nexus for a Condition
A nexus is what connects the condition to your military service. This is when the doctor states, “A is likely as not caused by B.” The goal here is to get a 50% or greater probability that something that happened during your military service caused or aggravated your condition. For example, Joe served in the Gulf War and has hearing loss. Joe was a mechanic on the flight line. It is as likely as not that being around planes caused or aggravated Joe’s hearing loss. Sometimes getting the nexus statement is easy, especially if there are in-service medical records to document that an injury happened or that you were treated for a condition that started in service. There are several ways to prove service-connection, however, if there are no treatment records from in-service; another route may be possible.
C&P examiners will review service records that are available in your Claims File. If you have records of an in-service injury or treatment, great, if not, what can you do? Often times there is scientific literature to substantiate a claim for connection. This type of literature, if uses scientific studies to show connections between events or exposures and conditions. For example, Agent Orange and Non-Hodgkin’s lymphoma have a connection proven through peer-reviewed studies. If you have literature that is peer-reviewed, scientific, or journaled and that supports your claim, bring it with you. Your examiner may not look at it, but then again, he or she might.
Be honest with your examiner. If you do not remember a date, tell them you do not remember, but try to approximate. If you approximate and tell them that is the exact date and it was not, you damage your credibility. Be honest about your symptoms. If you are filing a claim for PTSD and do not have all the symptoms to meet the diagnostic criteria for PTSD, do not lie and say you do or exaggerate your symptoms. Many of the assessment tools C&P Examiners use for physical and mental health exams can show if someone is exaggerating their symptoms and that could get you are very quick denial. State what symptoms you do have honestly and that will give you a better chance of the events you describe being believed by a rater when it comes time for a decision.
Determine the Level of Severity for a Condition
The third main thing a C&P Exam is used for is to determine the level of severity of a condition or the rating. Both at an initial exam and at a routine follow up exam, the examiner will identify specific parameters of your condition and the RO will use those parameters based on a scale to determine your level of disability. For example, a mental health condition with specific symptoms is rated at 30% if he or she is experiencing depression and sleep disorders. However, if the veteran is experiencing symptoms such as being unable to take care of their personal hygiene, they may be eligible for a 70% rating. Sometimes, the effect on performance affects the rating level. For example, if veteran loses his hand, it is rated as 70% for the dominant hand, but only 60% for the non-dominant hand. Here, the disability is based on how much ability the veteran has lost, which in the case of the dominant hand would be more than in the case of the non-dominant one. Some conditions have maximum ratings allowed by law. For example, 10% is the highest someone with tinnitus can be rated and for migraines, it is 50%. It cannot legally be higher than that according to the law.
This is another reason why it is so important to be honest about your symptoms and not exaggerate. Do not undercut yourself either. If you walk into the exam and the doctor says, “How are you today?” Do not take this as a rhetorical question. If you answer, “I am fine,” the doctor is going to note that on the exam. In addition, if the staff sees you walking down the hall at a normal pace and sitting still in the chair in the waiting room, do not expect to come into the exam limping and saying you cannot sit for more than 5 minutes at a time. They are watching you from the time you come into the area of the building, sometimes from when you get out of your car. There are exams that even stated, “Veteran was seen getting out of his vehicle with no assistance and sitting still in the lobby for more than 20 minutes.” The more honest you are, the more credible your claim will be, and the less chance someone can trip you up because remember, the VA will try. Read the very important blog: Seven Do’s and Dont’s for a Compensation and Pension Exam for more information.
