If you are in the process of filing for VA disability benefits from The Department of Veterans Affairs (VA), you will most likely be asked to complete a Compensation and Pension (C&P) examination.
This exam is to determine if your disability is service connected, the level of your disability and if the condition should receive a rating increase or decrease .
While the thought of another doctor’s appointment may be daunting, it’s important to remember that the cp exam is an important part of your disability claims process.
It also can be a time consuming and frustrating process at times. Fortunately, there’s some things you can do and be aware of to help ease the process.
What can I do to help make my C&P exam successful?
There are a variety of ways you can contribute to the success of your C&P exam . Here’s a list of a few simple rules you want to keep in mind:
Prepare for Your C&P exam ahead of time.
- Keep careful records of your condition.
- Know what you are being evaluated for.
- Have all the appropriate forms at hand.
Be upfront with your concerns and day-to-day issues.
- Be straightforward and honest with your answers to questions.
- Note if your conditions are interfering with your work or home life.
- If you are limited by pain, anxiety or other issues not accurately able to be measured at the appointment, be sure to let the examiner know.
Explain about “bad days” and how often they occur. For example:
- What does your disability prevent you from doing in your normal life?
- Does it prevent you from working? Interacting with friends and family?
- Does it impede basic activities?
Get a copy of the C&P results.
- The VA will be able to provide you a copy with this report.
- This report is helpful if you need to argue about a diagnosis later.
Bring someone close to you to the appointment.
- Someone close to you may be able to offer valuable insights.
- They also can offer another set of eyes about the appointment details.
Note: Sometimes the examiner may not allow a 3rd party to attend the exam, but they can still be helpful in noting things like how long the exam was or observing other circumstances surrounding the appointment.
For example, if you were kept waiting for an extended period of time.
Remember that you might have multiple visits.
If you file multiple claims, you might have multiple cp exams. It is frustrating, but it occurs quite often.
Just remember, these exams should be used for your benefit and to help your claim.
The more successful and smooth they can be, the better it is for your claims case.
You may have a chart review instead of a C&P exam.
Sometimes the VA won’t bring you in for an exam, but instead have an examiner do what is called a “chart review” for your exam.
It can often feel like they may be passing over your claim, but depending on the circumstances surrounding the claim, a chart review might be sufficient.
If you feel like the chart review is insufficient, you can always get a second opinion through an independent medical facility.
Other Frequently Asked Questions about C&P Exams
What is a C&P exam and why do I need one?
A C&P exam, as mentioned above, is a part of the claims-review process that allows the VA to determine:
- if the veteran’s disability is service-connected
- the level of the veteran’s disability , and
- if the condition should receive a rating increase or decrease.
The VA bases your rating on how severe your disability is–and your rating will affect how much disability compensation you receive.
Compensation may include things like monthly payments and enrollment in the VA healthcare program.
The length of time that a C&P exam lasts will vary greatly depending on what medical condition you have.
For example, a common evaluation for mental health conditions can often last between two and four hours.
During the cp examination, you will be asked questions, have your behavior observed, have a physical examination performed, or they may just review your file with you (a chart review).
What is the difference between a C&P exam by a QTC and an examination at a VA Medical Center?
A Compensation and Pension (C&P) exam is a medical examination performed by a healthcare provider to evaluate a veteran’s disabilities and determine the level of disability compensation they may be eligible to receive from the Department of Veterans Affairs (VA). The
se exams are conducted by either VA medical professionals or private contractors, such as QTC.
The main difference between a C&P exam conducted by QTC and an examination at a VA Medical Center is the location and who is administering the exam.
QTC is a private company that contracts with the VA to perform medical exams, while VA Medical Centers are government-run healthcare facilities.
In terms of the actual exam, the procedures and evaluations performed are generally the same, regardless of whether it is conducted by QTC or at a VA Medical Center.
The examiner will review the veteran’s medical history and conduct a physical examination to assess the current state of their disabilities.
However, some veterans may prefer to have their exam conducted at a VA Medical Center due to the familiarity and trust they have with the VA system.
On the other hand, some veterans may prefer to have their exam conducted by QTC due to the convenience of scheduling and location.
Ultimately, the decision of where to have a C&P exam conducted is up to the individual veteran and their personal preferences.
How does my C&P exam get scheduled?
The VA or VA contract examiner will mail you a letter or call you with your appointment date and time.
If you are receiving treatment at a medical center, make sure the facility has all of your updated information (address, phone number, email, etc.)
The wrong information could potentially delay your appointment.
You can request the specific sex of your medical provider for gynecological, breast, ana/rectal and mental health examinations during the scheduling process.
Additionally, if the claim is related to a mental or physical health condition resulting from Military Sexual Trauma (MST), the law permits you to choose the sex of your examiner.
Prior to the exam, contact the VA or the VA contract examiner to confirm your exam date, time and location.
If you do not report for your exam, it could delay or hinder your claim.
What if the date and time don’t work for me? Can I reschedule?
If a life event prevents you from being able to attend your scheduled exam, immediately notify the VA at the number you are provided to try and reschedule.
Unless it’s an emergency, you should try to reschedule at least 48 hours before the appointment.
What can I expect during my C&P exam?
A c p exam varies significantly from a typical medical exam, because the examiner will not be giving you any treatment or prescribing any medication.
They may ask you questions, observe you and/or perform a limited physical exam. They also may ask you questions in regards to your mental health, if you are taking an exam related to a relevant diagnosis.
The purpose of the exam is to have your condition evaluated and review claim-related medical records and your claim file (C-File) .
The C-File typically includes medical records, personnel records, treatment records from health care providers, and any other documents you may have submitted.
What is a Disability Benefits Questionnaire (DBQ)?
A Disability Benefits Questionnaire (DBQ) is a form used by VA to evaluate and rate disabilities claimed by veterans.
The DBQ is completed by a medical professional, such as a doctor or nurse practitioner, who has knowledge of the veteran’s medical history and current condition.
The form asks specific questions about the veteran’s disability, such as symptoms, severity, and how it affects daily life.
The completed DBQ is then used by the VA to determine the appropriate disability rating and compensation for the veteran.
The DBQ is intended to streamline the claims process and ensure accurate and consistent evaluations.
What not to say at a C&P Exam?
Under no circumstances should you lie or stretch the truth (also called malingering) when it comes to your VA disability claim. At your c p exam, you should be appearing as you do on a normal day. For example:
- If you don’t reguarly use a brace or a walker, don’t utilize them just for your c p exam.
- If you are capable of doing day-to-day activities like showering, dressing, etc. then disclose this information.
- If you are able to do physical exercises and have mobility, be clear of what you believe your limitations are.
You also don’t want to downplay your symptoms. It is perfectly okay to not be okay! You should let the examiner know this, if it is the case.
If you are feeling awkward or vulnerable disclosing the level of discomfort and impact of your disability on your life, just remember – the end result of this c p exam is to help get you benefits you deserve, which probably are much needed and will help your quality of life! Therefore, it’s important to be forthcoming.
This includes levels of occupation and social impairments, too.
What happens after my claim exam?
The examiner will write up a report and then send it to the VA.
The VA will then review all of the evidence in your file, including the VA cp exam report, and then make a decision on your disability claim and send you a letter.
The processing time for your claim depends on how complex your claim is and how many conditions you’ve claimed.
Note: Your examiner who performs your exam is not a part of the decision-making process.
They will never know the outcome of your pending disability claim , so they will not be able to tell you the status of your claim.
To get a claim status update, contact the VA at 1-800-827-1000 to have a representative assist you.
How do I get a copy of my claim exam results?
You can request a copy of your claim exam results, but you cannot get them directly from the provider.
Instead, you will need to fill out a Freedom of Information Act or Privacy Act Request ( VA Form 20-10206 ).
You can submit this form by mail or in person.
What if I had a favorable C&P exam still denied?
In some instances, there may be a circumstance in which you had a C&P exam that went well, and may have even been service-connected, but your VA disability claim was still denied.
Some reasons why this may happen may include if the rater misinterprets the results of the C&P exam, or other evidence in a veterans case file. The VA may completely disagree with the provider who conducted the exams decision, or there may have been many case files and an error was made.
Regardless of the circumstances, it’s important to note that this can and does happen, and know what to do when it does!
If a veteran receives a favorable Compensation and Pension (C&P) exam but their claim is still denied, there are several steps they can take to address the situation:
- Request a Copy of the Decision: The first step is to request a copy of the decision letter from the Department of Veterans Affairs (VA). This letter will outline the reasons for the denial and provide crucial information to understand the basis of the decision.
- Review the Decision Letter Carefully: It’s essential to thoroughly review the decision letter and understand the specific grounds on which the claim was denied. Pay attention to any errors, discrepancies, or misunderstandings that may have influenced the decision.
- Seek Assistance from a Qualified Representative: Consider reaching out to a qualified representative, such as a Veterans Service Organization (VSO) or an accredited attorney or claims agent. These professionals have experience in navigating the VA claims process and can provide valuable guidance and advocacy.
- File a Notice of Disagreement (NOD): If the veteran believes the denial is unjust or incorrect, they can file a Notice of Disagreement (NOD) with the VA. This initiates the appeals process and indicates the veteran’s intent to challenge the decision. The NOD must be filed within one year of receiving the decision letter.
- Gather Supporting Evidence: During the appeals process, it is crucial to gather additional evidence that supports the veteran’s claim. This may include medical records, expert opinions, buddy statements, or any other documentation that strengthens the case.
- Consider a Higher-Level Review or Request a Supplemental Claim: Depending on the circumstances, the veteran may choose to pursue a higher-level review or submit a supplemental claim. A higher-level review involves having a senior reviewer reassess the evidence, while a supplemental claim entails submitting new evidence to support the claim.
- Request a Decision Review Officer (DRO) Hearing: If the veteran disagrees with the outcome of the higher-level review or supplemental claim, they can request a DRO hearing. During this hearing, they have an opportunity to present their case directly to a Decision Review Officer and provide additional evidence or arguments.
- File an Appeal with the Board of Veterans’ Appeals (BVA): If the claim remains denied, the veteran can file an appeal with the Board of Veterans’ Appeals. This stage involves a more formal and legal process, and it may be necessary to engage an attorney or accredited representative for expert representation.
- Pursue Legal Action: In rare cases where all other options have been exhausted, veterans have the right to pursue legal action by appealing to the U.S. Court of Appeals for Veterans Claims (CAVC). This avenue involves filing a formal appeal and presenting arguments before a judge.
It’s crucial for veterans to remember that the appeals process can be complex and time-consuming. Seeking assistance from qualified professionals and maintaining diligent communication and documentation throughout the process is essential.
What information will the VA use to make a decision about my claim?
- Medical records you’ve submitted
- Exam report (C&P) from the provider
- Results of any medical tests the provider ordered
- Statements from you and others about your claim
- Your military and personnel records
What if I disagree with the results of my C&P exam or had a bad experience with the examiner?
If you had a bad experience with the provider at your claim exam, you can report your concerns to the VA right away.
You can report in any of these ways:
- Give feedback on the contractor’s customer satisfaction survey.
- Write a letter and submit it as part of your claim file.
- Call the contractor who scheduled your exam.
- Call the VA at 1-800-827-1000..
You can also request a second opinion from a non-VA medical provider to submit with your claim as additional evidence .
How long after a C&P exam should I expect my decision?
The current estimate by the VA for the number of days to complete veterans disability-related claims is, as of September 2022, 106.4 days .
If you are interested in learning more about filing for disability benefits, check out our FREE ebook The Road to VA Compensation Benefits .
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