Picture this: you are welcomed into the office by your VA C&P Disability Examiner, given a short introduction to what you’ll be covering during the visit, and after a few questions, you notice that your examiner starts writing down information while you’re still speaking.
It seems rude, because even though they appear to be listening and asking good clarifying questions, they’re still spending much of their time staring at the screen in front of them during the exam and typing away.
This is a great example of just how technologically-driven the VA Disability process is.
But why is this?
Consider the fact that your examiner has been tasked by the VA to gather copious amounts of information in relation to each of your claimed conditions.
It’s impossible to ask the 20+ detailed questions needed to properly evaluate your knee issue and then write it down at a later time.
Because of this, the best examiners write it down as you tell it to them – especially if they are interested in being as detailed as possible.
So if technology is so central to the VA Disability process, how can you make that work to your advantage?
What tools can you use to ensure better success leading up to and during your meeting with your examiner?
After three years of performing these exams, I’ve noticed that the most prepared veterans are often the most successful at establishing service connection for their claims, so let’s dive into some best practices and ideas.
#1: Determine When and When Not to Use the ACE Telehealth Process
Several years ago, the VA began allowing the use of telehealth for the completion of some types of disability exams.
This is called the ACE process and allows an examiner to complete an exam over the phone or with just a review of your existing medical records.
In some cases, this is obviously a great tool – it allows the veteran the freedom of attending the visit from the comfort of their home.
That said, there are circumstances in which telehealth and the ACE process may not be desirable.
Lots of exams are considered “ACE-eligible,” but in my experience as an examiner, there are a few that would be better served with in-person face-to-face examinations… even if the VA says you could conduct them via telehealth!
What are those exams?
The best illustrator of this point is a Heart Examination (aka DBQ).
If I’m evaluating a veteran for cardiovascular condition, there’s a lot of information that I cannot glean just from looking at records and talking to them over the phone – I need to see them!
Questions I need visual answers for are things like:
- How is the veteran’s respiratory effort?
- What did they look like walking up the stairs to the clinic?
- What color is the skin on their lower extremities?
- How much swelling do they have on their ankles?
- Did they lose the hair on their toes or is their lower extremity skin smooth and shiny?
These questions can be critical in substantiating your true clinical status and the functional impact of your heart condition.
In some cases, it may make sense to perform these as telehealth exams, but only if there were copious amounts of information regarding your physical exam findings (this is almost never the case).
If you’ve been scheduled for an ACE process exam, but would rather prefer one in-person, you can request that the VA reschedule your appointment as one that is conducted face-to-face.
If you’re trying to understand when that’s advisable, the best thing to do is to simply consider whether or not your disability would benefit from direct visualization/physical examination.
#2: Have Patient Portals Readily Available
I’ve mentioned before that the VA’s official guidance when it comes to bringing anything to your disability exam is to not – they expect that all your paperwork and documentation should be submitted before the exam via official channels and then be available to the examiner on the day of examination itself.
Unfortunately, this is not always the case.
It is not uncommon for me to be examining a veteran and be missing one critical piece of information.
One example is that of a veteran I was examining for diabetes: the VA requires two separate Hemoglobin A1c lab values > 6.5 in order to confirm a diagnosis of diabetes.
For whatever reason, despite the fact that she had already submitted this documentation via formal channels as requested, they were not available in my file during the exam.
Thankfully, she was the kind of person who kept a close eye on her health and was able to instantly log into one of her patient portals on her phone, find some recent A1c labs, and show them to me during the exam.
This allowed me to substantiate the fact that she was, in fact, diagnosed with diabetes per VA diagnostic criteria.
You might be surprised at the regularity with which things like this happen: a knee MRI, an echocardiogram, or an endoscopy procedure note is missing and the veteran is able to quickly pull up what’s needed on their patient portal app to ensure consistent corroboration regarding the claimed condition.
Having access to these sorts of patient portals can also help when your examiner may be looking for a very specific piece of information that you couldn’t have anticipated needing to prepare prior to your exam.
If you’re not too familiar with these kinds of apps or websites, it’s helpful to know that most doctor’s offices and health systems (including the VA) upload your records to the cloud so you can access them on your phone or a laptop.
Just ask your doctor’s office if they have anything like this in place and how you might access it.
If you’re in the VA system, you’ll be using My HealtheVet.
You may also consider bringing your laptop to an exam for even quicker navigation and ease of visibility.
#3: Use Monitoring Apps for Health Tracking
Similar to the above point, it’s often helpful for an examiner to see a log of your symptoms or other biometric data.
They can use data like this to form a more accurate opinion as to the severity of your disability.
In one instance, a veteran had access to their CPAP machine recordings (a medical device used for sleep apnea) on their phone, and I was able to substantiate their adherence in sticking to the treatment.
If you use a CPAP, your manufacturer likely offers cloud data like this.
Another example is migraine diaries – while they are still technically subjective information, they allow an examiner like myself to add information to the clinical picture about your headaches.
Sometimes obtaining this information can be automated, like having your smartwatch record your oxygen or heart rate at various moments and logging when they’re abnormal – this could help when evaluating a cardiac or respiratory condition.
Make sure you’re tracking this data in the weeks and months leading up to the exam and have an easy way to access it (paper or digital copy) during the exam itself.
#4: Take pictures!
Pictures are especially helpful for conditions that have significant flare-ups.
For example, one veteran I encountered had a skin condition that only presented a few times a year.
On the day of the exam, he didn’t have any abnormal skin findings, but he was able to show me a picture of his rash at various moments in time that allowed me to choose an accurate diagnosis.
If you have a lower back condition that tends to result in spasms which make your pain much worse and affect the way you walk and complete daily activities (this is common in many lumbar conditions), take a video of how you’re impacted right in the middle of the flare-up when it’s at its worst.
You can use photographic evidence in this way to give your examiner a much broader picture (pun intended) of the functional limitations associated with your disability.
#5: Use ChatGPT as your Research Assistant
This piece of advice may come off as a bit of surprise.
How could ChatGPT help with your disability exam?
To understand this, you must first know about the two most important purposes of an examination:
- Confirm your diagnosis.
- Determine if your diagnosis is due to military service.
While ChatGPT may not help you with the first point, it can definitely help with the second.
Here’s how: the determination of your service connection often (though not always) comes down to a “Medical Opinion,” which is an examiner’s opinion on whether your disability was caused by service.
In order to form such an opinion, we consider the entire narrative of your illness, the way that you present during a physical examination, an understanding of your history, and extensive knowledge of up-to-date medical research.
For example, you may have sleep apnea but have a hard time linking it to service. If only you had access to a medical research assistant who could give you some ideas… oh wait – now you do!
With a little help, ChatGPT may help you find some indirect relationships, like the fact that your other service-connected back condition prevents you from exercising, which has led you to gain weight over the years, which then leads to the development of sleep apnea.
So how do you practically go about doing this?
After signing up for a ChatGPT account (you can also use Google Bard, Bing Chat, or others), put together a little history on your medical problem, explain the condition for which you are seeking service connection, give some background to the condition, and ask if there are any potential service-related mechanisms which would cause you to develop the disability.
Ask it to cite research papers in the answers it gives you.
Keep in mind that ChatGPT is more helpful the more information you give it.
One thing that is critical to keep in mind, however, is that ChatGPT is not perfect.
Many have accused it of “hallucinating” facts…!
While a large language model like this does often provide legitimate information, that information should always be verified through other trusted resources.
If ChatGPT cites a research paper, go and actually read the abstract.
You don’t have to be a pro at reading research, but you should be able to look elsewhere online and see if the ideas that are generated are worth legitimate investigation by an examiner during via a C&P exam.
This last bit of advice is my favorite, but all of the above tactics are ways to use technology to your advantage leading up to and during a VA C&P examination.
Armed with these insights on the disability exam process, learn to consider yourself an active collaborator before and during your C&P exam instead of simply subjecting yourself to the mercy of the process.
From telehealth examinations to patient portals, monitoring apps, the use of photographic evidence, and even the help of AI research assistants like ChatGPT, the opportunities are out there – it’s just a matter of using them!
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