VA Disability - Step 4: The C & P Exam

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What is the C & P Exam?

The Ratings Veterans Services Representative [RSVR] is a primary decision maker on your claim. Once you have filed your claim, a folder or file is created. Data, or evidence, is added to your file for consideration by the RSVR. Likely some past evidence exists in the form of a Service Medical Record [SMR]. Or you have records of diagnosis and treatment from civilian providers.

In addition, it's likely that the Veterans Service Representative [VSR] or the RSVR will request a VA contractor to examine you. The examiner is usually a physician, a registered nurse practitioner or a physician's assistant. 

You will get a notice telling you when and where your medical exam will be. This is called a Compensation and Pension Examination, often referred to as the C & P Exam.

How in depth is the exam?

The examiner will not treat you or order any medications. He may order lab work, x-rays and other such studies. The depth of the examination is determined by the VSR or RSVR's order, which is included in the exam request. The examiner has no authority to go beyond what was requested.

Frequently the examiner will not have your medical records or any other history. This is often the case when the VSR wishes to determine, for example, only the degree of a joint function, as in a knee injury. In that instance, the examiner won't consider your medical history or treatments over time. She will be looking for only the physical effects that are observable and measurable at that moment. The examiner may flex and rotate the knee, then record those motions for comparison to the norm. If there is scarring, crepitus (joint noise), swelling or redness, all of that will be noted in a report.

In other cases, the VSR or RSVR may request the examiner to review the medical record very thoroughly, to determine whether a condition originated during military service. For example, you claim a back injury. The SMR may reference a similar injury 30 years prior to the date of your claim. The examiner will be asked for an opinion as to whether your condition today is likely, or not, to have resulted from the injury in your SMR. Or he may report that the cause of your condition likely happened long after the expiration of your time in service (ETS) . This is sometimes referred to as a "nexus statement." It connects the condition you allege today with an event that happened many years ago.

Should I bring my file to the exam?

It's important to know and remember that the examiner does not make the decision on your claim. The RSVR will consider the examiner's report along with all of the evidence in your file. As you prepare for your exam, you may take copies of any notes or other documents that you believe are relevant. Then you may offer those to the examiner. But don't be surprised or offended if the examiner refuses to accept or review your papers. If her orders don't include an historical view, she isn't allowed to accept your evidence and won't be able to do anything with it in any case.

Whether or not to carry copies of files with you is often the topic of intense debate. Generally examiners are not required to review your records or files you may have with you. Their assigned task is to provide a snapshot of the moment. How far does that joint move? Do you walk with a normal gait? How large is the scar that troubles you? They only report on the degree of the disability at that moment, not anything about how it may have happened. That said, it often pays to be prepared and take anything with you that you think is relevant. Offer it to your examiner. If it's refused, don't argue and move on. If the examiner accepts and uses your paperwork, then you may have advanced your case a bit.

Be prepared and go with the flow. Be cooperative with your examiner. Your goal is for the examiner to write a report that agrees with your own conclusion about your condition. Expressing hostility, complaining about how terrible you're being treated or otherwise acting out your frustrations isn't going to help your cause.

What if I'm asked to perform maneuvers that cause me pain?

For example, the examiner asks you to extend your arm out straight in front of your body. You can politely inform the examiner that the pain will prevent you from completing that act. If the examiner attempts to assist you with the motion and you are positive that it will cause you pain, you can again politely tell the examiner that you can't allow that due to the harm it may cause you. It isn't the time or place to argue about it; a courteous explanation is all that's needed.

Can I have a witness or support person in the room during my exam?

Your examiner may or may not welcome family or friends to accompany you as you're being examined. You do not have the absolute right to be accompanied. Try arranging this beforehand with the VA Regional Office if you absolutely need this support. Otherwise, you may ask the examiner if your spouse may accompany you. If the examiner denies your request, don't argue the point. It isn't one you're going to win, and it may cause the cancellation of your exam.

What should I watch for during the exam? 

As you are examined, pay close attention to what the examiner does. Later you may not agree that you had a complete exam of all the relevant medical issues. In that event you'll want to be precise in detailing all you can about your exam. You may want to write down these details while they are fresh in your mind.  Keep your notes in your folder.

The examiner must follow VA-created guidelines; these are set out on worksheets. If you're sure that your examiner didn't follow those guidelines and your claim is later denied, you may want to raise  "inadequate examination" as a point of appeal.

What if I don't want to go to the exam?

VA may require a C & P exam at any time. You may not refuse a C & P exam or re-exam. Although you may feel that you have provided more than adequate evidence from private physicians, VA will usually insist on a C & P exam by one of their own examiners. Your benefits can be iinterruped or even terminated for failure to report for a VA exam. 

June 2010