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Do I Have to Have Another C&P Exam If My Claim is Denied

Do I Have to Have Another C&P Exam If My Claim is Denied

So you or your loved one recently had a C&P exam (Compensation & Pension Examination) and then got a disability claim denial or disability rating below what was expected. Perhaps the C&P exam report reflected information you think is inaccurate or incomplete.

How can this be fixed? Can there be a second C&P exam to make corrections?

This article explains how C&P exams work, how they factor into VA disability claims decisions, and what you can do about a less-than-optimal result after a C&P exam. 

What a C&P exam is and why it is important

A Compensation & Pension Examination (C&P exam, for short), is a process whereby the VA requests a veteran who has made a disability claim appear and be examined by a medical professional of the VA’s choice. These evaluations are conducted by VA doctors, or other medical professionals who are contracted with the VA, not your regular doctor. 

The purpose of the C&P exam is different from a regular doctor visit. They are not engaged in a diagnostic or treatment process with you, but instead will be asking you questions and doing medical evaluations to see if your actual condition matches up with the disability claim you have made and your medical records. Furthermore, they are evaluating how serious your disability is. 

After the C&P exam and a review of your medical records, the C&P examiner will create a report documenting their conclusions and that report will be sent to the VA and become part of your disability file. The C&P exam report will be an important factor in the decision-making process on your claim. 

C&P exams are often requested by the VA, but not always, depending on the development of your VA claim. Sometimes more than one C&P exam is scheduled as when the nature of the disability requires different specialists to evaluate them.

How long does it take to get a disability claim decision after a C&P exam

The VA estimates that a veteran will get a decision on their disability claim approximately 3-4 months after the C&P exam has been completed. If you have been requested to participate in more than one C&P exam (such as with different specialists), plan on 3-4 months after the last of these examinations.

Is it common for C&P exams to result in disability claim denials?

People sometimes ask whether it is possible for C&P exams to be denied, but that is a misunderstanding of the process. C&P exams are a fact-finding, investigative process and the report generated by the examiner becomes part of the decision making on a VA disability claim. Disability claims are either granted (the VA agrees that the veteran has a disability) with a disability rating assigned (a rough measurement of the severity of disability on a percentage scale from 10%-100%) or denied. This is not the end of the process, though. A veteran can appeal a denial or the ratings decision though the VA claims appeal process.

Is it common for the C&P exam to be a key piece of evidence leading to a denial of a disability claim, or a lower-than-expected disability rating? Sometimes, but there are things that can be done to counteract that, such as submission of additional medical information and doctor’s opinions about your condition, something that can be done during an appeal of the Notice of Decision letter issued by the VA.

Do I have to have another C&P exam if my disability claim is denied? 

Maybe. Remember that C&P exam paperwork (or report) is not, by itself, a denial of your VA disability claim, but it certainly factors into the decision-making process. If your disability claim is denied, whether as a direct result of the C&P exam findings or for other reasons, you have one year from the date of the Notice of Decision letter to file an appeal. 

The first thing you should do if you are dissatisfied with the Notice of Decision on your VA disability claim is to contact a law firm that specializes in VA disability claims appeals. While almost all VA disability claims are prepared and filed by veterans themselves, lawyers can and do get involved in appeals and their fees are usually paid when you get a favorable ruling and an award of compensation benefits. 

A veterans disability claims appeal attorney will be able to review your claims file and resulting decision with an eye towards corrections that can be made, or holes in evidence that need to be filed, in order to give the VA sufficient factual basis to grant your claim or increase your disability rating.

Your appeals attorney may send you to a specialist to get more information and evaluation needed to support your appeal. Likewise, the VA may request another C&P exam during the appeal process when they feel they need additional information. This is not a penalty for an appeal, just part of the process of evaluation. Also, the VA may request a fresh evaluation of a condition that is likely to have changed, for better or worse, since the prior C&P. 

Can I improve the results of my C&P exam? 

People sometimes ask “can I improve the results of my C&P exam?” and the answer is technically “no.” However, the results of a C&P exam can be supplemented by an evaluation by another doctor, either one the veteran hires independently or if the veteran demonstrates that the initial C&P exam was insufficient or done improperly.

Write down notes right after your C&P exam while everything that happened is fresh in your memory. C&P examiners are not perfect and sometimes they don’t ask all of the necessary questions. Did they ask you about your pain levels in different circumstances? Did they inquire about whether your symptoms interfere with your ability to work? Did the examiner seem to have reviewed your medical records in advance and follow-up on information there, or did they seem a little lost? Did the examiner seem to have in-depth knowledge about the disability you have already been diagnosed with? Did they stick with collecting information from you, or did they stray into lectures about what treatment you should do?

If the C&P examiner didn’t thoroughly do their job, you can request a second C&P exam, but it may make the most sense to have an independent medical examiner. This isn’t about shopping around for an opinion that you like, its about getting a complete evaluation of all of the necessary information. Hopefully a more thorough examination will result in an improvement of the VA disability claim decision, on appeal if not initially.

Is it possible to appeal the results of a C&P exam? 


No, but it is possible to appeal the results of a VA disability claim decision that may have been based on C&P exam findings. You have one year after the Notice of Decision letter to file an appeal

Keep in mind that a C&P examination is one step in the process of collecting information that the VA will use to evaluate your VA disability claim application. The better the information they receive, the more likely they will render a decision that is appropriate in view of your service-connected disability. The VA isn’t perfect, but the appeals process allows for the correction of many types of errors, including C&P exam findings that might not be as thorough as they could have been.

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If you believe that the VA improperly denied your disability claim, or underrated your disability, whether because of a C&P exam report or other reasons, see if Veterans Law Group can help. Veterans Law Group has handled thousands of veteran disability claim appeals; it is all that they do.

 

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