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What is The Importance of C&P Exams

What is The Importance of C&P Exams

What is a C&P Exam and Why is it Important?

A Compensation & Pension Exam (usually referred to as a C&P Exam) is an examination by a health care provider designated by the VA to evaluate and measure the extent of the disability a veteran has claimed when they filed a VA Disability Claim. It also may request a medical opinion to see if your disability stems from your time in the military. It is requested in many cases, but not all cases.

This article will explain what the C&P Exam is and how it works, as well as some helpful tips on navigating this step of your VA Disability Benefits Claim. 

Is a C&P Exam necessary for every VA Disability claim case? 

No. The goal of a C&P Exam is to gather information and the more information that is gathered by the veteran in advance, the less likely the VA will need additional information or a C&P Exam. With that said, however, the VA is likely to order an exam in most cases. 

A C&P Exam is nothing to fear, just another part of the process towards getting a full and fair evaluation of your disability compensation claim.

Is it common to fail your C&P exam? 

A C&P exam is not a “pass or fail” type of exam. The purpose of a C&P Exam is to gather information. As long as you show up for your appointment, be honest and straightforward with the health care provider doing the exam, and make sure they have your medical records in advance, the C&P Exam will generate a report that will be used by the VA when they make a decision on your disability claim. 

Is it common that the findings from the C&P exam do not support your disability claim at all, or reflect a lesser degree of disability than you think you have?

The truth is that there are frequently times where there is some difference of opinion between, for example, your treating physician and the health care professional conducting the C&P exam. However, there are things that can be done to challenge C&P exam findings within the disability claim process.

It is a good idea if you think you had a bad C&P examination you should immediately write out a statement identifying your concerns on a 4138 VA form as to their experience and submit it to the VA to become a part of your disability claim file

The VA may, after seeing that, schedule you for a new exam.

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

Directly, no. After the C&P Exam is conducted, an exam report will be generated that is added to your electronic claims file with the VA, and it, along with the rest of your file, will be reviewed and a decision rendered later.

Although you cannot “appeal” a C&P exam report directly, you can appeal the later decision by the VA on your disability claim. Sometimes that appeal will involve adding new information and medical records that perhaps the C&P examiner overlooked, didn’t see, or didn’t connect the dots in the same way as another medical professional has. In other words, the C&P report created after the C&P exam can be challenged in certain respects during an appeal of the overall rating decision on your disability claim.

What do you need to do to prepare for the C&P exam?

Make sure that your claims file is as complete as it can be.

If you have some new, non-VA medical records that have not yet been submitted to your claims file, take a copy of the records with you to the C&P examination.  You will also separately have to send them to the VA as the examiner will not be able to make them a part of your VA claims file.  

You should also spend a little time collecting information and writing it down. In the stress of an unfamiliar environment it is easy to forget things, so write them down in advance.

Make a list of all of your symptoms, how frequent they are, if you know any triggers for those symptoms include that too. Make note of how they affect your job, your relationships with family and friends, and your other activities. Include the symptoms that maybe others in your family don’t even know about – the sleepless nights, cravings for alcohol or drugs to numb yourself, intrusive thoughts you can’t seem to shake.

This is not the time to gloss over or power through these things – be honest with yourself and with the C&P examiner.

It is also helpful to talk with your spouse or other family members about observations they have about your symptoms that you may not have even realized you had. Encourage them also to discuss your condition with candor, the good, bad, the ugly.

Knowledge is better than just ignoring things and not allowing the C&P examiner, and the VA, to see what is actually going on in your life.

Make sure that you are able to go into the examiner’s office alone or with a friend or spouse. If you have children, make arrangements for them to be elsewhere during your appointment so you can have candid conversations with the health care provider. If you have a spouse or immediate family member that has intimate knowledge of your symptoms and history, you may want to have them along with you, but make sure the exam is focused on you, that you answer questions of the examiner to the extent you can, and that your support person contributes appropriately.

The examiner needs to understand you, your symptoms and your history so that they can put more context to the black and white paper record they have already reviewed.

List of things you need in order to prepare for a C&P exam

There really isn’t anything you need to prepare for a C&P exam except, perhaps, as suggested, notes of your symptoms or anything you want to make sure you tell the examiner.  Remember they are there for exam purposes only and not treatment.

You should probably bring your C&P exam scheduling letter for reference purposes, wear comfortable clothes and shoes, be ready to answer questions about your health, and be ready to submit to a basic physical exam, and possibly get x-rays, lab work, or other similar testing relevant to your claim. 

Do not go dressed to impress the C&P examiner. They want to see you as you usually look, as you usually present yourself to the world. This is part of their analysis. 

Consider bringing along your spouse or someone who spends a lot of time with you and daily sees your condition. They might be able to shed more light on your condition, and also to check you when you try to minimize your symptoms because you are trying to be tough.

How do I set up a C&P exam? 

You don’t need to set up a C&P exam. Staff at your local VA medical center or a local doctor office they partner with will contact you to set up an exam if one is needed. This notice will come by letter with a pre-designated date, or you can call and reschedule a different date and time if that one won’t work. Make sure the VA has your current address, phone number, and email address to facilitate their efforts to contact you and make arrangements. 

Don’t delay an appointment if you can avoid it. Although the VA or doctor’s office may let you, it will delay the processing of your disability claim

Who performs a C&P exam?

C&P examinations are conducted by a doctor (or practitioner) designated by the VA, either a VA doctor or one contracted by the VA.

The general practitioner will be selected for many conditions, but for certain conditions you may be scheduled with a specialist in that field to conduct the C&P exam. If the claimed disability is a vision, hearing, dental, or psychiatric condition, a specialist must do the evaluation.

The inconvenient result of that requirement to have a specialist conduct the C&P for certain conditions, and the fact that the doctor should examine every condition that is part of the veteran’s disability claim, sometimes result in more than one C&P exam being scheduled for the same claimant.

For example, if you have service-connected vision problems and PTSD, you may have to be evaluated by two separate doctors.

What happens at a C&P exam?

A C&P exam is for the purpose of collecting information about your physical (and, if applicable, mental) condition to help evaluate the etiology, existence and severity of the disabilit(ies) you have claimed in your VA disability claim.

Although the C&P exam may be similar in some ways to a regular doctor visit, it does not result in any treatments or recommendations for treatment, nor will you be given referrals for other medical professionals. 

The C&P exam is really a two-part process, and you are only required to be present for part of it. The examiner will spend some time reviewing your medical file to see your history, diagnoses by other doctors, and treatments.

From this medical file review, the examiner will determine what portions need to be confirmed by talking to you or by performing certain tests, and what is needed to make a reasonable determination of the origin and/or severity of your disability. The C&P examiner may not come to all of the same conclusions as other doctors who have treated you.

The second part – the C&P exam you may have to appear for – is all about getting information from you, what you have to say, and what the results of basic physical tests or lab work show. 

The length of a C&P will depend on the nature of your disability claims and whatever information is needed to create a reasonably complete picture for the C&P examiner. In our experience, expect an hour or less for most C&P exams, but understand that some may take a bit longer. Some illnesses and disabilities have levels of complexity that other simply injuries or conditions do not have. 

What does not happen at a C&P exam is recommendations for treatment or mitigating your symptoms. Those issues will continue to be handled by your treating health care providers, whether at a VA medical center or elsewhere.

What is the worst thing I can do at a C&P exam?

A common error at a C&P exam is to pretend that things are fine when they are not. We understand that this is a struggle. Even though you may have been discharged from the military decades ago, there is a certain internal programming from being a soldier that you never complain, you never succumb to weakness, you never say you can’t do anything.

While that served its purpose while you were a service member, it is the wrong approach to take in a C&P exam. 

If you were “okay” or had “no complaints” you would never have filed your claim for VA disability benefits in the first place. You have one or more physical or mental conditions that drove you, despite the aforementioned toughness, to acknowledge you needed some assistance with respect to a service-connected condition. Do not take the approach of the Black Knight in Monty Python’s Search for the Holy Grail who just lost an arm, but responds “‘tis but a scratch.”

More often than you might expect, veterans go to a C&P exam and tell the doctor they “are fine” even though they have been unable to hold down a job since discharge because of PTSD symptoms, they cannot work any job involving more than 15 minutes of standing because they broke their back in a humvee accident, or can barely see even with strong corrective lens.

There is no drill sergeant at a C&P exam. Take that short window of time, and your prep time in advance, to acknowledge what you really are experiencing on a day to day basis.

On the flip side, don’t exaggerate your symptoms. Don’t go scouring the internet for what symptoms sound good. The truth will come out sooner or later if you are trying to make yourself look more seriously disabled than you are.

How does the C&P examiner know what to check?

The collection of information within a C&P exam is guided by Disability Benefits Questionnaires which are forms developed by the VA to guide the doctor while he or she conducts C&P examinations. By using this formulaic process, it is easier to determine a rating of the disability.

These questionnaires were previously only semi-public, used by the VA and C&P examiners, but as of March 2021 a Public Disability Benefits Questionnaire is available to the public. In other words, you can know in advance what the examiner is looking for during the exam.

A veteran can request their own physician using the Public Disability Benefits Questionnaire to conduct a C&P exam, however, it is discretionary with the VA as to whether they will accept that on face value or still go ahead and schedule a C&P exam with their own designated physician.

These PDBQ questionnaires are not mandatory for use with your own doctor, but if you do, be sure to select your doctor with the most information about your condition.

What if I miss my C&P exam appointment or need to reschedule?

Whenever possible, try to adjust your schedule to be able to appear for the initially scheduled C&P examination date. Sometimes it takes awhile to reschedule and, if the VA has requested a C&P exam, they will not proceed to the next steps of processing your disability claim until it is completed and the C&P examiner has issued his or her report. 

That being said, sometimes things happen. As soon as you are aware of a potential scheduling problem with your C&P exam, directly contact the medical office where it is scheduled and try to work with them to reschedule as close to the original date and time as possible.

Also tell them why you need to reschedule – candor goes a long and necessary way under these circumstances.

If you have missed a scheduled appointment, the VA is a little forgiving, but not too forgiving. Contact the VA as soon as possible and be ready to explain your good reason for missing the appointment. If you were in a car accident on the way to the appointment, or an immediate family member just died, or something substantial, let them now and be prepared to prove it up.

If the VA considers your reason to be “good cause,” then they will work with you to reschedule.

What happens after the C&P exam?

After you have your C&P exam the examiner will create a report that is forwarded to the VA and it will be part of the entire package of information that is evaluated by VA claims examiners who will decide (1) whether you have a disability; and (2) if so, what your disability rating is. Disability rating ranges from 0-100% in increments of 10 points. This rating, in turn, determines the amount of benefits you will receive.

You will not be separately sent a copy of the C&P examination report, however, you can get a copy of the final report by contacting the nearest VA office. 

When the file review, including the C&P exam report, is complete, the VA will send out a written Decision Notice explaining what their findings are and, if they grant the disability claim, will provide a disability rating and an explanation of the dollar amounts of benefits based on that information.

This decision by the VA can be appealed within one calendar year of the date of the letter. You can appeal the factual findings, the disability rating, and a few other aspects of a decision notice. This is also the point (if you want to consider an appeal) where attorneys can get involved to assist you in creating your best argument for the VA reconsidering their decision, including the severity of your disability.

If I appeal the VA’s disability claim decision, will there be another C&P exam?

Sometimes, but not always. It depends what you are trying to argue on appeal. For example, if your argument is that the C&P exam says “there is no documented history of the patient being treated for diabetes” and your argument is that “it’s on page 52 and 67 of the medical records we already provided” that might not require a new C&P exam. If your argument is that the C&P examiner mistakenly examined your right eye instead of the left eye in which you have impaired vision, that might require a new C&P exam to get all of the accurate information.

Remember that the purpose of requesting a C&P exam is always for acquiring necessary information for the file, and not to frustrate your schedule or punish you for appealing.

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Has your claim for VA Disability Benefits been denied or is at a lower rating than you think it should be? Click here for a free consultation from Veterans Law Group, a law firm that spends 100% of its time helping veterans get all of the VA Disability Benefits they are entitled to.

 

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