Our PTSD Guide will explain what PTSD is (Part 1), what is needed to get PTSD service-connected (Part 2), what to expect from a Compensation & Pension (C&P) exam for PTSD (Part 3), how PTSD is rated by the VA (Part 4), how to receive Total Disability Based on Individual Unemployability (Part 5), what to do after the VA decision (Part 6), and helpful resources (Part 7).
What is a VA PTSD C&P Exam?
After a Veteran files a claim for PTSD with the VA, they will then have the Veteran complete a C&P Exam. During the C&P exam the VA will verify the Veterans diagnosis for PTSD, even if the Veteran has already had a qualified medial professional properly diagnosis them with PTSD. This is just part of the qualification process to receive benefits from the VA.
The C&P exam will also determine if the Veterans PTSD is service-connected and will also asses the severity of the Veterans PTSD. Even if the Veteran is being treated and diagnosed by a VA doctor the Veteran must attend a C&P exam.
Why does a Veteran have to do a VA C&P exam for PTSD?
The C&P exam is to verify that the Veteran has PTSD. If the Veteran has been receiving mental health treatment at any of the VA medical facilities, the doctor that the VA has assigned to do the C&P exam will not be the Veterans regular treating doctor.
Even if a Veteran has been being treated by a VA doctor for years and that VA doctor diagnosed the Veteran with PTSD after their in-service military trauma, the VA will have the Veteran complete a C&P exam with a different doctor to have their PTSD evaluated per the PTSD rating criteria. The VA doctor who does the C&P exam any not agree with the Veterans PTSD diagnosis from their doctor.
How does a VA C&P examiner approach the PTSD C&P exam?
It is extremely important that the Veteran be honest and open with the VA C&P examiner about what in-service event caused the Veterans PTSD and how it is affecting them on a daily basis. The VA will normally give more weight to the C&P examiners diagnosis then the Veterans treating doctor. The VA will more then likely deny the Veterans PTSD claim if the C&P examiner puts down that the Veteran does not meet the diagnostic criteria for PTSD. They is why it is extremely important for the Veteran to be honest and open during the C&P exam.
There are times when the VA C&P examiner will diagnosis the Veteran with a different mental health condition. When this happens, the VA will deny the Veterans PTSD claim. The VA considers the C&P examiner's opinion to have more wight.
If the Veteran has more then one mental health condition, how will that affect the Veterans C&P exam?
Veterans that have more then one mental health diagnosis can have problems telling the different mental health conditions apart. The reason for this is because many of the mental health conditions share symptoms. One example is when a Veteran with PTSD also has symptoms of depression and anxiety. The Veteran who is being treated by the VA for PTSD might not be diagnosed with PTSD by the C&P examiner.
The VA C&P examiner might say that the Veteran has an anxiety disorder and not a PTSD. Since the VA rates all mental health conditions under the same rating formula, sometimes the actual diagnosis does not matter as much as the weight the VA C&P examiner gives the symptoms for the rating.
There are many Veterans who have PTSD that want the VA to recognize their PTSD. The Veteran wants their medical records to show that their PTSD is service-connected, and that its not just general anxiety, depression, or another mental health condition.
What does VA use to determine a Veteran has PTSD?
The criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is what the VA uses to diagnosis the Veteran with PTSD. The Veterans PTSD diagnosis has to meet all of the criteria in the DSM-V for the VA to validated the Veterans PTSD diagnosis.
It is very important for the Veteran to document all of their PTSD symptoms. The Veteran needs to be honest and open with their doctors and the VA doctors about their PTSD so the VA can properly understand how the PTSD is affecting the Veterans life.
What does a Veteran need to do at the VA C&P exam for PTSD?
A Veteran can take a witness with them to their VA C&P exam. The witness can be their spouse, an adult child, family member, or even a close friend. There are three main reasons why it is a good idea for the Veteran to bring a witness along with them.
1. The Veteran does not always fully understand how their PTSD affects them. The witness is able to talk about how the Veteran interacts with others, which is a major part of PTSD.
2. A C&P exam can cause a Veteran to have more stress then normal. A witness can help the Veteran hand their stress about the C&P exam.
3. When under stress there is the opportunity to forget important details. A witness can help the Veteran remember the details.
The Veteran should take their witness into the C&P exam room with them if possible. If the examiner denies the Veterans request to allow the witness to be in the room with them, the Veteran has to complete the C&P exam. If the Veteran does not follow thru and complete the C&P exam the VA can automatically deny their PTSD claim.
Why should a Veteran have their symptoms written down before their C&P exam?
When a Veteran goes to their C&P exam for their PTSD they do not need to bring an itemized medical history or their complete medical records. The C&P examiner will not have the time to review it. But the Veteran should bring a written list of their PTSD symptoms so they do not forget any, even the hard to talk about and embarrassing symptoms! The C&P exam is the Veterans chance to show the VA how their PTSD is affecting their life.
A Veteran needs to tell the C&P examiner every detail, even if they do not think it is important. The VA C&P examiner needs all the details in order to make a proper decision about the Veterans PTSD claim. You do not know what details could be the key to your claim.
What type of symptoms should a Veteran bring up during their PTSD C&P exam?
Nightmares are one of the most intrusive symptoms of PTSD. As bad a nightmares are they fall under the 30% rating of the VA rating formula. This is one of the reasons why it is so important for the Veteran to be open and honest with the C&P examiner about all of their symptoms. Symptoms like dealing with authority or anger along with nightmares and other symptoms can move the Veteran into a higher rating for their PTSD.
The frequency and intensity of a Veterans symptoms are the true measurement of the severity of the Veterans PTSD. A Veterans spouse, adult children, other family members, close friends, and caregivers can write a statement about what they observe when the Veteran is interacting with others.
What is a VA PTSD DBQ?
A Disability Benefits Questionnaire (DBQ), per the VA, help collect necessary medical information to process the Veterans disability claims. Veterans can use these forms to submit medical evidence from their health care providers. This information helps to support the Veterans claims for disability benefits.
The VA has been requesting that all C&P examiners use the DBQs to help in the process of streamlining the VA claims process. The VA created the DBQs to assist with not only the streamlining of the claims process but to keep the VA claims process consistent. The VA says that there are different DBQs for the majority of the disabilities including PTSD. The DBQs might not be available to the public, but the Veteran can get an idea of what a PTSD DBQ entails.
The Veteran should always ask for the C&P examiner's business card and contact information when the exam is completed. By having the contact information of the C&P examiner the Veteran can then request a copy of their C&P exam report. The Veteran will want to check to make sure that the C&P examiner is also the person who wrote up the final report.
What should a Veteran do when attending a C&P exam for an increase in their PTSD rating?
After the VA has service-connected a Veteran for PTSD the next thing to focus on is getting the proper rating for their symptoms. The VA ratings for mental health vary from 0% to 100%. Veterans with PTSD frequently become socially isolated due to the PTSD symptoms causing relationships issues with people in the Veterans lives. The Veterans PTSD can also lead to occupational and social issues that can prevent the Veteran from being able to maintain gainful employment or work. It is just as important that the VA raters get the rating correct for the Veteran as it is important to show that the Veterans PTSD is service-connected.
When a Veteran is filing a claim for an increase to their PTSD rating the VA will send the Veteran to another C&P exam. The new C&P exam will also have more psychological testing.
What kind of tests do the VA PTSD C&P examiners use?
There are several different tests that the VA PTSD C&P examiners can use. One of the test that the VA PTSD C&P examiner might use is the M-FAST (Miller-Forensic Assessment of Symptoms). The M-FAST test consists of a 25-item screening interview over seven scales or categories. The seven scales or categories are: reported vs. observed symptoms, extreme symptomatology, rare combinations, unusual hallucinations, unusual symptom course, negative image, and suggestibility. While the M-FAST was created to be used alone it can also be used as a part of a larger assessment that the VA C&P examiner does. When a Veteran score is higher then a 6 on the M-Fast additional tests such as the MMPI-2 (Minnesota Multiphasic Personality Inventory-2) may be done.
What should a Veteran do after their PTSD C&P Exam?
When the Veteran's PTSD C&P exam is completed they should and any witness they have brought with them write down their thoughts about the C&P exam right away so they do not forget any details. The type of things that should be noted by the Veterans witness are the following:
- How long the Veterans C&P exam took
- If the C&P examiner would allow the Veterans witness to go back with the Veteran and provide their observations of the Veteran
- Were there any changes in the Veteran’s mood or behavior before and after the exam was conducted
- any other observations that they have about the facility and its employees
The type of things that the Veteran should note are the following:
- Was the C&P examiner thorough
- Was the Veteran allowed to express all of their thoughts and symptoms about their PTSD during the exam
- Did the C&P examiner write down the Veterans responses and was the C&P examiner attentively listening to the Veterans concerns
- Did the C&P examiner show any negative opinion to the veracity of the Veterans in-service event, the Veterans symptoms, or the strength of the Veterans claim
The more detailed the Veteran and the Veteran's witness can be about any issues with the C&P exam the better. If the VA denies the Veteran's PTSD claim the Veteran can show the VA documentation about the inadequate C&P exam.
The Veteran's representative or the Veteran themself can file a response to the VA denial challenging the results of the C&P exam. When challenging the VA denial can result in a new C&P exam by a different C&P examiner or the VA could request that the C&P examiner clarify their opinion.
For a Veteran to challenge a VA denial because of the results of the C&P exam the Veteran they would need to do the following"
- The Veteran must provide enough details describing their symptoms
- The Veteran must provide what their in-service stressor is and sufficiently describe the in-service stressor
- The Veterans must recognize and reconcile the previous reports that prove their PTSD diagnosis
- The Veteran must explain why the newest C&P exam report is not supportive of their PTSD diagnosis and why it is incorrect
If your a Veteran or you know a Veteran that is suffering with PTSD, remember that there is nothing shameful about PTSD. PTSD is a disease that can be treated with proper care and treatment. Continue to Part Four, Service-Connected PTSD Ratings, to learn more about how to get PTSD service-connected in order to receive the VA disability benefits you have earned.
PTSD Guide
