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 had 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 asked for in many cases, but not all cases.
This article will explain what the C&P exam is, how it works, and 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 the veteran collects 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, are 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 decide on your disability claim.
Is it common that the findings from the C&P exam do not support your disability claim or reflect a lesser degree of disability than you think you have?
The truth is that there are frequently times when there is some difference of opinion between, for example, your treating physician and the health care professional conducting the C&P exam. However, you can do some things to challenge C&P exam findings within the disability claim process.
If you think you had an inadequate 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 the same way as another medical professional. In other words, you can challenge the C&P report created after the C&P exam 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 documents 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 and how frequent they are. If you know any triggers for your symptoms, include that too. Note how they affect your job, relationships with family and friends, and 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 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 to honestly discuss your condition – the good, the bad, and 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 you can 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 the examiner’s questions 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 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 prepared 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 typically 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 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’s 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. Ensure 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 specific 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?
The purpose of a C&P exam is to collect 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 to 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 review 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 required to make a reasonable determination of the origin and/or severity of your disability. The C&P examiner may not come to 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 the information 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.
Recommendations for treatment or mitigating your symptoms do not happen at a C&P exam. Your treating health care providers will continue to handle those issues 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 pretending 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 certain internal programming from being a soldier: you never complain, never succumb to weakness, and 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 concerning 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 a 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 are experiencing daily.
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, forms developed by the VA to guide the doctor while conducting C&P examinations. Using this formulaic process makes it 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.
Veterans can request their own physician using the Public Disability Benefits Questionnaire to conduct a C&P exam. However, it is discretionary with the VA whether they accept that on face value or still go ahead and schedule a C&P exam with their 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 a while 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 their 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, an immediate family member just died, or something substantial, let them know and be prepared to prove it.
If the VA considers your reason a “good cause,” 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.
You can appeal this decision by the VA within one calendar year of the date of the letter. You can appeal to 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 to reconsider 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 on what you are trying to argue on appeal. For example, if you argue that the C&P exam says “there is no documented history of the patient being treated for diabetes,” and you argue that “it’s on pages 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 the accurate information.
Remember that requesting a C&P exam is always for acquiring necessary information for the file, not to frustrate your schedule or punish you for appealing.
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