A Military Veterans Guide To Disability Compensation and Pension Benefits - C&P Exams

This is a part of a larger knol that is published to share knowledge about earned benefits from the Department of Veterans Affairs.

This is a work in progress and is not complete unto itself.

If you arrived here without entering the front page, "A Military Veterans Guide To Disability Compensation and Pension Benefits", please return to that page to read co-author's biographies and our disclaimer.

The C & P Exam

The Ratings Veterans Services Representative (RSVR) is a primary decision maker of the outcome of your claim for VA disability compensation benefits. Once the veteran has filed for the compensation benefit a folder or file is created and data...evidence...is added to the file for consideration by the RSVR.

The condition claimed will likely have some past evidence in the form of a Service Medical Record (SMR) or records of diagnosis and treatment from civilian providers. No matter the amount of evidence you have, it's likely that the Veterans Service Representative (VSR) or the RSVR will request that a VA contractor perform a C & P exam on you. The examiner is usually a physician or registered nurse practitioner or a physician's assistant.

The examiner will not treat you or order any medications. Lab work, x-rays and other such studies may be ordered by the C & P examiner.

The depth of the examination is determined by order of the VSR or the RSVR and is included in the request for examination. The examiner has no authority to go beyond what is requested. Frequently the examiner will not have your medical records or any other history available. That is often the case when the VSR only wishes to determine the degree of function of a joint, as in a knee injury.

In that instance, the examiner won't consider that the history or treatments over time is of any particular importance. She or he will only be looking for the physical effects that are observable and measurable at that moment. The knee may be flexed and rotated so that the examiner can 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 that the examiner give the medical record a very thorough review to determine whether or not a condition originated in the time of military service. A claimed back injury may have a reference of a similar injury in the SMR of 30 years prior to the date of the claim. The examiner will be asked for an opinion that will state that the condition of today is or is not likely to have resulted from the injury in the SMR or if it is a condition that is of different origin and likely happened long after the ETS.

This is sometimes referred to as a "nexus statement" and may connect the condition you allege today with an event that happened many years ago.

It's important to know and remember that the examiner does not make the decision of an award of disability compensation. The report that the examiner makes will be considered by the RSVR along with all the other accumulated evidence in the file.



As you ready yourself for your examination, you may take copies of any notes or other documents that you believe are relevant. Then you may offer those to the examiner. Don't be surprised or offended if the examiner refuses to accept or review such paperwork. If their orders don't include that as a part of their assignment, they aren't allowed to accept it and won't be able to do anything with it in any case.

Whether or not you should carry copies of files with you is often the topic of intense debate. Examiners are not generally required to review your records or and 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.

However, 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 with that 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 to have the examiner 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.

If you're asked to perform maneuvers that cause you pain, for example; actively extending your arm out straight in front of your body, you should politely inform the examiner that the nature and severity of 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 should 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.

Public Domain. South Vietnam - Medical evacuation patients on the deck of the Amphibious assault ship USS Tripoli (LPH-10) await transfer to the 22nd Casualty Station in Danang from which they will be sent to the States. Wounded Marines who cannot be returned to duty, or who require more than six days of hospital care are removed from the Tripoli and returned to the USA., 07/1967


Your examiner may or may not welcome family or friends to accompany you as you're being examined. You do not have absolute rights to be accompanied unless you've established that beforehand with the VA Regional Office that scheduled your exam. If you would like to have your spouse in the room with you, ask the examiner for approval. 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.

As you are examined, pay close attention to what the examiner does during the process. Later, if you don't agree that you had a complete examination of the relevant issues, you'll want to be precise in detailing all you can about your exam.






The examiner should follow guidelines that are established on worksheets. If you're sure that your examiner didn't follow those guidelines and your claim is later denied, an inadequate examination may be a point of appeal.

VA may require a C & P exam at any time. "Where there is a claim for disability compensation or pension but medical evidence accompanying the claim is not adequate for rating purposes, a Department of Veterans Affairs examination will be authorized." You may not refuse a C & P exam or reexamination. "Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations."

Although you may feel that you have provided more than adequate evidence from private physician sources, VA will usually insist on a C & P exam by one of their own examiners.

Failure to report for Department of Veterans Affairs examination may result in an interruption or even termination of your benefits.

Comments


Anonymous

C & P exam question

GREAT site-
Jim-I have a vet with a very provocative CUE claim.

The VA misapplied 38 USC 1111, and 38 USC 1153 in a 1969 denial, which also manifested the outcome of 2 more denials years later,

He was awarded for same disability 2 years ago by the BVA.

The VA also used one part of a MEB report to deny his claim whereas the part they ignored supported it.

In any event-the BVA noted that a VA examiner in 2005,via an addendum to his C & P "never considered whether the veteran's depressive/bipolar disorder began in service."

Since every C & P exam calls for the "nexus" statement I want to use the AMIE worksheet used in March 2005 as evidence but the mental disability worksheets were changed in 2007.

Then again- would I actually need the 2005 blank worksheet as evidence as the "nexus " statement is so fundamental to the claims process, that I could shape the CUE into violation of the M21-1 regs that call for the C & Ps to be performed according to the worksheets?

This is just one of the potential CUEs in the older decisions.It isnt resting on a question of how medical evidence was weighed- and of course the BVA award granted the claim-but in my opinion this is a clear and unmistakable error for an examiner- even in an addendum, per the BVA to have not made any nexus statement at all.

The veteran's claim was as valid for award in 1969 as it was when BVA awarded it.
Those 1969 VA decision (I have copy of his opriginal decision) sure were lacking in Reasons and BAses in such a way that a veteran could even appeal some of them.

As bad as things are today in the claims process- the SOCs are by far better then they used to be and they contain the keys to overcoming the denials.

He didnt even get a C & P when they denied in 1969.

Thanks for any thoughts here.

Berta Simmons www.hadit,com

Last edited Sep 8, 2009 9:26 AM
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Anonymous

C & P exam

If the C& P examiner only looks for 'physical' type of things while in his presence. I strongly believe that is unfair. An example being........the last time I had a C & P exam and one of the issues was respiratory problems for patroling in small boats in the smoke flume in 1991 (Persian Gulf), I took the appropriate meds in the AM before the C & P exam, like I have to do every AM. Nothing is going to show up or be visible to the C & P person if I took the appropriate meds. That part of a C & P exam is very unfair and doesn't show the proper problem because of the meds taken. In fact, this particular PA gave me a list of things I should be taken when that was not his job. I so related that to the Patient Advocate and another exam was scheduled......

Last edited Jul 13, 2009 3:02 PM
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Anonymous

What to do?

If the examiner orders X-rays and the films show what the vet is saying causeing his pain yet the X-ray dr fails to report such evidence in his report what should one do next ? After having such x-ray both the tech and i looked over the films and we both saw these wires that were left in me yet the dr failed to mention this in his report.

Last edited Oct 15, 2008 3:54 AM
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Jim Strickland
Jim Strickland
Veteran
Bloomingdale, Georgia, USA
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