You’ve applied for disability compensation or pension, and the VA is processing your claim. Sooner or later, you’ll almost certainly get a letter or telephone call asking you to report for a Compensation and Pension examination—a “C & P exam”—usually at a VA hospital or VA clinic. If you have a number of disabilities, you may be asked to report for more than one exam.
The doctor’s report goes to the VA Regional Office, where your claim for benefits is processed. It’s the Regional Office, not the doctor, that decides whether you’re entitled to disability compensation or pension. At a C & P exam, you won’t receive treatment or medication. Instead, the doctor will focus upon evaluating your medical conditions.
If your condition is psychological, the doctor will ask questions and give you an opportunity to describe what you’ve been experiencing.
Sometimes the doctor will also ask you to complete a few standard psychological tests. (For example, the doctor may read you a list of words to see how many you can remember five minutes later.) There’s no need to worry about these tests. They’re routine, and they’re a minor part of the exam.
If your condition is physical, the doctor will examine you for that condition, asking questions, conducting standard medical tests, and ordering lab work, as necessary.
The doctor will then prepare a report. Typically, the report will summarize your medical history, describe your current symptoms, and assess their severity. The report may also include the doctor’s professional opinion about whether your disabilities are related to your military service. (Sometimes there’s no question that the disabilities are related—and if you’re only applying for pension, it doesn’t matter whether they’re related or not.)
The doctor’s report goes to the VA Regional Office, where your claim is processed. It’s the Regional Office, not the doctor, that decides whether you’re entitled to disability compensation or pension. And it’s the Regional Office, not the doctor, that determines the percentage disability rating.
There’s no question that the C & P exam is a key factor in the VA’s decisionmaking process. But it’s not the only factor. The VA will base its decisions upon all the evidence that’s been gathered, not just the report of the C & P exam.
VA hospitals and clinics use one computer system; VA Regional Offices use another. The two systems are separate. Always make sure that both computer systems show your current mailing address and current telephone number; otherwise, you may not receive notice of your C & P exam. Here’s why.
Make certain the VA Medical Center has your current address and telephone number. When the Regional Office decides that an exam is needed, it alerts the VA hospital or VA clinic where the exam will take place. To notify you of the exam, the hospital or clinic generally retrieves your address and telephone number from its own computer system, not from the Regional Office system.
If you fail to show up for the exam, you may or may not be able to get it rescheduled by calling the Compensation and Pension unit at the VA hospital or VA clinic. The unit’s telephone number is usually listed in the letter notifying you of the appointment.
If the C & P unit is unable to reschedule the exam, contact the Regional Office—but be prepared for several months’ wait before you get a new appointment date. In some cases, the VA will deny your claim because you didn’t report for the exam. If this happens, it could be many months—or occasionally even years—before the exam is rescheduled.
An important note: you’re the only person who’ll receive notice of the upcoming exam. As soon as you receive the letter or telephone call, be sure to tell your representative or attorney. He or she may want to talk with you before the exam.
As the Regional Office processes your claim, it enters all of the records it receives—including medical records—into your individual Claims Folder, or “C-file.”
When it’s time for your C & P exam, the Regional Office is supposed to send your entire C-file to the C & P doctor, and the doctor is supposed to review it. If the doctor fails to review the file, the exam is considered “inadequate.”
If there’s a document that’s crucial to your VA claim, bring a copy with you to the exam. Most of the time, the Regional Office does forward the C-file to the doctor. Occasionally it doesn’t. If the first words out of the doctor’s mouth are “I don’t know why they’ve sent you to see me,” you’ll know there’s a problem.
What should you do in this situation?
Let’s say that you’ve received medical care from the VA. If your C & P exam is conducted at a VA hospital or VA clinic, your VA treatment records—or at least some of them—may be accessible on a computer terminal in the doctor’s office. They could give the doctor some idea of your medical conditions.
Tell the doctor that you’ve been seen at the VA. (But keep in mind that you or your advocate may later need to challenge the adequacy of the exam, because the doctor wasn’t able to review your C-file.)
There are several other potential problems you should know about. Even if all of your VA treatment records are available on the computer terminal, they may not tell the whole story. Let’s say that you’ve been treated by a private, non-VA doctor, and that you’ve submitted the doctor’s records to the Regional Office. Without your C-file, the C & P doctor won’t have access to these records. The same is true of documents such as your PTSD stressor statement, because they won’t be available on the terminal.
Even if the doctor does have the C-file, it probably won’t contain any documents that you submitted to the Regional Office shortly before the day of the exam. It usually takes the VA at least a few weeks to enter documents into your C-file.
If there are documents that are crucial to your VA claim, bring copies with you to the C & P exam and hand them to the doctor. This is particularly true of documents that won’t be available on the doctor’s computer terminal, and documents that may not yet have been entered into your C-file. But bring only the most essential documents—no more than 20 or 25 pages, if possible. Few doctors enjoy being asked to comb through hundreds of pages of records!
If any of the documents have not yet been submitted to the Regional Office, don’t count on the doctor to do it for you. Submit them yourself, as soon as possible.
One final wrinkle: not all C & P exams take place at VA facilities. If you live far from the nearest VA hospital or VA clinic, you may be asked to report to a private doctor, who’ll conduct your exam under contract with the VA. This doctor won’t be able to retrieve your VA treatment records from a computer terminal. If the VA hasn’t given the doctor all the materials you needed for an “adequate” C & P exam, the exam will need to be rescheduled.
Open up. If you don’t say it, the doctor won’t report it, and the Regional Office won’t know about it. Most Compensation and Pension examinations are routine: you go in, you see the doctor, and you leave. But there’s no question that other C & P exams are more difficult.
For example, if your claim is for PTSD, you’ll be asked to sit down with a stranger—the C & P doctor—to talk about events that you may not even wish to think about. It may help to keep in mind that you won’t be talking to the man in the street—you’ll be talking to a professional, someone who understands PTSD and may well have treated many veterans suffering from PTSD.
Even if you expect that your exam will be routine, it’s normal to be anxious beforehand. It’s only a doctor’s appointment, but it’s also a new experience, and there’s income at stake.
Our advice is simple: after the exam, tell your representative or attorney how it went—and then put the exam behind you. Don’t waste time second-guessing yourself. You did the best you could, and in all likelihood you did well enough.
This memorandum provides general information only. It does not constitute legal advice, nor does it substitute for the advice of an expert representative or attorney who knows the particulars of your case. Any use you make of the information in this memorandum is at your own risk. We have made every effort to provide reliable, up-to-date information, but we do not guarantee its accuracy. The information in this memorandum is current as of December 2012.
© Copyright Swords to Plowshares 2016. These materials are the property of Swords to Plowshares and are made available at no charge. For parties interested in using or distributing these materials, please note that no alterations are permitted and proper attribution must be given to Swords to Plowshares.
Because our legal staff is small and our resources are limited, Swords to Plowshares can represent only a small number of veterans who seek our assistance with VA claims. Please do not appoint Swords to Plowshares to represent you before the VA without our express consent.