VA Claims Exam (Compensation and Pension or C&P Exam)

-A A +A

 

Compensation and Pension Exam

Frequently Asked Questions

Q: What is a VA claim exam, also known as a Compensation and Pension (C&P) examination?

If you’ve filed a claim with the U.S. Department of Veterans Affairs (VA) for disability compensation or pension benefits, VA may ask you to go to an examination as part of the claim process. For disability compensation, this exam helps VA determine if you have a disability related to your military service or if your condition should receive an increased rating due to it worsening. In the case of pension claims, the exam documents the level of your disability. This is known as a VA claim exam or a compensation & pension (C&P) exam. C&P exams are free and considered part of the Veterans Benefits Administration's (VBA) 'Duty to Assist' policy.

This exam is different from a regular medical appointment because the examiner won’t prescribe any medicine or treat you – for instance, you won’t receive a referral to a specialist. The examiner will only perform a medical review to identify or confirm any disabilities shared in your claim application. They will record the findings and provide them to a VA claims processor to complete the claim process.

Q: Is everyone scheduled for a VA claim exam?

No, not everyone will be requested to attend a VA exam. After you have applied for disability compensation and/or pension, you may receive a phone call or a letter from VA or a VA partner asking you to come to a claim exam, also known as a C&P exam. If you have claimed benefits based upon several disabilities, you may be asked to report for one or more exams so each disability can be reviewed by an appropriate examiner. This is a routine request. You may be asked to go to a VA medical center or a VA partner to complete the claim exams. Not every application for a benefit will require an exam; it depends on what medical evidence has been included with the application.

Q: How is the VA claim exam or C&P exam scheduled?

A VA medical center or a VA partner is responsible for contacting you about scheduling a claim exam. They may either mail you a letter with the date and time of your appointment(s) and/or call you to find a time that fits with your schedule. If you are receiving treatment at a VA medical center, make sure they have your current address, phone number and email information. The wrong information could cause your appointment letter to be delayed and not reach you in time.

It is a good idea to call and confirm the exam time(s) and locations to make sure you and VA or the VA partner have the correct appointment information. Use the phone number on your appointment letter or if you were called, use the phone number left by VA or the VA partner. If you don’t show up to your exam, you may have a longer wait to get your exam rescheduled; it could delay your claim; and/or your claim could be rated “as-is” (using only the information in your file).

Q: The date and/or time of my C&P exam doesn’t work for me. Can I reschedule my exam?

If your scheduled exam date or time does not work with some other life event, immediately call the number provided and try to reschedule. Unless it is an emergency situation, try not to reschedule the exam the day before or on the day of the exam. Not responding to a phone or letter request for scheduling an exam or missing the exam could cause VA to delay its decision on your claim. Not showing up to your exam takes up an appointment time another Veteran could have used, and also could cause your claim to be rated “as-is” based only on the information in your application. Most facilities try to meet your requests (if possible) if you have a good reason for rescheduling your time and you give enough notice.

Q: How early do I need to get there before the VA claim exam?

It is helpful to be at least 15 minutes early to your scheduled exam time, leaving enough time to arrive at the facility location where your exam will take place. Once you check in with the exam staff, they will be able to answer questions on how long you will have to wait. Many examiners will not perform your exam if you are late, as they will not have enough time to complete the required history and exam review and take care of other Veterans on their schedule.

Q: What will the claim exam be like?

Unlike a typical medical exam or other healthcare appointment you may have with VA, the claim exam will not give you any treatment or prescribe any medicine. The examiner’s job is to review your medical records related to your disability claim, including the claim file, also known as your c-file/e-file. The c-file typically includes medical treatment records from Department of Defense (DoD), your DoD personnel records, treatment records from your health care providers and any other documents submitted.

The amount of time the examiner spends with you during your exam depends on what conditions you claimed and if VA needs more information to make a decision. Following your exam, the examiner completes a report that includes an analysis of clinical test results, if any were performed. You have the right to request and receive copies of your test results by contacting your VA regional office. If the exam was done at a VA facility the results may be available online at MyHealtheVet website under 'Blue Button' in the 'Notes' section: https://www.myhealth.va.gov/

Q: How long will my claim exam take?

Each exam is different depending on the information and needs of each Veteran. Exams can range anywhere from 15 minutes to an hour or more. The examiner may ask you questions, observe you, perform a limited physical exam or simply review your file with you. The time an examiner spends with you during your exam may appear brief, but remember, even if your visit is short, he or she is still carefully reviewing your claim. Examiners often spend an hour or more before or after your appointment reviewing your claim.

Q: Where does the claim exam fit within the claim process?

VA schedules the claim exam at the end of the “Information Gathering” stage, which is about 60% of the way through the claim decision process. After your exam, the examiner will complete a report that includes a review of the exam and any clinical test results. The examiner submits the report back to the VA regional office so it can be included within your c-file/e-file and they can continue processing your claim. VA will then perform a final review on your whole claim package, and make a decision on your claim.

The C&P Report is a significant factor in the VA's decision about whether or not to grant you benefits, but the VA will also consider all the medical evidence in your record and any DBQs (Disability Benefits Questionnaire) and nexus statements you may have submitted with your claim. DBQs are available online at http://www.benefits.va.gov/COMPENSATION/dbq_disabilityexams.asp

Q: Can the person doing my VA claim exam tell me the status of my claim?

No, the examiner is only involved in performing the exam and providing the results to the claims processor. They are not part of the rating process, and do not make the rating decisions. They will never know the outcome of your pending claim. Only a VA regional office can answer questions regarding rating decisions.

To get a claim status update, please go to eBenefits.va.gov or, if you are working with an accredited Veterans Service Organization (VSO) representative, contact them for a status update. You may also contact VA at 1-800-827-1000, and a contact representative will be pleased to answer your questions.

Q: Can I bring new treatment information or other evidence with me that I did not submit as part of my claim?

Yes, if you have any medical documents that were not previously sent to VA, you can bring them to your claim exam. However, the examiner may not be able to submit that information on your behalf. All new information can be uploaded through eBenefits.va.gov, submitted to your accredited VSO representative, or mailed to VA using the appropriate address found here - http://www.benefits.va.gov/compensation/mailingaddresses.asp. Ideally, you should submit all of your medical evidence with your claim application or before of your claim exam so the examiner doing your exam has the most complete picture of your health status.

Q: Can I bring my spouse or family member to my claim exam?

Yes, at your request and the approval of the examiner, family members, caregivers, and significant others may be allowed to join you during an exam, but may not participate in and/or interfere with the exam. Service animals are also permitted. The request must come from the Veteran without prompting. Family members are part of the PACT (Patient Aligned Care Team) for healthcare but not necessarily for benefits and C&P exams.

Q: I missed my scheduled claim exam, what should I do?

If you were unable to attend your exam and did not contact VA in advance, your appointment will be considered a “no show.” You will have to request a new exam appointment by calling 1-800-827-1000. If you fail to show up to any claim or C&P exam(s), it is likely that your claim decision will be delayed while VA tries to reschedule your exam. Your claim could also be rated “as-is” (using only the current information in your file). It is very helpful to make sure that both the VA regional office and the VA medical center nearest to you have your current address, phone number, and email information. This will help make sure VA can communicate with you about any need for a claim exam appointment. It is also a good idea to call and confirm the exam time(s) and location(s) that you have received to make sure you and VA have the correct appointment information.

Q: My claim exam is scheduled far away from where I live; can I get help with paying for my travel?

Yes, if you are scheduled for a claim exam or C&P exam, you can request travel reimbursement. Mileage is calculated from your door to the exam facility. Your travel pay request will be submitted to the beneficiary travel office. Contact the C&P Office if you need overnight accommodations.

Q: The examiner didn’t even touch me during my claim exam. Is that normal?

Think of the claim exam, or C&P exam, as a medical review. Unlike a typical medical exam or other healthcare appointment you may have with VA, an examiner will not provide you any treatment, make any referrals to other medical providers or prescribe any medicine. Depending on the information in your claim file, such as medical documents from current providers, and completed Disability Benefit Questionnaires (DBQs), the examiner will determine what additional questions and information are needed to confirm your health status and complete the exam. In some instances, your file may be so complete that only a few follow up questions may be needed. Know that your case is being carefully reviewed and VA’s decision will not depend on the length of your exam visit.

The in-person part of your claim exam is only one part of what examiners do as part of their evaluation. They also typically spend more than an hour before or after appointments reviewing claims files to ensure they are providing the most complete and accurate reviews possible. All of the supporting documents that you provide to support your claim play an important part in the examiner’s report.

If you have a question about what is happening during your claim exam, you should feel comfortable asking the examiner about what he or she is doing and what you can expect during your visit. Keep in mind they are medical experts who are following up on the medical information you provided in your claim application. Neither VA examiners nor VA partner examiners are involved in rating your claim. They are not always familiar with the full claim process and cannot tell you when a decision will be made. All claims-related questions should be directed to the VA regional office nearest you.

Q: I am unhappy with the treatment I received from the person doing my claim exam, what should I do?

If you attend your claim exam and have a negative experience with a VA examiner or a VA partner examiner, VA encourages you to share feedback immediately. You may go to the C&P exam supervisor within a VA medical center or the supervisor within the VA partner facility, reach out to the VA patient advocate at your closest VA medical facility, or call the number on your original appointment letter. It is helpful to write out a statement of concern that can be submitted as part of your claim file. Share concerns immediately. Do not wait until your claim decision has been made. This will help ensure any issues are handled as quickly as possible.

Q: My claim was denied without a claim exam or C&P exam. Is this a normal event?

VA awards disability compensation when the claim file shows three things:

  1. Current diagnosis of a disability
  2. Record of an event that happened during military service that could have resulted in the disability
  3. An opinion that the disability is related to military service, also called a “nexus opinion”

If the first two items are clearly shown in your claim application, that’s when the C&P exam process comes in. If you did not submit enough information with your claim application to show that you have a current diagnosis of a disability or that an event occurred in military service that may have caused the disability, there is no need for VA to schedule a claim exam to get a nexus opinion to tie the two events together. Make sure you submit all relevant military and treatment records as part of your claim application.

Q: Why is a contractor conducting my claim exam and not a VA examiner?

VA may use contractors or VA partners who are medical experts with experience working with Veterans to speed up the claim process. They support the timelier scheduling of claim exams and evidence gathering in support of your claim. You may get scheduled for a claim exam with a VA partner. They follow the same HIPAA policies as VA, so you are guaranteed that your privacy is protected.

The exam is performed at the expense of VA and, just as if the exam was done at a VA medical center, the exam is used in the claim decision process for disability compensation or pension benefits. The medical facilities that work with VA are bound by the same rules and privacy laws as VA, so you can be sure your exam can be trusted and all of your information is secure and will be shared directly with VA.

Q: Are there organizations that can help me with my claim exam?

VA recommends you work with an accredited representative, such as a VSO, to help guide you through the entire claims process. These representatives can help you gather evidence in support of your claim, help file your claim and address issues as you move through the claim decision process. You can search for a representative on eBenefits, https://www.ebenefits.va.gov/ebenefits/vso-search.

How to Answer Questions at the Exam

Don’t exaggerate your symptoms, but don’t diminish them either. When the doctor asks you questions, be truthful. Explain to the doctor exactly how your symptoms impact your life. This can be uncomfortable, since this will be your first visit with the doctor, but it is important to your claim that you be as open and honest as possible. Even if you feel frustrated by the questions or have a personal dislike of the doctor, be courteous.

 

If the VA Didn't Send the Doctor Your Records

Usually the VA does send the claims file to the doctor in advance of the exam, but sometimes the agency neglects to. If the VA doctor hasn't received the records, he or she may not even be sure of the reason for your visit. If this happens, tell the doctor you’ve been treated at the VA, and the doctor should be able to pull up your records on the computer. However, the doctor won't have any access to private treatment records if you have seen doctor’s outside the VA. And the doctor won't see any statements about your disability that you have submitted to the VA Regional Office.

Always submit all evidence PRIOR to the C&P exam. In fact, you should have submitted all evidence when you filed your claim. This includes DBQs (Disability Benefits Questionnaire's), medical opinions (nexus statements), logs (headache, Meniere’s, blood pressure, etc.), personal statement, spouse’s statement, Social Security Disability exams and determinations and other medical evidence you may have. Having all this submitted will provide the examiner the opportunity to review all pertinent information before the exam itself.

It is advisable to bring your latest DBQs (Disability Benefits Questionnaire's), medical opinions (nexus statements), logs (headache, Meniere’s, blood pressure, etc.), personal statement, spouse’s statement and other medical evidence. The C&P exam may have informed you to not bring anything to the exam. However, sometimes your evidence is not readily available to the examiner and having yours with you may help.

Some final thoughts...

If you live far away from a VA Medical Center, the VA may send you to a private physician. In that case, if the VA doesn’t send over your records, the doctor will not be able to access your treatment information on the computer at all. The Compensation and Pension exam will then have to be rescheduled. This is because a C&P report is considered inadequate by the VA Regional Office unless the doctor has reviewed the claims file.

If you need the use of a cane, walker or other assistive device, did you explain that in your personal statement and take that to your C&P exam and every time you see your doctors? Do you use a shopping cart to hold yourself up when shopping? Do you have a brace, TENS unit or eStem and did you wear them for the exam and every time you see your doctors? Did you explain to your doctors and C&P examiner and in your personal statement how you manage your rated conditions...meditation, exercise, acupuncture, chiropractic, physical therapy (even self-administered), Tai Chi? When going to any appointment, remember that the appointment starts at your driveway and ends at your driveway.

You do not want a video of you skipping down the road after your exam!

May 10, 2019 - 9:10pm