Important Update:

If you have a C & P exam scheduled, use caution when the examiner asks you any financial questions.

When you are asked, "How are finances handled and bills paid around your house?, be aware that the wrong answer could start the fiduciary appointment process for you.

A simple reply like, "My wife handles my checkbook and pays the bills at my place." is a signal that says you are incompetent to handle your own finances. Once the examiner notes that in your record, the Regional Office is likely to send a Field Agent to your home to start the process of appointing and to have you pay a stranger to receive and manage your VA benefit money.

If you are capable of managing your finances but like most of us you and your spouse have agreed to just one of you doing the bills, be very careful how you answer any finance questions during a C & P exam.

Also see Fiduciary Appointments.





You have an absolute right to a good and adequate C & P examination. All too often, the examiner doesn't stick to the rules he or she should follow closely.

I've personally had examinations by professionals who were concerned about my health and went way beyond what they had to do to ensure a perfect examination.

I've also encountered examiners who appeared to be totally dumbfounded by the world around them and they hardly noticed I was there.

You have to prepare for either extreme. The following will tell you how to get the best exam and what to do if you don't feel your exam was adequate.

It's your job to understand how the C & P exam should progress. Nobody can or will do this for you.

Before you have a C & P exam...read the instructions for yourself.

Read this page of the A to Z Guide carefully. Now, read it again.

Then, go the the VA Disability Worksheets. Find the category that fits your claim. Read until you understand what the examiner should be doing.

Next, go the the C & P Service Clinician's Guide

Commit to memory as much as you can of the general guidelines that will apply to you.

The rest is easy.

Get to the exam early. When you arrive, remember that the people nearby may be employees of the C & P department. Don't say anything about your exam. Don't speak with anyone you don't need to speak to.

Have a driver. Even if you don't usually need a driver, you're under a lot of stress today and it's best for you to be relaxed.

Don't ever think about embellishing or overstating anything. These people are often expert in their jobs and they'll know. If you don't usually use a wheelchair, don't use one today. If your neck or back isn't ordinarily in a brace and your arm isn't usually in a sling, don't try to impress anyone with such gadgets.

Don't present yourself as happy and healthy. You don't ever want to fake it but you do want the examiner to understand your problems. If you're greeted with, "Hello, how are you today?" and you answer with, "I'm great doctor, I feel fine." it's game over.

If you're feeling so good, why are you there?

Do carry copies of any records you believe may be relevant. Do offer them to the examiner. Don't be surprised or offended if the examiner doesn't want them. The examiner is under orders by the Regional Office and will only do what those orders say to do.

As your exam begins, be polite, courteous, respectful and go with the flow.

You may ask for a friend or spouse to accompany you during the exam. The examiner may decline your request. If declined, don't make a fuss...go with the flow. It's not a big deal at this point.

During the exam you should attempt to do as the examiner asks you to do. However, when asked to do tasks that may cause you pain or fatigue you excessively, you may politely decline. For example, "Please flex your arm upwards and place your hand behind your head." "I'm not able to do that doctor, it hurts me too much and causes my arm to be numb."

Should the examiner attempt to do a maneuver for you, you may decline...again, politely and without any rancor. Simply state that there is too much pain.

If asked to walk and it tires you, make it clear that you become fatigued easily.

The bottom line is that you should attempt to comply so that you will get an adequate exam but you aren't required to hurt yourself.

Your exam probably will take from 5 to 25 minutes. You may have additional imaging studies (x-rays) or lab work ordered.

From the moment you arrive until you're far off the campus, don't speak unnecessarily.  Keep it in mind that courtesy, a respectful attitude and giving the examiner and staff the benefit of the doubt will be in your favor.

Once your exam is complete, make notes for future use. Who was your examiner? What happened during the exam? What was said? Was the examiner interrupted by telephone calls or staff with questions? How often?

You won't remember these details next week, make written notes now.

You will currently have to write a formal request to your Regional Office to request a copy of your exam be delivered to you.

EXCEPTION...if your C & P was for mental health, you may need your mental health provider to release that to you. The rules protect mental health records...even from the veteran.

Now you have your C & P report in hand.

Do you have an adequate or an inadequate examination?

If favorable to you, you'll accept it as adequate. If unfavorable, you should begin to use your notes to write out why it's unfavorable.

You must provide details. If the regulations require a goniometer for measurement and you know that there was no goniometer used, you have a point of appeal.

So...you have had an inadequate examination...now what?

You may write it up and ask for a new exam right now or you may wait for the decision and use "inadequate exam" as your appeal point.

There isn't any way to say which path an individual should follow. The variables will depend on the other evidence you have and so on.

The key to success in appealing an inadequate exam is that you must be able to define and tell the VA why the exam was inadequate and unfair to you. Simply making the statement isn't enough. As with everything else VA, you must prove every word that you say.


Your examination will most likely be conducted by a contractor. The usual contractor is a company called QTC.

Read more about QTC here.


The examiner does not make the decision about your rating!


QTC Management

"QTC is the largest private provider of government-outsourced medical and disability examination services in the nation. "


TITLE 38 PART 4 SCHEDULE FOR RATING DISABILITIES
 
Subpart B
 
Sec. 4.70  Inadequate examinations.

If the report of examination is inadequate as a basis for the
required consideration of service connection and evaluation, the rating
agency may request a supplementary report from the examiner giving
further details as to the limitations of the disabled person's ordinary
activity imposed by the disease, injury, or residual condition, the
prognosis for return to, or continuance of, useful work. When the best
interests of the service will be advanced by personal conference with
the examiner, such conference may be arranged through channels.

Note: The VA may claim an examination is inadequate for the purposes of rating and the veteran may make the same claim. If you believe your examination was less than perfect, you may appeal that.


The C & P Exam

The Ratings Veterans Services Representative (RVSR) 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 RVSR.

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.

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.

Also See;

IME Exam


Random thoughts on C & P, some of this may be a repeat...because it needs to be. I get a lot of questions about C & P so let's review some basics;

* The C & P exam is only one step in the process. You generally do not win or lose a benefit because of a C & P exam.

* The C & P examiner does not decide your case. He or she makes a report to the Regional Office and that report goes into a file and a Ratings Veterans Service Representative looks at all the evidence to decide your case.

* Yes, you should take copies of pertinent records and reports with you. You should not be surprised if the examiner declines to accept or review them. The examiner is given an order of what to do in an exam. If that order says that he or she is to measure the range of motion in your right knee, that's all that will be done. The history of your right knee isn't important to the order. Don't push it if your papers aren't accepted.

* Be nice. No matter how you feel about your exam, keep it to yourself. These people are human and they are at work and if you mouth off about your dissatisfaction you may not get the break they could have given you.

* Know what to expect. If your knee is being examined, study up on what the range of motion is supposed to be and what yours really is in your own eyes. Use this guide to learn how the C & P examiner works. Use these links to learn what the examiner will look for:

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

http://www.warms.vba.va.gov/admin21/guide/cliniciansguide.doc

* Don't be late, don't miss your exam. If an exam is ordered, just do it.