The C & P Exam
by Jim Strickland
The information provided herein may or may not apply to your particular circumstances.
This information is provided for your general knowledge only. Please consult an attorney or other qualified representative before you make a decision.
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.