“Hi, my name is Zack Evans. I’m a veterans disability benefits attorney with Woods and Woods attorneys in Evansville, Indiana. Today, we’re going to be talking about C&P examinations. I’m going to talk a little bit about what a compensation and pension examination is, what to expect, how to prepare for it, and how it’s laid out.”
What is a C&P exam?
“First of all, a C&P exam, or a compensation and pension examination, is set up by the VA Regional Office of the Veterans Benefits Administration. It’s an exam to assess your level of disability or assess whether a disability you suffer from is related to your time in service.”
Who will perform a C&P exam?
“A C&P exam will typically be performed by a medical professional. It’s not always a doctor, but a lot of times they are performed by doctors. We also see psychiatric nurses, clinical psychologists, nurse practitioners, and people with other credentials who administer some sort of medical examination or make an analysis.
“The difference between a C&P examiner and a private doctor is sometimes nothing. Sometimes, we’ll have private doctors who will contract with the VA to do some compensation and pension exams because as you can imagine, there’s a huge backlog of claims. There’s also a huge backlog of exams that need to be completed.
“Sometimes you’ll go to a VA medical center, and you’ll receive a compensation and pension exam from a VA doctor in a VA facility. Sometimes, your C&P exam will be performed by someone who is affiliated with the VA or has an agreement with the VA but doesn’t necessarily work for the VA directly. The goal is to try to get this huge volume of exploratory examinations and assessments completed so that the regional office can issue you a decision on either service connection or about the severity of your disability.”
What to expect at a C&P exam
“Typically, at a C&P exam, you’ll show up to the location of the exam and you’ll have a battery of questions that an examiner will ask you about your condition. If it’s a psychiatric examination, they’ll ask you a little bit about your personal history. They’ll ask you about your current symptoms. They’ll ask you about some of the challenges you face in your daily life. They’ll ask how your PTSD, major depressive disorder, or your anxiety disorder impacts you on a daily basis.
“Some of these exams are more thorough than others. But typically, what I see in my practice is that issues that arise with the thoroughness of exams tend to come up more often in mental health exams. This is because it’s really tough to cover the full breadth of someone’s mental health disability in the course of a relatively short examination period.”
Is the C&P exam like a physical exam?
“This depends on what you’re going in to have assessed, or in other words, what’s being evaluated. Obviously if it’s a psychological assessment, a physical exam is not likely to happen unless maybe you have other examinations pending that day. For example, you might go see an orthopedist in the morning and then a couple of hours later you might talk to a clinical psychologist, and some of those assessments can dovetail together really nicely.
“Let’s say you have a back condition that you sustained in service as a result of a lumbar spine injury, and that is really impacting your activities and daily living, your mood, and your state of mind. Some of those things will overlap.
“For the orthopedic conditions themselves, there’s absolutely a physical component. One of the things that needs to be tested on orthopedic examinations is your range of motion, and your range of motion is going to be impacted by things like flare ups, what your current level of baseline severity is, what happens to you during a flare-up event, and what happens to you during periods of prolonged usage such as during a typical workday, especially if you work on your feet.
“Some of these examinations will have a physical component where they’ will test a certain body part and how it moves, whether it moves freely, and whether you get some locking or some crepitus in the knee.”
How long does a C&P exam take?
“Because of these varying types of C&P examinations, the length and the breadth of what’s discussed can vary pretty significantly. Unfortunately, we’ve heard that some of these examinations only last 5-10 minutes, and the evidence has borne that out when we review the file.
“We’ll get a questionnaire, typically in a standard form called a DBQ, or Disability Benefits Questionnaire, where a psychologist will run pretty quickly through some boxes that ask a certain number of questions, and they will, like I covered earlier, ask you about your employment history and your diagnoses, and then they’ll ask you about the current challenges that you face with that condition.
“In my opinion, the mental health examinations should be longer. There should be much more time dedicated to fairing out what has occurred to a veteran, and how some of these behaviors or coping skills took root in service and then progressed throughout a person’s life.”
How to prepare for a C&P exam
“What you really need to be doing to prepare for your C&P exam is getting yourself in an open mental space to be able to talk about these things that you’re dealing with, especially for mental health exams.”
1. Be honest and open at your C&P exam
“It is very easy for survivors of military trauma to want to shut down in the middle of a psych exam and to not want to discuss the full range of things they’ve been dealing with. It’s understandable. Sometimes that’s a coping mechanism that is wrapped up in someone’s diagnosis.
“You need to be thinking about exactly how your condition impacts you and the things you want to get out there. One of the things I see pretty commonly in veterans’ psych files is a diminished or impaired ability to interact with loved ones, even people that they trust, like their family. That is not something that you want to leave out of a C&P exam discussion because if it’s not discussed, if it’s not brought up, if you are not being heard in this examination, then, by omission, the VA will assume you’re functioning at a normal level in terms of your social and familial interactions, and often times, that simply isn’t the case.
“Some of those things are difficult to recall. They’re difficult to bring up in the moment by just relying on your memory. Sometimes, there’s a lot of ground to cover in these examinations. Sometimes, there are quite a few different areas of impairment related to a mental health condition or a back injury. In order to make sure you’re covering all the bases and you’re getting everything on the record that you can in that exam, having good notes and trying to think clearly before you go in about exactly what you need to get out there can be really helpful.”
2. Keep a journal of your symptoms
“I recommend that veterans keep journals of their conditions. I really think it helps if you journal in the morning and in the evening, it doesn’t have to be very long. It should just be something that recounts some challenges you faced as a result of your service-connected knee pain or as a result of your PTSD. A journal does a good job of keeping a record for you of exactly how this impacts you day to day, and that’s the piece that’s typically missing from C&P exams.
“In the couple of weeks leading up to a scheduled compensation and pension exam, if you can, do a daily rundown of what your day looks like and challenges you’re facing as a result of your service-connected conditions. You are, without them being there, essentially trying to walk the examiner through how this impacts you on a daily basis.
“Obviously a C&P exam can’t take two weeks or almost no one would get an exam done. But if you take a good written record in of, for example: ‘I woke up in the morning and as soon as I tried to get out of bed my knee locked up. Then I noticed that my service-connected ankle was extremely swollen. I had fluid on my knee. Then I went outside to get the mail and I got a few steps and my sciatica started acting up from my old back injury that I received whenever I was in the Marines.’
“These are all little pieces that can help paint a really good picture of how these conditions are impacting you. The goal is to make it real for the person reading it, because it is easy for an examiner to just see you as a number or as an appointment and to check down a few discussion drivers or items of conversation. They’ll check some boxes on what your functionality is and then that’s it. They’re on to the next examination.”
“The firm got me to 70%, and I was happy. Individual unemployability was awarded to me and to this day, I’m so grateful. My future is no longer bleak. These people work very hard for you.“
3. Be thorough at your C&P exam
“The plain language you use, a lay person’s language that you use with an examiner is OK. You don’t have to know the ins and outs of clinical psychology. You don’t have to know the mechanics of orthopedic injuries. No one’s expecting you to understand or be fluent in those things.
“Certainly, some of you probably are because you’ve been dealing with these things for so long. You’ve been in and out of doctor’s offices. You’ve had multiple surgeries. You’ve probably seen multiple mental health providers that have provided you with some insight using these medical terms. If you’re comfortable using those words, certainly do so. But don’t let that deter you from just saying what’s on your mind and your heart and what you’re dealing with, because this is your chance to get all of this on the record. This is your chance to tell your story.
“If you feel like an examiner is rushing you, do everything you can to respectfully slow them down. Ask them for an opportunity to be heard and make sure they know that you feel the examination is not complete, that the discussion is not over, and that you have more you want to talk about.
“Remember, this examination, while it’s being administered by a medical professional, is your examination. If you feel like something isn’t being explored enough or if you feel like you’re being glossed over in the examination, you need to say something. You need to redirect the conversation. You need to say, you know, ‘Excuse me, sir or ma’am, but I feel like there are a few other things I would like to discuss here that are important and relate to how this condition impacts my life.’
“When you leave the exam, take notes about your feelings, things that were discussed, things that were not discussed, and keep that. As a lawyer, if someone provides me with notes that they felt like an examiner was rushing over bits of evidence, that helps the case. Let’s say your C&P exam is for a knee and they don’t even discuss the knee surgery that occurred just 10 months ago — I would like to jump on that.
“So, you want to make sure you’re keeping good notes on exactly what was discussed, what was not discussed, and how many times you were rushed or hurried through conversations. That’s all useful. If they are ignoring your discussion items, recent operations you’ve had, or some of the directives of your mental health treatment provider and they’re not encompassing that within the scope of this C&P examination, there’s an argument to be made that we have an inadequate exam that cannot form the basis for a VA decision that can stand as valid.”
4. Do something to destress after the exam
“Do something fun when you’re done. Schedule some time with your family or friends, whether it’s fishing with a buddy or taking your grandson to a racetrack, or if it’s running racks of eight ball at the VFW with your friends, do that. Take the time to do something that’s enjoyable and can get your mind out of this cyclical type of thinking that can result from digging up these old bones. Because what we want to make sure of is that the C&P examination is as accurate and as thorough as possible, but we don’t want you to be impacted long term. These examinations are difficult enough. We want to make sure that you’re trying to make plans to do something that can sort of relieve the stress and allow you to get back to as much functionality as you can, because life is about enjoying.”
How Woods and Woods can help
“Give us a call. Again, my name is Zack Evans, a VA disability benefits attorney with Woods and Woods in Evansville, Indiana. We look forward to hearing from you.”
Zack Evans
VA disability lawyer
Woods and Woods
VA Accreditation Number: 41455
