What to Expect from a VA Disability Claim Exam
A veteran who files a disability claim with the Department of Veterans Affairs will be asked to submit medical evidence to support their claim and may be required to have a VA medical exam, formally known as a Compensation and Pension examination.
This plays a crucial role in the VA’s decision-making process. It determines the severity of the veteran’s claimed disabilities and whether those disabilities connect to military service. Veterans should understand what to expect during this process.
Purpose of the Exam
The C&P exam provides the VA with a medical opinion on the nature and extent of the veteran’s claimed conditions. The examiner reviews the veteran’s medical records, conducts the physical exam, and questions the veteran about their symptoms and how they affect daily life.
The exam’s findings help the VA determine if a service-connected disability exists and assign a disability rating.
Read next: Disabled Veteran Benefits Guide
Scheduling the Exam
The VA or a contracted third party schedules the exam. They typically notify the veteran by mail or phone. Sometimes, the veteran receives short notice, so it is important to check mail and answer phone calls. Veterans should confirm the appointment and ask any questions they have.
Preparing for the Exam
As implied above, veterans should prepare for the exam by gathering all relevant medical records and documentation. This includes records from private physicians, hospitals, and any other healthcare providers. Veterans should bring a copy of their claim paperwork and a list of their symptoms and how they affect their daily life. Veterans should also consider writing down a timeline of their symptoms and how they relate to their military service.
Arrive at the exam prepared to discuss past medical history and current symptoms in detail. Veterans should be honest and accurate in their responses. Don’t exaggerate OR minimize any symptoms.
Read next: Disabled Veteran Benefits Guide
The Examination Process
The exam begins with the examiner reviewing the veteran’s medical records and claim paperwork. The examiner then conducts a physical examination, which may include checking vital signs, testing reflexes, and assessing range of motion. Hearing and vision tests may include the use of auditory equipment, eye charts, and other typical exam tools.
There’s also an interview component. The examiner may ask specific questions related to the claimed disabilities. For example, if the veteran claims a back injury, the examiner may ask about pain levels, range of motion, and any limitations in daily activities.
If the veteran claims a mental health condition, the examiner may ask about symptoms such as anxiety, depression, and sleep disturbances. The examiner will observe the veteran’s behavior and demeanor during the exam. Mental health claims may require additional follow-up appointments.
The examiner notes signs of distress, discomfort, or other symptoms. The examiner will also document the veteran’s responses to their questions and their observations during the physical examination.
Types of Examiners
The VA may use various healthcare professionals, including physicians, nurses, physician assistants, and psychologists, to conduct C&P exams.
The type of examiner depends on the nature of the claimed disabilities. For example, a veteran claiming a mental health condition will likely see a psychologist or psychiatrist. A veteran claiming a physical injury will likely see a physician or other medical specialist.
The Examiner’s Role
The examiner’s role is to provide an objective medical opinion to the VA. They do not decide whether the veteran’s claim is approved or denied. They simply provide the VA with the medical evidence needed to make a decision. The examiner’s report will include the examiner’s medical opinion on the nature and extent of the veteran’s claimed disabilities.
Read next: Disabled Veteran Benefits Guide
PACT Act Issues and VA Claim Exams
The PACT Act expanded the list of presumptive conditions related to toxic exposure during military service. This means that for veterans who served in specific locations and timeframes and have been diagnosed with one of these presumptive conditions, the VA presumes that the condition is service-connected.
This shifts the burden of proof in many cases and affects the C&P exam process in several ways:
Reduced Need to Prove Direct Connection:
Before the PACT Act, veterans had to establish a connection. between their military service and their health conditions, especially for those not automatically considered service-related.
The PACT Act’s presumptive conditions list eliminates this requirement for many veterans. If a veteran has a presumptive condition and meets the requirements (location and timeframe), service connection is automatically granted.
Emphasis on Diagnosis and Severity:
While the C&P examiner will still review the veteran’s service history to confirm they meet the location and timeframe criteria for the presumptive condition, a significant part of the examination will now center on accurately diagnosing the condition (if not already formally diagnosed) and thoroughly evaluating the current symptoms and their impact on the veteran’s daily life and occupational functioning.
The examiner will likely conduct a physical examination, review medical records, and may order diagnostic tests to gather this information. The findings are documented on condition-specific Disability Benefits Questionnaires (DBQs).
Toxic Exposure Risk Activity (TERA) Exams:
The PACT Act introduced the “Toxic Exposure Risk Activity” (TERA) concept. Even if a veteran’s condition is not on the presumptive list, if they can demonstrate participation in a TERA during their service, the VA must conduct a medical examination and obtain a medical opinion to determine if a nexus exists between the disability and the toxic exposure.
C&P exams for TERA claims will involve the examiner considering the veteran’s exposure history, medical evidence, and the likelihood that the current condition is linked to that exposure.
Toxic Exposure Screenings
The PACT Act requires all veterans enrolled in VA healthcare to receive a toxic exposure screening. This 5-10 minute screening identifies potential exposures during military service and connects veterans with resources.
While the screening itself is separate from a C&P exam, the information gathered during the screening might inform future C&P exams if the veteran develops a related condition.
After the Exam
After the exam, the veteran should keep copies of any documentation they provided to the examiner. They should also note the date and time of the exam and the examiner’s name. The VA will review the examiner’s report and other evidence in the veteran’s claim file. Never provide original copies of medical records or other documents.
The VA will, after a period of review, decide on the claim. This process can take several months. If a veteran disagrees with the VA decision, they can use the right to appeal by filing a Notice of Disagreement and request a higher-level review. They can also request a hearing with a Veterans Law Judge. The veteran may also submit new and relevant evidence to support their claim.
Common Concerns and Misconceptions
Many veterans have concerns and misconceptions about C&P exams. Some veterans worry that the examiner will not believe their symptoms. Others worry that the examiner may be biased in favor of the VA rather than trying to help the veteran.
Remember that the examiner’s role is to provide an objective medical opinion. They are not there to judge the veteran’s credibility. Some veterans believe that they must have a diagnosis from a private physician to receive VA disability benefits. While a diagnosis can be helpful, it is not required. The VA will consider all medical evidence, including the examiner’s report, when deciding on the claim.
Some veterans also believe they need a lawyer to attend the C&P exam. While a lawyer or Veterans Service Officer can be helpful, it is not required. Veterans can represent themselves at the exam.
The C&P exam is a critical step in the VA disability claim process. Without it, your claim may not be approved. Skipping the examination process is tempting for some because of the time and travel involved for some appointments. But the process is crucial for getting a VA disability compensation claim approved.
Read next: Disabled Veteran Benefits Guide
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.
