Any kind of exam can cause a lot of stress. But for veterans making a VA benefits claim, Compensation and Pension (C&P) examination is on a whole new level. But have you stopped to consider how much weight does a C&P exam have?
Considering that this test is one of the key determinants of whether you’ll get your benefits or not, stressing about it is warranted. The good news is, the C&P examiner doesn’t make the final decision, so not all is lost if things go south.
Let’s analyze the evidence to find out how much weight does a C&P exam have and what you can do if it’s unfavorable.
Why does the VA request this exam?
For veterans who file a claim for benefits, a C&P exam is required in order to evaluate the validity of the medical conditions they claim to have, as well as to decide if the service connection is justified. This is also the time when the examiner gathers evidence to assign a rating, in case VA grants you a service-connected disability compensation.
The three most common reason a VA requests this exam is to:
1. Establish the connection between the veteran’s service and the medical condition(a nexus) and determine if the condition in question is service-connected.
2. Gather additional information about the veteran’s condition or symptoms.
3. Examine any inconsistencies with the diagnosis.
What’s the role of the examiner?
Before we address how much weight does a C&P exam have, let’s talk about who they are and what they will do.
Integral to the outcome of your claim, the examiner is a physician either working for or contracted by the VA who is qualified to examine a veteran’s medical condition. For instance, an orthopedic doctor can’t evaluate a mental health condition like PTSD.
This is the reason why you might have a different checkup for each of your disabilities.
Before the exam, they will familiarize themselves with your case by closely looking at the file containing your medical and service records (commonly known as a c-file).
On the examination itself, your VA physician might ask for more information about your disability and how it connects to your service. They might also do a physical inspection of you.
Is a C&P exam required for a disability rating?
While a favorable exam is the best way to get an accurate disability rating, it’s possible to get one without even getting examined.
Going through this assessment is necessary only when VA needs to connect your service to your disability and the extent of the disability itself. Additionally, a C&P exam is also required when VA needs to determine the amount of compensation you’ll receive.
If you have to get a C&P exam, it usually means that you might not have been offered proper medical evidence for your disability claim – documents such as test results or doctor reports.
The big question: how important is the C&P exam for the ruling?
Now that you’re familiar with what this entire process is, let’s see just how much weight does a C&P exam have.
The answer isn’t as straightforward as you might think. First, the examiner doesn’t issue the decision – they simply offer their expertise on the evidence you provided. Their report is simply taken into account when ruling on if your disability occurred as a result of service.
This means that you should be honest and detailed about your condition and symptoms in the exam instead of trying to persuade them.
In their report, the examiner can corroborate the description of your condition. Alternatively, they can also disagree with the evidence you presented.
Nonetheless, they are merely stating their professional opinion, and they’ll express it with statements such as:
1. At least likely as not: means that there is a high probability that your disability is caused by your service.
2. Less likely than not: means that there is a high probability there’s no connection between your service and your current disability.
How to deal with a negative exam?
So how much weight does a C&P exam have?
A negative outcome doesn’t mean that your claim is completely lost but at the same time, it might negatively affect your chance of winning government support. That’s because a document that states that your disability isn’t as severe or is unrelated to your time in service will be given a lot of weight by the VA adjudicators.
The good news is that it’s possible to refute the examiner’s findings if you’ve got a genuine disability and can prove it.
Quick tip: Request a copy of the report right away by sending a request letter to your Regional Office. There is a chance the report doesn’t properly represent the details of your ailment that you described to the examiner.
Here are the actions we recommend you take:
1. Get a medical opinion from a private doctor
In most cases, your claim will be denied because you either don’t have enough medical evidence or have no clear nexus.
Luckily, nothing is stopping you from seeking a second opinion. A medical opinion from a private doctor can be used to disprove the report by the examiner. In fact, you’re allowed to obtain medical opinions that will be weighed in with the results of the C&P examination.
In a sense, how much weight does a C&P exam have depends on the weight of the other medical evidence you present.
A doctor who specializes in areas related to your condition might be able to provide a better explanation of the severity as well as the cause of the ailment than a general practitioner from the VA.
Most importantly, a private healthcare provider can write a perfect medical nexus letter which
will be effective at connecting your condition directly to your military service
To make your case even stronger, you can submit proof of private treatment. For instance, if you went to a private specialist for your back pain, you should request treatment notes so you can submit them to the VA.
2. Submit the Notice of Disagreement
If the result of your C&P exam is unfavorable you should submit a statement about why you disagree with the results of the C&P examination.
If you get rejected by the VA, a Notice of Disagreement (or NOD) is your opportunity to explain to the VA why you think their decision was wrong.
This form is included with your claim decision.
There is a block for every medical condition you claim so you can list the decisions you don’t agree with.
Additionally, you can also disagree with the decisions on service connection, evaluation of disability, and the effective date. There is also a narrative section where you can explain why exactly you disagree with the evaluations in the examiner’s report.
3. Request an examiner’s credentials
As a last resort, you can claim that the examiner was not qualified to establish an objective opinion on your medical condition.
To make sure your examiner was qualified in the relevant medical field for your condition, legally you’re allowed to request the examiner’s credentials.
If you challenge the competency of your examiner, the VA is required to explain why the examiner is competent.
An unfavorable C&P exam might not be a big deal
Hopefully, this sheds some light on how much weight does a C&P exam have. While a C&P examination might seem like the end of the world, ultimately, its purpose is to help you get a favorable disability rating (especially if you didn’t provide adequate medical evidence).
We know it might be a headache to reapply again, but now that you know which steps to take if your initial application fell a bit short, it’s going to be a safer bet the next time around.
If your claim gets denied and you have all the necessary medical documents and nexus that support your claims, feel free to take it a step further and take action. We recommend you hire an attorney to help you face an unfavorable exam head-on! After all, it’s easier when you’re not going at it alone