COMPENSATION & PENSION EXAM (C&P) and Disability Questioners (DBQ)

 

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C&P Exams

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The VA Secretary's duty to assist a claimant includes providing a VA medical examination (commonly referred to as a "C&P exam") or obtaining an independent expert medical opinion (known as an "IMO") when such an examination or opinion is necessary for VA decides on the claim. This does not mean that VA must provide every claimant with a medical exam. VA is required to do so only when such an examination "is necessary to make a decision on the claim." This means that if a medical examination could not make a difference, for example, if the claimant has a dishonorable discharge and is ineligible for benefits, VA will not provide a C&P exam.

 

In most cases, VA will schedule a medical examination after receiving a substantially complete application even if a claimant submits supporting examination reports from their doctor. VA can accept the results of a medical exam by a claimant's private physician as long as the examination report satisfies VA requirements. Claimants, however, should still submit their medical reports whenever possible because if a VA examination is ordered, the VA examiner must consider the private medical reports in arriving at their conclusion. Even if a claimant disagrees with the need for a C&P exam, a claimant must attend any scheduled C&P exam because failure to participate in an examination is a basis for denying a claim.

 

A C&P exam must comply with several legal requirements that a claimant should be familiar with before the examination. Most importantly, the C&P exam must be "adequate" and the resulting report sufficiently detailed to support the results. A C&P exam report is adequate when it is based upon the veteran's prior medical history, fully describes the condition, and provides the reasons for each medical conclusion. If an examination report does not contain sufficient detail or is otherwise inadequate, VA is required to obtain a clarification of the report or schedule another C&P exam.

 

A claimant has a critical role in a C&P exam and in making sure that the examination report accurately reflects their medical condition. A C&P exam will usually be conducted by a VA physician or contractor physician who may not have expertise with the claimant's particular medical condition. The physician must comply with standard examination report requirements when documenting their medical opinion. A prepared claimant, such as reviewing the relevant C&P Examination Work Sheet (see related pages below) and who can clearly describe their symptoms and provide appropriate medical history information, can help the examiner more accurately assess the condition. Even when the C&P examination report does not support service connection, a complete and accurate report of symptoms and medical history can help challenge denial of an award.

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Exams Scheduling Do's and Don'ts:

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• Never miss an exam without good cause

• Always ask what conditions you are being examined for

• Always schedule at your convenience; appointments are available seven days a week; please refer to your calendar before scheduling.

• Always schedule your exams at a minimum of two weeks out.  

 

 

Advocates Notes:

The VA will order a third-party exam through QTC, LHI, or VES; they will contact you to schedule an exam within 30 - 90 days after your application for benefits; always ask for what conditions are being examined. If you would like to discuss the exam before attending, please schedule your exams at least two weeks out to be placed on the Advocates Calendar. If you need to reschedule your exam, please call the company directly; please do not miss these appointments without good cause. Please use this link to schedule a pre-exam appointment - https://outlook.office365.com/owa/calendar/VADisabilityAdvocateAppointments@VADisabilityAdvocate.com/bookings/.

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After all, your scheduled exams are complete; your claim will move to ready for decision. There's no time frame for this process; the VA could ask for additional information, second opinions and order additional exams. Once the VA is satisfied with all the information required to make a decision, your VA disability claim will be sent to a decision review officer to finalize your claim.  

 

 

 

VA Disability Benefits Questionnaires (DBQ's)

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It is essential to note that the Department of Veterans Affairs (VA) will not pay or reimburse any expenses or costs incurred in completing and submitting DBQs completed by the veteran's healthcare provider. In most instances, a Veteran is entitled to a no-cost disability examination to be furnished by VA. In some cases, VA may determine that an additional disability examination is still required to complete the claim for disability benefits. When a VA examination is scheduled, the claimant must cooperate by reporting for the examination.

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Advocates Note:

If you are receiving specialized care for a disability, print out the appropriate DBQ and ask your physician or specialist to assist you; the VA has a practice of using nurse practitioners who may not possess the necessary expertise to assess your disability.

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