VA Compensation and Pension Exam

Category: Veterans Disability Law

Article by Daniel J. Tuley

When a veteran is disabled in the military to a point that affects their daily life, they are entitled to monetary compensation for that condition. The U.S. Department of Veterans Affairs (VA) is responsible for determining whether or not a veteran is eligible for benefits and how much money they receive. Even if a veteran submits a current medical diagnosis with their disability claim, the VA will require an approved professional to conduct a C&P exam.

A C&P exam, or compensation and pension exam, is a medical exam ordered by the VA to evaluate a veteran’s conditions in reference to their disability claim. C&P exams are essential in determining the VA rating, a percent value that decides what level of compensation an individual will receive from the government. The VA rating is based on the severity of an individual’s condition and how debilitating it is. C&P exams provide medical information that will help a veteran receive the proper VA rating, and they are not always necessary depending on the disability being assessed.

Evaluating Post Traumatic Stress Disorder

Mental health disabilities typically require C&P exams because of the subjectivity of medical diagnoses. Even if a veteran has a current diagnosis from a medical professional, the VA will typically still require a C&P exam for conditions like anxiety, depression, and PTSD.

Post-traumatic stress disorder (PTSD) is a mental health disorder that involves flashbacks, nightmares, or intense episodes that are related to and/or caused by a traumatic event. Due to the high number of possibly traumatic events that occur around active military members, a disproportionate number of veterans suffer from this condition. The VA rating for PTSD can range from 0% to 100%, but typically lands around 30%.

PTSD can be especially difficult for the VA to assess. When filing a disability claim for PTSD, it’s important to be as honest and forthright as possible about symptoms. Providing a clear picture of how the condition is affecting one’s life can influence the VA’s decisions about compensation.

PTSD C&P Exam

A VA C&P exam for PTSD can be ordered when determining original severity or when a veteran believes they deserve an increase in their rating. The exam must be conducted by a VA approved psychologist, therapist, or other mental health professional that the veteran has no history with. If an individual has a current diagnosis from a VA approved professional they’ve already been seeing, the C&P exam must be proctored by a different professional. This professional might not come to the same conclusion as the veteran’s regular doctor.

While a current diagnosis can help a veteran’s claim, the VA will typically weigh the C&P examiners opinion more heavily in determining compensation. For this reason, it’s recommended that a veteran going to a C&P exam should bring a witness with them and document as much of the process as possible. Proving service connectedness is one of the most important parts of filing a VA disability claim. The C&P examiner’s opinion is often looked to as proof of the connection between an individual’s disability and their time in active military service.

One of the ways examiners gather this information is through the use of a DBQ.

PTSD DBQ

During the C&P PTSD exam, the proctor will administer a PTSD DBQ, or post-traumatic stress disorder disability benefits questionnaire. A DBQ is a publicly available form created by the VA for veterans to fill out that helps quantify the severity and service-connection of a disability. The form includes a variety of VA mental health evaluation questions that measure both the condition and the likelihood that the condition is linked to events that occurred in the service. There is a DBQ for individuals who are under review for PTSD and there is a DBQ initial PTSD form that relies more heavily on the DSM-V (see ‘DSM-V’ in next section) for categorization.

Through a series of questions, the DBQ strives to reveal how a person views their own experience with PTSD. An individual’s answers to the PTSD DBQ and overall PTSD C&P exam results are some of the main factors when determining a VA rating.

C&P Exam Process

For a veteran with a disability, the first step is to document all relevant symptoms as they develop and progress. The more in-depth notes a veteran has to present at the time of a C&P exam, the more evidence they have towards building a case for benefits. As mentioned earlier, it’s also helpful to bring along a witness to the examination; this witness can both give testimony and confirm that the examiner is being fair. Sometimes a witness will be able to communicate how a disability has affected the veteran’s life more than the veteran can.

Upon arrival the examiner will compare the PTSD symptoms a veteran is experiencing with the recorded criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The DSM-V is an inclusive mental health condition database created by the American Psychological Association (APA) that provides official definitions and symptoms for all known psychological disorders. The DSM-V criteria for PTSD require the following:

• Stressor — The patient was exposed to some variation of a traumatic experience.
• Intrusive Symptoms — The patient consistently experiences the traumatic event in some way or another (g., flashbacks or nightmares).
• Avoidance — The patient avoids stimuli related to the traumatic event.
• Negative Alterations — The patient experiences a negative change to their mood or cognition that began or got worse after the trauma occurred.
• Arousal and Reactivity Alterations — The patient becomes easily irritated or reacts much more intensely to normal stimuli as a result of the trauma.
• Duration — The patient experiences symptoms for more than one month.
• Functional Significance — The patient is distressed or impaired as a direct result of symptoms.
• Exclusion – Symptoms are not present as a result of other factors (e.g., substance abuse, medication, or illness).

If a veteran meets the criteria for PTSD, they will typically be required to complete a DBQ to further explain the symptoms they are experiencing and how those symptoms are connected to time in the service.

Possible Questions

As mentioned above, the PTSD DBQ forms are available for anyone to access on the VA’s website. One of the best ways to prepare for a C&P exam is to look over these questionnaires and gather information to help answer the prompts completely and accurately. Some examples of what the questions might cover include:

• Information about medical diagnoses
• Whether or not an individual suffers from multiple mental disorders
• Levels of occupational or social impairment; how does the PTSD inhibit an individual’s ability to interact with friends or coworkers
• Relevant medical, legal, behavioral, substance abuse, educational, family, work, and mental health history
• Symptoms and criteria for PTSD
• Any additional observations or remarks about how the condition affects the individual’s life

During the entirety of the C&P exam, both the veteran and the veteran’s witness/guest should be documenting the process from their perspective. Recording information such as how the examiner asked questions and responded to the veteran is important in case an appeal needs to be filed in the future.

Malingering

There is one aspect of a PTSD diagnosis that can throw off VA compensation — malingering. Malingering means that an individual is intentionally producing false or exaggerated symptoms to satisfy external incentives. Essentially, to malinger with PTSD is to pretend that it’s worse than it is to do things such as:

• Avoid military duty
• Avoid work
• Obtain drugs
• Escape prosecution
• Obtain financial compensation

While mental health experts agree that malingering is not as common an issue as the VA persists, the VA still refutes a decent amount of claims each year on its behalf.

There are a multitude of personality tests that the VA doctor can use to uncover malingering, however, scores of a malingerer are fairly similar to those of someone experiencing severe PTSD symptoms. What really matters is an individual’s visible behavior compared to what they claim their symptoms are. Remember that a C&P examiner can observe a veteran from the moment they walk into the office, including how they interact with staff and other patients.

If there is no evidence of malingering and symptoms of PTSD are present and potent, an individual is more likely to receive VA PTSD disability compensation.

C&P Results

Once the C&P exam is completed, it usually takes around three to four months for the VA to process a claim from start to finish. The results of a C&P exam are not available to the individual until after the decision is made. They include the DBQ answers, the opinion of the C&P examiner, and the reasons the examiner gave that opinion.

If the veteran would like to see their results, they must contact their nearest regional VA office. A copy of the results can be sent to the veteran upon request, otherwise the veteran will hear the results when the VA makes their final decision on the individual’s disability benefits.

If a veteran does not agree with the VA’s ruling, whether it be too low of a rating or no rating at all, they can appeal the decision. During the appeal process, the veteran should obtain the C&P exam results and compare the examiner’s opinion to the notes they took during the exam and other medical opinions that state the disability is more severe than the VA ruled. Depending on the VA’s decision, the veteran may be required to undergo another C&P examination.

C&P Reevaluation

When a veteran is being evaluated a second time for PTSD the process is very similar. Whether they are trying to receive a higher rating or they are appealing an unfavorable decision, they must examine with a different VA approved mental health professional. The questions on the DBQ are slightly different because there is an additional layer that includes how the condition has changed over time.

Typically, the first time through the C&P exam the examiner may pay less attention because they receive a large volume of applicants and are expected to keep things moving smoothly. If an individual proves that they document the examiners behavior and can show that their initial proctor was not following regulations or treating them fairly, the next examiner will be more apt to provide an accurate rating. Especially with the help of a legal representative, the appeal or review process is usually easier because the weak points of the case have been identified.

Fighting to ensure veterans get the compensation they deserve is important, therefore it’s necessary to be as prepared as possible.

Preparing for the C&P

The best way you can prepare for the C&P, the DBQ, and the potential appeal process, is to keep a detailed record of all relevant information from start to finish. Having written statements of everything you can remember from the event that caused the PTSD to the ways the symptoms have affected your life can help build a strong case to the VA.

There is also a VA C&P exam drug test to reveal whether or not certain substances are affecting your behavior. Although a claim will not usually be denied for the use of lesser drugs such as marijuana, certain medical treatments or procedures can be withheld. In preparation for the C&P exam, avoid consuming any substances that may possibly interfere with a clear diagnosis.

Filing a VA PTSD Claim

Remember that while the C&P exam is an integral part of a PTSD disability benefits claim, it is only a part of the total process. The C&P results will be sent directly to the VA as evidence for your case, but it’s important not to stop there. Submitting other proof of your disability can help earn the proper compensation. As with any VA disability claim, you must have three things:

• A current diagnosis
• Evidence of an inciting event
• A medical nexus that links the diagnosis to the event

The main function of a C&P exam is to serve as the medical evidence that proves your life is significantly affected by events that transpired during active military service.

Working with a VA Disability Lawyer

The process of preparing for, attending, and if necessary, appealing a C&P exam can be lengthy and difficult on your own. Working with an experienced attorney who has practice handling VA disability claims can greatly reduce the headache associated with filing for compensation. The lawyers at Tuley Law Office have the knowledge and understanding to answer any questions you may have related to your claim or service-connected disability.

Whether you’re on the verge of making a claim, or have already reached the appeal process, reach out to our attorneys to set up a consultation today.

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