Preparing for your C&P exam

Who runs the exam, and what it is not

• The examiner does not decide your claim. VA's words: the provider "can't make decisions about your claim." The examiner documents your condition. A VA rating specialist decides the claim later, using that report plus everything else in your file.
• Your exam is done by a VA provider or by a VA contract provider — Loyal Source Government Services, OptumServe Health Services, Leidos QTC Health Services, or Veterans Evaluation Services. VA says "our contractors follow the same medical training and licensing standards as our VA providers." A contractor appointment counts exactly the same as a VA one.
• The contractor calls or emails you first. Caller ID shows Loyal Source, VA EXAM-Optum, VA EXAM-QTC, or VA EXAM-VES. That is why unknown numbers get ignored and appointments get missed. Answer it.
• This is not treatment. The examiner will not treat you, prescribe, refer you, answer claims questions, or tell you the results.
• Any tests VA orders for the exam — X-rays, blood work — are at no cost to you.
• It may take 15 minutes or it may run over an hour. A short exam is not automatically a bad exam.

C&P exam vs. your VA treatment

Both end up in your file. They do different jobs.

• Your treatment visits build a written record of your condition over time. VA says it can help you gather documents from a VA medical center, so tell VA where you have been treated (what evidence VA accepts).
• Your own doctor can fill out a DBQ and you can send it in, but VA says it will not pay or reimburse the cost of that.
• If a symptom is getting worse, book VA treatment. Waiting for the claim exam to be treated is not how either one works.

Send your evidence to VA, not to the examiner

• VA says you do not need to bring anything to the exam. Records handed to a contract examiner may never reach your claim file.
• Submit medical records, test results, medication lists and lay or buddy statements to VA before the appointment. Upload at va.gov/claim-or-appeal-status. That tool takes uploaded evidence for an initial claim, but not for a decision review or appeal.
• Bring a personal copy for your own reference if it helps you remember. That is fine.
• Arrive about 15 minutes early. VA's page says if you are late, the provider may cancel the exam.
• A support person: you can ask to have a caregiver or Family member with you, but it is the provider's call and they may be asked to wait outside. For a sensitive exam you can request a medical assistant or chaperone who works with the provider to stay in the room. Either way, they cannot answer for you.
• You may not need the exam at all. Under 38 CFR 3.326, VA orders an exam when the medical evidence with your claim is not adequate for rating purposes. An outside exam report or a private physician's statement can be accepted for rating without further examination if it is adequate. Thorough evidence up front can save you the appointment.

Do not miss it — and if you have to, move it

Good cause is broader than people think.

• The regulation says good cause "include[s], but [is] not limited to, the illness or hospitalization of the claimant, death of an immediate family member." Not limited to. VA's claim exam page gives these examples: the death of an immediate family member, homelessness, hospitalization or a terminal illness. If life hit you, say what happened, in writing, and ask.
• Already drawing compensation, or asking for an increase? The missed-exam and reexamination rules, including the 60-day notice, are on our increase page.

What to be ready to describe

VA publishes no script for what to say. Come with your own numbers.

38 CFR 4.10 puts the duty on the examiner: it "imposes upon the medical examiner the responsibility of furnishing... full description of the effects of disability upon the person's ordinary activity." Your job is to give the examiner the material to do that. Fill these in for yourself before you go.

Do not stop at yes or no. "Yes, but" and "I can, but here is what it costs me" carry the information. And if you do not know or do not remember, say so — guessing puts a wrong fact in your file. "I don't know" and "I don't remember" are acceptable answers.

Typical day and worst day — say which is which

38 CFR 4.1: "the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability." Same section: "accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition."

• Describe both your ordinary day and your bad days, and label them plainly. Bad days are not a distraction from your claim — frequency, duration and severity of flare-ups are ratable information.
• Do not present a worst day as if it were every day. 38 CFR 4.2 requires the rating specialist to reconcile your exam against your whole recorded history. A description that fights your treatment records costs you credibility on the whole claim.
• Do not shrink a total limitation to sound specific, either. If you cannot do the activity at all, say that plainly and describe what happens when you try. 4.10: "a person may be too disabled to engage in employment although he or she is up and about and fairly comfortable at home or upon limited activity." Trading a true "I can't" for a tidier "I can, but" can lower your rating.
• Tell the truth in both directions. Overstating is self-defeating under 4.2, and it is a false statement to the government. Understating is money you never get back.

Phrases that can cost you — and what to say instead

Short answers that leave out the bad days get written down as your whole story.

• Answer the question you were asked. Stay on the condition you claimed and keep it direct.
• Give the same timeline you gave in your records, DBQs and statements. Differences get weighed against you under 38 CFR 4.2.

Range of motion — how the joint test works

For knees, shoulders, ankles and other joints, how far it moves can be part of the rating.

• Range of motion (ROM) is how far a joint moves, measured in degrees. The rating schedule for joints is 38 CFR 4.71a; 4.71 and its Plates I and II give the standard measurements.
• Tell the examiner when pain starts, not just where the motion stops. Do not push through pain to make the number look better.
• The joint DBQs ask the examiner to record active and passive motion and to address pain on weight-bearing and non-weight-bearing, and to record whether you report flare-ups.
• If you use a brace, cane or other device, tell the examiner when you use it and why. VA does not require you to bring anything.
• VA’s ankle and hip and thigh exam forms also ask whether you can do repetitive-use testing with at least three repetitions, and whether you lose motion or function after them.
• Flare-ups. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), as the Board describes it, the examiner has to try to get the severity, frequency and length of flare-ups, and what you lose, from the record and from you. “Cannot estimate” has to rest on a gap in medical knowledge generally, not just the examiner’s own. More on hip and ankle ratings.

Normal ranges VA uses

Example: knee flexion, Diagnostic Code 5260

• The lower the number, the higher the rating. Knee extension is rated separately under DC 5261, and VA's General Counsel has held that both can be rated for the same knee when the limitations are separate.
• Check the current schedule at 38 CFR 4.71a before relying on any single table; ratings are set by VA, not by this page.

Four things veterans never mention

• Painful joints. 38 CFR 4.59: "It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint." Where there is joint or periarticular pathology, that minimum applies even if your motion measures normal. The joint is supposed to be tested for pain on both active and passive motion, and weight-bearing and nonweight-bearing. Say if it hurts. The Court of Appeals for Veterans Claims has held that 4.59 is not limited to arthritis (Burton v. Shinseki, 25 Vet. App. 1 (2011)) and that objective evidence of painful motion can come from lay testimony, not only from a measurement (Petitti v. McDonald, 27 Vet. App. 415 (2015)). Evidence that helps show it: when and how it hurts, flare-ups, swelling, muscle guarding, popping or grinding, and pain with repeated use or after activity — and buddy statements and work records.
• The medication itself can be the criterion. Everyone gets told to say what medication does not fix. Also state exactly what you are required to take, and how often. Under some diagnostic codes the requirement is the rating — diabetes (DC 7913) is 10% when "manageable by restricted diet only" and 20% when "requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet."
• The close call goes to you. 38 CFR 4.7: where there is a question as to which of two evaluations applies, the higher one is assigned if your disability picture more nearly approximates it.
• "Secondary" is a legal term, not a figure of speech. A secondary condition is a separate disability proximately due to or the result of a condition you are already service connected for (38 CFR 3.310) — and aggravation of a non-service-connected condition by a service-connected one counts too. If your back caused the knee, that is its own claim. Do not let "secondary effects" get used to mean "how it affects my life" and then never file the real one.

If work is the problem, say the word TDIU

Total disability based on individual unemployability pays at the 100% rate.

Tell the examiner how the condition affects your work. The thresholds and forms (including VA Form 21-8940) are explained on our increase page.

Get a copy of the exam report

• VA is explicit: you cannot get the results at your exam or directly from the provider. You have to request the final exam report.
• The route is VA Form 20-10206, Freedom of Information Act (FOIA) or Privacy Act (PA) Request — va.gov/find-forms/about-form-20-10206. File it online, by mail, or in person. Request it as soon as the exam is done. There is no promise it reaches you before the rating decision does.
• By mail or in person: VA's claim exam page says to mail the completed form to Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444, or bring it to your nearest VA regional office. Check va.gov/resources/va-claim-exam for the current address before you send it. I did not find a processing time on VA's pages, so keep a copy of what you send.
• A thin exam is not the end of it. 38 CFR 4.2: "If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes." Same section: "Each disability must be considered from the point of view of the veteran working or seeking work."
• Check your claim at va.gov/claim-or-appeal-status and answer VA requests fast. You can download decision letters there for certain claim types — you need the date on that letter to run your appeal clock.

If the exam was bad

A bad exam is not the end of the claim. Do not ignore it.

Signs the exam may be inadequate:

• The examiner did not seem to have or review your records, or the exam was very rushed.
• You were not asked about your symptoms, flare-ups or how it affects daily life and work.
• What you said was ignored, or the report says something that contradicts your records.
• Required tests were not done, such as range of motion for a joint.
• The report says "normal" where your records document a problem.

Your travel is reimbursable

• A scheduled VA claim exam is its own approved reason for beneficiary travel. No minimum disability rating is required for that trip.
• Separately, travel for treatment of a service-connected condition qualifies at any rating, not only at 30% or higher.
• File within 30 days. VA: "Plan to file within 30 days. You can still file a claim after 30 days. But claims filed after the 30-day limit are usually denied." Steps at va.gov/health-care/get-reimbursed-for-travel-pay.
• If a contractor did your exam, the contractor pays the travel reimbursement. If it has not arrived after 14 days, call them.
• Who is not eligible: active-duty service members, and veterans living outside the United States or its territories. You also cannot claim it if VA provided the transportation free.

If the decision comes back wrong

The clock starts on the date printed on your decision letter.

The review options and their deadlines are laid out on our appeal page.

Free help exists, and fees are regulated

• Help from an accredited VSO representative is free. Who may charge a fee, and when, is on our increase page. Find a representative at va.gov/get-help-from-accredited-representative/find-rep.
• Want to see the actual questions the examiner works from? The public Disability Benefits Questionnaires are posted at benefits.va.gov/compensation/dbq_publicdbqs.asp.