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.

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. If life hit you, say what happened, in writing, and ask.
• Already drawing compensation and you miss a reexamination? 38 CFR 3.655(c): VA sends a pretermination notice giving you 60 days to say you are willing to report, or to send evidence. Answer inside 60 days and the exam is rescheduled. Ignore it and your payment is reduced or stopped. Miss the rescheduled exam and the reduction is immediate — no second notice.
• Requesting a hearing within 30 days of that notice defers the payment change while it plays out (38 CFR 3.105(i)(1)).

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.

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.

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 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.

• 38 CFR 4.16(a): one disability ratable at 60% or more, or two or more disabilities with at least one at 40% or more and a combined rating of 70% or more — plus being unable to secure or follow a substantially gainful occupation because of service-connected disability. Marginal employment, generally earned annual income at or below the poverty threshold for one person, does not count as substantially gainful.
• Below those percentages you are not shut out. 4.16(b) requires rating boards to refer veterans who are unemployable because of service-connected disability, but who do not meet the percentages, to the Director, Compensation Service, for extra-schedular consideration. Ask for it by name.
• The form you file is VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability — va.gov/find-forms/about-form-21-8940.
• VA Form 21-4192 is not yours to file. It is a request for employment information that VA sends to your employer. Do not go hunting for it.
• Back your work testimony with what you can get yourself: a signed employer or supervisor statement, leave and timekeeping records, and lay or buddy statements. A number with nothing behind it gets weighed against your records under 38 CFR 4.2.

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.
• 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.

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.

• Higher-Level Review — a more senior reviewer looks at the same evidence. VA's page: request it "within 1 year of our decision on your initial claim or Supplemental Claim (the 1-year timeframe starts from the date on your decision letter)." va.gov/decision-reviews/higher-level-review
• Board Appeal — a Veterans Law Judge. Request "within 1 year of the decision on your initial claim, Supplemental Claim, or Higher-Level Review." va.gov/decision-reviews/board-appeal
• Contested claim — where two people are claiming the same benefit. That one is 60 days from the date on your decision letter, and Board Appeal only. Higher-Level Review is not available for a contested claim at all. This is the deadline people blow.
• Supplemental Claim — the route when you have new and relevant evidence, such as the private records or statements you did not have the first time. Do not assume you can take your time with it; when you file affects what VA can pay back to you. Check the current rule on VA's decision reviews pages before you let it sit.

Free help exists, and fees are regulated

• An accredited VSO representative — a veterans service organization representative VA has recognized to handle claims — works your claim for free. Recognized organizations and their accredited representatives are barred from charging you for that work. Find one at va.gov/get-help-from-accredited-representative/find-rep.
• An accredited attorney or claims agent may charge, but only for representation provided after VA issues notice of its initial decision on the claim. Under 38 CFR 14.636, a fee not exceeding 20% of past-due benefits is presumed reasonable if the representation continued through the date of the decision awarding benefits, and a fee over 33 1/3% is presumed unreasonable.
• Verify anybody before you sign. VA's accreditation search is free: va.gov/ogc/apps/accreditation. A person who does not come up is not accredited.
• One narrow door for somebody who is not accredited. 38 CFR 14.630 lets a person represent you one time only, if VA Form 21-22a is filed and you both sign a statement that no fee will be charged. Your spouse or a buddy helping you gather your own records is not representation at all — that is just help, and nothing stops it.
• 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.