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§4.2 Interpretation of examination reports.
Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. 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.
Have you been scheduled for a C & P exam?
This may be the most important information you'll read today. Take your time, read everything here carefully. Then read it again.
We have tried to arrange this in a way that it will make a very complex topic easy to understand. However, it remains a complex topic and you must put a lot of effort into understanding how the C & P process works.
You will find links to other pages. Follow those and learn all you can. Many of the links you see will take you to the definition of that word. Other links may take you to pages where you can read the federal regulations that support the C & P exam.
Understanding the complex jargon is important. Take your time and read these things thoroughly. The C & P exam may make the difference between a high rating and a smoother path to the benefit you deserve.
Purpose of the Clinician’s Guide
This guide is designed to assist clinicians when performing compensation and pension (C&P) examinations. Since C&P examinations differ markedly from traditional medical examinations, special clinician guidance is required. This guide provides information for performing examinations that meet the requirements of the federal law.
Since the federal law (rating schedule) is written in legal language, it is often misinterpreted by clinicians. This guide, therefore, bridges this gap and explains the law in clinical terms.
Both this Guide and the worksheets should be utilized when performing C&P examinations.
A typical C & P exam.
Jim Strickland is a Vietnam era Army veteran and nationally recognized expert on VA disability benefits and a member of the Stateside Legal Website Advisory Board. Jim's Mailbag, is a regular column where veterans, servicemembers, and family members can ask Jim their questions about VA and Social Security disability benefits.
You can browse all of these Q&As here, and search the Jim's Mailbag archives for helpful answers.
If Jim hasn't already addressed the questions you have, you can submit your own question.
I'd like to ask you about...TDIU and Activities of Daily Living, Charges against Purple Heart Disabled Marine, Total hip replacement and complications, Agent Orange Presumptive Conditions, Prostate Cancer "cured" but now recurring, Ischemic Heart Disease and new stents implanted, Applied for disability via his doctor...and many many more.
Compensation & Pension Examinations
When you are ordered to attend a C & P examination, you must attend. Failure to show up is likely to terminate your application for benefits immediately or cause significant delay.
Don't reschedule the exam, even if it isn't convenient for you! It doesn't matter if you don't understand why you are scheduled for a C&P exam. That isn't important.
You must attend and you must understand how the process works. The C & P exam is usually done by a health care professional who works for a company that is a contractor to the VHA. We call these people C& P Examiners.
The C & P Examiner does not make the decision about your claim!
The Ratings Veterans Services Representative (RVSR) is a primary decision maker of the outcome of your claim for VA disability compensation benefits. Once the veteran has filed for the compensation benefit a folder or file is created and data (called evidence) is added to the file for consideration by the RVSR.
The condition you claimed will likely have some past evidence in the form of a Service Medical Record (SMR) or records of diagnosis and treatment from civilian providers.
No matter the amount of evidence you have, it's likely that the Veterans Service Representative (VSR) or the RVSR will request that a VA contractor perform a C & P exam on you.
The C & P examiner will not treat you or order any medications. Lab work, x-rays and other such studies may be ordered by the C & P examiner.The depth of the examination is determined by order of the VSR or the RVSR and is included in the request for examination. When you have filed a claim or VA has decided to review the status of your condition, the VSR completes an order to have you attend a C & P exam. The order is very specific as to exactly what the VSR believes should be examined. If you have claimed a condition of your left leg, the C & P examiner will only address issues about your left leg.
The examiner has no authority to go beyond what is ordered by the VSR. Frequently the examiner will not have your medical records or any other history available. That is often the case when the VSR only wishes to determine the degree of function of a joint, as in a knee injury.In that instance, the examiner won't consider that the history or treatments over time is of any particular importance. She or he will only be looking for the physical effects that are observable and measurable at that moment. The knee may be flexed and
rotated so that the examiner can record those motions for comparison to the norm.
If there is scarring, crepitus (joint noise), swelling or redness, all of that will be noted in a report. In other cases, the VSR or RVSR may request that the examiner give the medical record a very thorough review to determine whether or not a condition originated in the time of military service. A claimed back injury may have a reference of a similar injury in the SMR of 30 years prior to the date of the claim. The examiner will be asked for an opinion that will state that the condition of today is or is not likely to have resulted from the injury in the SMR or if it is a condition that is of different origin and likely happened long after the ETS.
This is sometimes referred to as a nexus letter and may connect the condition you allege today with an event that happened many years ago.
QTC is a contractor that does C & P exams for the VA.
QTC is the largest private provider of government-outsourced occupational health and disability examination services in the nation.
Avoid the Fiduciary Trap
Be aware that during any C & P examination you may be asked about how you handle your finances.
The examiner may seem casual as you're asked about who pays the bills at your house. The wrong answer will see VA proposing to appoint you a fiduciary because of your "incompetence". If you are capable of managing your money and paying your bills, say that clearly. If the examiner has any reason to doubt you, you may be caught up in the VA fiduciary web.
Separating Fact From Fiction
The Must Do & Must Not Do of the C & P Exam
* The examiner does not make the decision about your claim.
* You may take records with you but the examiner may refuse them.
* The examiner won't treat you or prescribe medicines.
* NEVER try to fake any symptom. If you aren't prescribed a neck brace, don't wear one.
* The examiner will only perform the task assigned by an order of the regional office.
* You do not have to allow the examiner to cause you pain or discomfort during the exam by manipulating joints, etc.
* The examiner does not have any insight about how your claim will be decided. Don't ask.
* You may request that a family member or friend join you during the exam. The examiner may agree or refuse your request.
* DO NOT attempt to secretly record any part of the exam.
* DO make notes for yourself before you go. This is the only way you'll be sure to tell the examiner all the details you want to share.
* DO NOT over-exert yourself trying to please the examiner. This exam is about your worst symptoms, not the best.
* DO be courteous at all times. Don't complain to the examiner about all the indignities you've suffered. Focus on the reason you're there.
* DO use your common sense. This exam probably won't make or break the decision about your claim but it can help.
If you are scheduled for a C & P exam, you must attend.
If you believe that a mistake has been made in scheduling your exam, you may argue that with VA after the exam is finished.
If you don't attend an exam, VA will default to whatever action was being considered when the exam was scheduled. That is rarely going to be in your favor.
Even if it's a surprise and very short notice, we advise that you show up promptly regardless. If you don't go to your exam, be aware that you may quickly lose benefits.
Compensation and Pension Examinations - All you ever wanted to know about the C & P exam.
VAWatchdog knows that the C & P exam produces more anxiety than any other of the steps during the claims process. Understanding how the C & P exam works is vital to winning your claim. You must take time from your schedule to read this page carefully...and then read it again. What you'll learn here today may make the difference in winning or losing.
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