Kristian T.F. Terison: [00:00:00] can you talk a little bit about the purpose of the C&P exam and how it fits into the disability claims process?
Atty. Francis Jackson: Sure. It’s helpful to go all the way back to the beginning, if you will, and the VA process was originally established to help veterans to get disability benefits as compensation for injuries or illnesses that they had suffered as a result of their military service. And it was intended as kind of a benevolent system where the VA would actively help the veteran to establish entitlement to benefits.
And so, that has come to be called the duty to assist. And the VA has a duty to assist veterans in developing their claims.
Atty. Francis Jackson: [00:01:00] Welcome to Victory Over VA, your guide to unlocking your VA disability benefits. If you’re a veteran applying for benefits, subscribe to our podcast for the latest developments in VA disability.
So, welcome all. Today, we are going to talk about the C & P exam, or Compensation and Pension exam, that is so integral to the VA disability process. Who are we? Well, I’m Francis Jackson. This is Kristian Terison and we’re from Jackson MacNichol, and we’re a law firm that specializes in getting justice for veterans on their VA disability [00:02:00] benefits.
And we do literally thousands of these cases from around the country. And so we want to take this opportunity to tell veterans a little about how the system works. So who is this show for? Well, it’s obviously for veterans, but it’s also for folks who care about veterans, whether you’re family or a friend or just a member of the community looking to support veterans. This is the podcast for you.
Kristian T.F. Terison: All right. Well, as you mentioned our topic for today is sort of, the Compensation and Pension, or C& P, exam. So can you talk a little bit about the purpose of the C&P exam and how it fits into the disability claims process?
Atty. Francis Jackson: Sure. It’s helpful to go all the way back to the beginning, if you will, and the VA process was originally established to help veterans to get disability benefits as compensation for injuries or illnesses that they had [00:03:00] suffered as a result of their military service. And it it was intended as kind of a benevolent system where the VA would actively help the veteran to establish entitlement to benefits.
And so, that has come to be called the duty to assist. And the VA has a duty to assist veterans in developing their claims. Part of that is that, if a veteran doesn’t have his or her own medical person who is evaluating him and providing that information to the VA, then the VA is supposed to provide a medical and opinion about the particular claim that is being considered.
And so, that’s where the compensation and pension exam comes from.
Kristian T.F. Terison: All right. And I guess, can you walk us through what typically happens at a C&P [00:04:00] exam?
Atty. Francis Jackson: Yeah. The way it usually works is the C&P exams are contracted out. Meaning the federal government specifically the Department of Veterans Affairs has a contract with a company whose process is to find local medical folks and arrange with them to do evaluations for which they pay them a, certain amount of money.
And those can be either physical or mental conditions. So, it might be a review by a nurse practitioner or a physician’s assistant for a physical claim. It might be a review by a psychologist or very rarely, a psychiatrist for a mental health claim. But they’re all contracted.
So, unfortunately the side effect of that is that the company is trying to find people that they can pay a relatively modest amount of money to, so that the examiners tend to have an interest in doing this in the least possible [00:05:00] amount of time for the amount they’re getting paid. Those sadly, are the realities.
Kristian T.F. Terison: Okay. And I guess in the exam itself, how would it be different from a physical that you’d get every year?
Atty. Francis Jackson: Well, it may not be much different although we get complaints from veterans that actually their physicals are much more thorough in some cases.
But here’s how it works, the VA employee decides that a compensation and pension exam is needed. They put together a request for an examination and they will typically highlight certain records that they think the examiner should pay attention to. Theoretically, the examiner is going to look at the entire VA claims file.
In reality, my experience is that often is not correct, that the examiner doesn’t have the time or take the time to read the whole file. And the problem is that these files are not organized and indexed in a meaningful way in most [00:06:00] cases. So, you can literally have a file that is several thousand pages long, has lots of the same material repeated over and over in different places, and is really difficult to get specific information about a particular claim out of in any quick and easy way.
So the net result is that examiners miss stuff. And it’s just unfortunate because it often leads to exams that are not entirely accurate. Sometimes they’re grossly inaccurate. Sometimes they’re really good. But overall, they’re okay, if you will. They’re not great. But usually not really awful.
Kristian T.F. Terison: I know in, the hundreds of cases I’ve personally worked on when looking for errors in the report that comes out of a C & P exam, it’s a rare case where I can’t find something that was up or done wrong.
Atty. Francis Jackson: Yeah. [00:07:00] And, unfortunately sometimes, it’s the really important part that gets mixed up or done wrong.
And so it’s a crapshoot, frankly. Sometimes there are really good C & P exams. Sometimes there are not.
Kristian T.F. Terison: So, how can veterans prepare for a C & P exam to ensure that it accurately reflects their condition?
Atty. Francis Jackson: Well, a couple of things. I think it’s helpful for veterans to make a list of things that are important to their condition in terms of details of what happened in service and if the particular event is not recorded specifically in their service records. They need to provide the examiner, I think, with a careful explanation of what happened and why it’s not recorded in the records.
In addition to that, it’s really important that veterans complain. know, one of the unfortunate side effects for purposes of VA compensation is, from the military mindset is that folks are taught to be a little on the macho side, kind of [00:08:00] power through, not be held back by pain or difficulty, and not to complain.
And unfortunately, in these C & P exams, it’s just the opposite. You need to complain, you need to sound like the worst whiner in the world because you need to get across to the doctor what the problems are. And if the doctor says, well, does your leg hurt, and it’s actually so painful that when you have a flare up, you’re just limping around, can barely move, and you say, well, it’s not too bad, then the doctor’s going to think, well, it’s not too bad.
He’s not going to know that you have flare ups where you’re barely able to get around for days at a time. So it’s really critically important for veterans to really provide details about what difficulties they’re actually having.
Now, we don’t want anybody making anything up. We just want people to accurately say what level of difficulty they’re having and one of the questions that is going to be asked about physical problems in particular, do you have flare ups? And most [00:09:00] people, for most physical conditions, have symptoms that vary in intensity. You know, today it’s mild, tomorrow, you know, it’s a rainy day and cold and it really hurts.
And so, it is really important for veterans to explain the severity and intensity of their symptoms if they wantthe doctor to understand them. But know, the complaints I get from, so many people are that, number one the doctor was in a hurry and didn’t want to listen, that’s a, big complaint.
But another problem that is frequent and recurring. You know, I’ve, had spouses go with somebody to these things and I’ve heard it in hearings where the person at the hearing will say, well, you know, it’s not too bad. And then when the wife testifies, she’ll say, you know, he said it wasn’t too bad, but here’s what really goes on.
And so, it’s a problem. You really, you have the veteran prepare and explain exactly the level of difficulty they’re having rather than minimize it.
Kristian T.F. Terison: All right. Is there anything a veteran [00:10:00] should bring with them to a C&P exam? Anything like that?
Atty. Francis Jackson: I think it’s sometimes helpful to bring any recent medical test results, MRI reports, x-ray reports, blood test reports whatever kind of testing may be relevant to the condition that you’re talking to the doctor about.
I think it’s very helpful for them to have the most recent stuff. And if this is something that occurred in service and was recorded, I think it’s extremely helpful to literally offer the doctor a copy of the record showing, you know, this is the day I got hurt. This is how it happened. Here’s the report.
You know, it’s, I think not a situation where the doctor will always accept the information, but there’s no downside to trying to provide it.
Kristian T.F. Terison: Okay. And how does, the VA decide when a veteran needs a C & P exam? And sort of related to that, can a veteran request that they have a C & P exam for a particular condition?
Atty. Francis Jackson: Sure. A veteran can always request a C & P exam. That doesn’t mean they’ll get it, [00:11:00] but you can always request it. And in terms of how the VA decides, generally speaking, the way it works is, If there is medical evidence that you have a current condition, whatever that condition is, and the regional office sees something in the file suggesting that in fact something occurred in service that could lead to that condition, then ordinarily um, um, set up P exam.
Now set up a C & P exam uh, even when they’ve got good medical reports from people outside the VA system that explain what’s going on and how it should be rated and everything else but the flip side is that if they don’t see something in the file that suggests that something happened in service to cause this problem, often they won’t schedule a C & P exam at all even if the veteran has carefully explained what’s what happened and why it’s related.
Kristian T.F. Terison: And, what happens if a veteran disagrees with the findings of the C & P exam? What options do they have at that point?
Atty. Francis Jackson: Well, there are [00:12:00] a couple of options. One is obviously to complain to the VA that the exam wasn’t properly done, wasn’t comprehensive enough, didn’t consider the actual facts and so on.
I have not seen very many instances where the VA responded in any meaningful way to those complaints. But it’s at least worth if you are the veteran and you think the exam was not comprehensive enough, it’s worth making sure that you put that in writing and it’s recorded in the file.
But the most meaningful thing, I think, is to have a private exam and a report if the C & P exam was not useful or not favorable. VA doesn’t put nearly as much stock, if you will, in outside reports. But at the appeals level at the board, they pay pretty careful attention to those reports.
And a good report, a well written report by someone with good credentials that carefully explains what’s going on is often persuasive.
Kristian T.F. Terison: Okay. And I know that oftentimes [00:13:00] when people veterans are set for a C & P exam. They just get the notice in the mail with a date and a time. What should veterans be doing if they’re unable to attend a scheduled C&P exam?
Atty. Francis Jackson: Oh, that’s very important. If someone is scheduled for an exam and doesn’t show up, that in and of itself is a basis for the VA to deny the claim.
So, it’s really important if someone can’t attend the, scheduled compensation and pension exam, to contact the VA right away and make sure that they explain that they can’t go, why they can’t go, ask to have it rescheduled, and get the name of the person that they talked to and ask them to make a record of it in the file because I’ve seen a number of cases where C&P was scheduled, the veteran couldn’t go to the VA facility where it was scheduled or other location.
And the veteran said they told the folks at the VA that, but all that shows up in the file is veteran didn’t attend the exam, claim denied. So it’s really [00:14:00] important and it’s best, if at all possible, to not only call but to follow it up in writing and say, I called Jones today at the VA and told him I couldn’t go to this exam and it needed to be rescheduled and here’s why.
Kristian T.F. Terison: Yeah, definitely the belt and suspenders approach.
Atty. Francis Jackson: Absolutely.
Kristian T.F. Terison: Because it’s very easy for things to get lost in the shuffle over at the VA.
Atty. Francis Jackson: And that one is so critical because that failure to show at the exam alone often leads to denial of the claim, no matter how good the claim is.
Kristian T.F. Terison: Now, are there any common misconceptions that you’ve encountered that veterans hold about C&P exams?
That, you know, you’d like our viewers to know about?
Atty. Francis Jackson: A couple. One, is that, the VA exams aren’t very good and I, shouldn’t bother to go. Yeah. That, as you can see, puts them in the, they didn’t show for the exam and therefore their claim should be denied category, which is very bad.
A second one is that, I shouldn’t have to, this is particularly true of [00:15:00] mental health claims, I shouldn’t have to relive with this examiner stuff that’s already in my file because it’s distressing to me to talk about.
So many times, if the veteran isn’t willing to talk about an experience that led to mental health issues with the examiner will write that experience off as insignificant, even if it’s actually devastating to the veteran, and that’s why he can’t talk about it. So that’s another problem that we see a lot.
Kristian T.F. Terison: Are veterans allowed to bring someone with them to the C & P exam, family member, representative?
Atty. Francis Jackson: I wish I knew the answer to that. I have never seen anything that says they can’t, but I have heard stories of examiners saying, oh no, your wife can’t come in with you, etc. I don’t think there’s actually anything that precludes someone from having someone accompanying them at the exam, but it seems that’s an issue that examiners don’t necessarily agree on.
Kristian T.F. Terison: I was gonna say I’ve, seen both in cases I’ve worked on. [00:16:00] Actually, one case where the veteran uh, was allowed to bring their spouse in. And the spouse provided a lot of necessary detail. This was a mental health case, and they had a lot more to say about the veteran’s symptoms than the veteran did initially.
And it was actually instrumental in getting them to open up in the context of the exam.
Atty. Francis Jackson: Yeah, I think it’s useful to try to bring someone, as I said, I’ve seen situations where veterans have reported back that the examiner refused to allow anyone in.
Kristian T.F. Terison: Yeah, same here, so, maybe we should look up the rule one way or the other on that one. Get some guidance from the VA.
I don’t,
Atty. Francis Jackson: I don’t think there is a rule. I can’t find one.
Kristian T.F. Terison: Ah, okay, so you have looked. I should have known.
Atty. Francis Jackson: I’ve tried to find a rule. I don’t, see one. I think it’s the examiner’s discretion, essentially.
Kristian T.F. Terison: So where are the most common places that you see C & P exams go wrong? For a veteran there and there and I know you talked about.
Atty. Francis Jackson: Well as I mentioned, I think the biggest thing is when veterans under report their symptoms or are unwilling to talk about in mental health cases the [00:17:00] distressing circ*mstances. Those are the biggest things.
The other place that just goes wrong all the time is this whole business of it’s scheduled, you can’t go and you tell them you can’t go and then it still gets written up as refused to go to the exam, claim denied those just happen so often.
Kristian T.F. Terison: And then specifically for veterans with mental health claims, is there any difference in the C & P process for those folks, or is it comparable to what’s out there for physical conditions?
Atty. Francis Jackson: Well, in physical conditions, the examiner is supposed to use, in most cases, an angiometer, sorry, a goniometer, and measure things like range of motion and that sort of thing. So it’s very specific, if you will.
Mental health cases are different in that. It’s really all about the veteran’s symptoms, the importance of a, careful explanation of the intensity and frequency of the symptoms as you were alluding to earlier in your example. But it’s very hard for a lot of [00:18:00] veterans with mental health problems to really talk about um, what may underlie these,
or about the intensity frequency of the symptoms.
One of the things that is a frequent issue, I think, is that veterans with serious mental health problems are very scared, terrified sometimes, that if they tell the examiner the extent of their symptoms that they are going to be involuntarily hospitalized.
We’ve had that issue many a time, and it’s, very difficult to resolve. You know, lot of veterans are just unwilling to talk about the severity of their problems for fear of hospitalization.
Kristian T.F. Terison: Dr. Quinn Austin Small, one of our providers we work with who’s a mental health specialist and a mental trauma specialist who’s saying that to talk about those things is, re traumatizes each time it’s brought up.
So, you know, it’s a real thing, and it’s a real problem, and [00:19:00] unfortunately, because of how the disability claims process is structured. It’s a necessary step if a veteran wants to have a successful mental health claim.
Atty. Francis Jackson: It is. And it’s, very hard for some veterans to do that in a setting with an examiner they’ve never met before, you know, have no familiarity with, no way to ease into it, if you will. It’s just difficult and it’s a recurring problem with no apparent solution. Thank you.
Kristian T.F. Terison: on that delightful note, we’re out of time for today. This has been Victory Over VA. Please be sure to subscribe and tune in next week for the latest in Veterans Disability Benefits news.
Atty. Francis Jackson: And we’ll see you then.
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