The Compensation and Pension (C&P) exam is a medical evaluation requested by the Department of Veterans Affairs (VA) during the processing of a disability claim. Its findings serve as the foundation for determining a veteran’s eligibility for benefits. The examination is mandatory for establishing a medical link between a claimed condition and military service, known as a service connection, or for assessing the current severity of an existing service-connected condition.
Defining the C&P Examination and Its Purpose
The C&P exam is fundamentally different from a routine medical appointment because the examiner does not provide treatment, prescribe medication, or offer medical advice. The purpose is to gather objective medical evidence for the VA claims rater to use in making a decision. The examiner has two primary objectives: determining the “nexus,” the medical opinion linking the disability to military service, and assessing the current severity and functional limitations for rating purposes. The examiner must determine if the condition is “at least as likely as not” related to service, which is the VA’s medical standard of proof.
These evaluations are conducted by licensed medical professionals, who may be VA staff providers or contract providers working for third-party companies. Major contractors often include Veterans Evaluation Services (VES), Optum Serve Health Solutions, and Leidos QTC Health Services. All examiners are trained to follow the same VA guidelines and protocols for evidence gathering.
Preparing for the Examination
Preparation for the C&P exam involves focusing on documentation and logistics to ensure the most accurate evaluation. Before the scheduled appointment, review your claims file, or C-File, which contains all the medical and personnel records the VA is considering. Understanding what records the examiner has access to can help you anticipate the focus of the appointment.
Gathering personal notes detailing the history and impact of your symptoms is important. These notes should focus on the frequency, duration, and severity of symptoms, and how they specifically affect your ability to function in daily life and work. This detail provides the examiner with a comprehensive picture of your condition beyond what is documented in medical charts.
Respond promptly to the scheduling notice from the VA or the contractor to confirm the time and location. Appointments may be scheduled at a local VA medical center or a contractor’s facility, often within a 50-mile radius of your home. Failure to attend a scheduled exam can lead to the denial of a claim unless you notify the scheduler with an acceptable reason.
What Happens During the Appointment
The C&P appointment format varies depending on the condition being evaluated. It may take place in-person, via telehealth, or involve only a review of records, known as an Acceptable Clinical Evidence (ACE) exam. In-person or virtual exams can range in length from 15 minutes for a straightforward review to an hour or more for complex conditions.
During the exam, the provider will ask you questions based on the medical records in your file and the specific condition being claimed. The examiner is guided by standardized forms called Disability Benefits Questionnaires (DBQs), which are condition-specific templates used to document the necessary medical information in a structured way. This ensures that the essential data points for rating the disability are consistently captured.
It is important to provide a thorough and honest account of your symptoms as they are today, not as they were on your best day or exclusively during your military service. The examiner needs to understand the current functional impairment of the condition, which is a significant factor in the final disability rating. For physical conditions, the examiner may perform a basic physical assessment, such as measuring the range of motion of an affected joint.
How Exam Results Influence the Disability Rating
Once the C&P exam is complete, the examiner compiles their findings and medical opinion into the DBQ and a final report, which is submitted to the VA claims rater. This report serves as the primary medical evidence the rater uses to adjudicate the claim. The examiner’s opinion on the medical nexus is particularly influential in determining whether a service connection is granted.
The report also details the current severity of the condition and the resulting functional limitations, which the rater directly compares to the VA’s Schedule for Rating Disabilities. This schedule outlines the criteria required to assign a specific percentage rating, which in turn determines the level of monthly compensation. The C&P exam effectively translates the veteran’s medical condition into the specific language and metrics the VA uses for benefit determination.
If a veteran disagrees with the outcome of their claim due to an unfavorable C&P exam report, they have options for recourse. They can submit a Supplemental Claim with new evidence, such as an independent medical opinion, to counter the examiner’s findings. Alternatively, a veteran can request a Higher-Level Review, where a senior VA claims adjudicator reviews the existing evidence for potential errors.