A Compensation & Pension (C&P) exam is a medical assessment ordered by the Department of Veterans Affairs (VA) when a veteran files a disability claim. The exam’s primary function is not to provide medical treatment but to gather objective evidence about a claimed condition, such as hypertension. The C&P exam helps establish two things: whether the condition is connected to military service (service connection) and the degree of its severity for disability rating purposes. The examiner, often a VA or contract healthcare provider, will review the veteran’s medical history and perform a limited physical assessment. They complete a standardized Disability Benefits Questionnaire (DBQ) to provide the VA with the necessary clinical information.
Pre-Exam Preparation and Required Documentation
Preparation for the C&P exam should focus on compiling comprehensive medical documentation and organizing a clear narrative of the condition’s history. Gathering all existing medical records related to high blood pressure, including the initial diagnosis, treatment history, and any related conditions, is a necessary first step. These records should ideally contain blood pressure readings taken on at least three different days, as this is a VA requirement to confirm a current diagnosis of hypertension.
Veterans should also create a detailed list of all medications currently used to manage hypertension, including the dosage and frequency, to present to the examiner. It is beneficial to prepare a symptom log or diary that details the impact of hypertension on daily life, noting any episodes of symptoms like dizziness, headaches, or chest pain. Furthermore, having evidence that legally links the condition to military service, known as a nexus, is important for establishing service connection and should be ready for review.
The Examination Process and Examiner Focus
During the C&P exam for hypertension, the examiner will first conduct a thorough review of the veteran’s medical records and military service history. They will ask specific questions about the onset and progression of the high blood pressure, the effectiveness of current treatments, and how the condition affects the veteran’s ability to function. The goal is to collect all the data required to complete the specialized Hypertension Disability Benefits Questionnaire (DBQ).
Accurate blood pressure measurements are typically taken multiple times during the appointment. The examiner may take these readings in different positions, such as sitting, standing, or lying down, to get a comprehensive assessment of the condition. The healthcare provider is not there to treat the hypertension but to verify the diagnosis and severity according to the VA’s legal standards. They will also check for any physical signs or complications related to hypertension, such as heart or kidney issues, which may influence the final rating.
Understanding VA Rating Criteria for Hypertension
The VA evaluates hypertension under Diagnostic Code 7101 within the Schedule for Rating Disabilities (38 C.F.R. ยง 4.104), which uses sustained blood pressure readings to determine the disability rating percentage. The mildest compensable rating of 10% is assigned when the diastolic pressure is predominantly 100 or more, or the systolic pressure is predominantly 160 or more. This 10% rating is also the minimum evaluation assigned for an individual who requires continuous medication to control high blood pressure, provided their diastolic pressure was predominantly 100 or greater at some point.
The ratings increase based on higher, sustained pressure readings, reflecting a greater level of disability. A 20% rating is warranted for a diastolic pressure predominantly 110 or more, or a systolic pressure predominantly 200 or more. The 40% rating is reserved for cases where the diastolic pressure is predominantly 120 or more. The highest rating of 60% is assigned when the diastolic pressure is predominantly 130 or more, indicating severe, sustained hypertension that persists despite treatment.
Post-Exam Procedures and Timeline
Immediately after the C&P exam, the examiner will finalize the DBQ and their detailed report, which summarizes the findings and provides a medical opinion on the condition’s severity and service connection. This completed documentation is then transmitted directly to the VA regional office handling the veteran’s claim. The claim then moves into the evidence review and decision phase, where a Veterans Service Representative reviews the C&P exam results alongside all other evidence in the claim file.
The timeline for a final decision after the exam is variable, often ranging from one to four months, depending on the complexity of the claim and the workload at the regional office. If the initial evidence or the C&P report is incomplete or unclear, the VA may issue a Request for Evidence (RFE) or schedule a follow-up exam to seek clarification. The veteran will be formally notified of the final decision, including the assigned disability rating and the effective date, via a decision letter sent by mail.