What is A Claim & Pension Exam?

April 15, 2022

A Claim and Pension exam, or “C&P” exam for short, serves two main purposes:

  1. Make determinations as to how severe the disability is.
  2. Determine if the disability is related to an in-service event, injury, exposure, or condition.

The exams is performed by a VA healthcare provider, or more commonly as of late, a healthcare professional contracted by the VA. 

C&P exams are not automatic. It must be requested by the VA if the claim contains sufficient information to ascertain that there is a current disability and something in service that could have caused that disability.

On the other hand, the VA may (rarely) grant a disability if there is enough medical evidence in your file to support your claim, they won’t ask for a claim exam. Medical evidence may include hospital or doctor reports, test results, and other documents.

What Happens at A Claim and Pension Exam?

The exam is done at the office of a VA-contracted healthcare provider or a VA clinic or hospital. The medical provider should conduct an examination of the Veteran, including a medical history. When the examination is over, the medical provider will review medical records in the file or provided by the Veteran, and then writes a report based on their findings using what the VA calls a “Disability Benefits Questionnaire,” or DBQ. The report then goes back to the VA’s Regional Office where the application submitted initially for benefits.

If you have a mental health disability, your doctor will ask you questions and explain your symptoms. They may also ask you to complete some psychological tests. If you have a physical disability, the doctor will examine you, take measurements, and ask you questions. If necessary, they will perform some medical tests.

The VA Medical Center or VA-contracted health provider is responsible for sending you a notice for your C&P exam with the date and time of appointment. This is why it is really important to keep your contact information on file with the VA. If they don’t have your information, you may not get notice of your C&P exam, and if you don’t show up, you may not be able to get it rescheduled. Your benefits may get denied as a result, or you may have to wait months for another opportunity.

Things to remember before attending your exam

  • Don’t exaggerate your symptoms, but don’t diminish them either.
  • Be truthful in your answers when being examined.
  • Explain to the doctor exactly how your symptoms impact your life. 
  • Even if you feel frustrated by the questions or have a personal dislike of the doctor, be courteous.

The VA is supposed to provide a copy of your claims file to the medical provider in advance of the exam. For a C&P exam to be considered adequate, the doctor is required thoroughly check through all the documents in your claims file.

It is a good idea to bring newer medical records that you haven’t sent to the VA yet, or documents you have submitted in the previous month with you to the C&P exam, in addition to submitting them directly to the VA. Do not assume that the medical provider will upload those documents to the VA, though, so remember to submit a copy of the records yourself. 

What Happens If the VA Didn’t Send the Doctor Your Records?

The VA usually sends the patient’s claims file to the medical provider pre-exam, but sometimes they neglect to do so. If the medical provider has not received records, he or she may not be sure of the reason for your visit. If this is the case, tell the doctor you have been treated at a VA facility, and he or she should be able to pull up your records on the computer. 

The Claim and Pension Report

After your exam, the medical provider will write a report. This report will generally have information about your medical history and how severe your symptoms are. It may also include the medical provider’s opinion on whether your conditions are related to your military service, or “service-connected.”

The doctor’s report on your disability will be sent to the VA Regional Office which is processing your claim for benefits. It isn’t the doctor who decides if your disability qualifies you for benefits, but the VA Regional Office. They will also decide what disability rating you should get, not the doctor.

The C&P Report is a significant factor in the VA’s decision about whether to grant you benefits, but the VA will also consider all the medical evidence in your record.

Resuming in-person C&P exams

In early April 2020, the US Department of Veterans Affairs (VA) suspended in-person medical disability examinations for its C&P programs due to increasing concerns about COVID-19 infections. On May 28, 2020, it was resumed in locations where it was safe to do so. VA has since expanded these in-person examinations to other locations based upon local COVID-19 risk assessments.It may help to contact the VA directly but if you feel you’re fighting an uphill battle with your C&P exam contact a seasoned Veterans Advocacy lawyer at the Law Office of Andrew P. Gross.