HomeVeterans Guide to VA BenefitsFiled Claim - What Happens Next?C&P Exam

14.2. C&P Exam

Even though VA has a duty to assist, it is always a claimant's responsibility to initially support his or her claim for benefits. Every claim for compensation benefits requires medical evidence to establish a current condition and a nexus (connection) with an in-service event. Pension applicants require medical evidence to establish that they are totally disabled or over 65 and unemployable.

The Secretary's duty to assist a claimant includes providing a VA medical examination (commonly referred to as a "C&P exam") or obtaining an independent expert medical opinion (known as an "IMO") when such an examination or opinion is necessary for VA make a decision on the claim. This does not mean that VA must provide every claimant with a medical examination. VA is required to do so only when such an examination "is necessary to make a decision on the claim." This means that if a medical examination could not make difference, for example if the claimant has a dishonorable discharge and is ineligible for benefits, VA will not provide an exam.

In most cases, VA will schedule a medical examination after receiving a substantially complete application even if a claimant submits supporting examination reports from his or her own doctor. VA can accept the results of a medical examination by a claimant's private physician as long as the examination report satisfies VA requirements. Claimants, however, should still submit their own medical reports whenever possible because if a VA examination is ordered, the VA examiner must consider the private medical reports in arriving at his or her conclusion. Even if a claimant disagrees with the need for a C&P exam it is very important that a claimant attend any scheduled C&P exam because failure to attend an examination is a basis for denying a claim.

A C&P exam must comply with several legal requirements that a claimant should be familiar with before going to the examination. Most importantly, the exam must be "adequate" and the resulting report sufficiently detailed to support the results. A C&P exam report is adequate when it is based upon consideration of the veteran's prior medical history, fully describes the condition, and provides the reasons for each medical conclusion. If an examination report does not contain sufficient detail or is otherwise inadequate, VA is required to obtain a clarification of the report or schedule another C&P exam.

A claimant has an important role to play in a C&P exam and in making sure that the examination report accurately reflects his or her medical condition. A C&P exam will usually be conducted by a VA physician or contractor physician who may not have expertise with the claimant's particular medical condition. There are standard examination report requirements with which the physician must comply when documenting his or her medical opinion. A claimant that is prepared, such as by reviewing the relevant C&P Examination Work Sheet (see related pages below) and who can clearly describe his or her symptoms and provide relevant medical history information can help the examiner more accurately assess the condition. Even when the C&P examination report does not support service connection, a complete and accurate report of symptoms and medical history can be helpful in challenging denial of an award.

VA does not necessarily discharge its duty to assist by conducting a medical examination; the examination must be adequate for adjudication purposes.  See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report).  Whether a medical opinion is adequate – and consequently, whether the Secretary complied with his duty to assist – are factual determinations by the Board, which the Court reviews under the "clearly erroneous" standard.  See 38 U.S.C. § 7261(a)(4); D'Aries v. Peake, 22 Vet. App. 97, 104 (2008); Nolen v. Gober, 14 Vet. App. 183, 184 (2000) (per curiam order).

For example, in the context of examinations evaluating functional loss in the musculoskeletal system under DCs based upon limitation of motion, when pain is associated with movement, to be adequate for rating purposes an examination must "compl[y] with the requirements of section 4.40, and the medical examiner must be asked to express an opinion on whether pain could significantly limit functional ability during flare-ups or when the arm is used repeatedly over a period of time."  Zang v. Brown, 8 Vet. App. 246, 252–53 (1995).  Such "determinations should, if feasible, be 'portray[ed]' ... in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups."  Id. (quoting section 4.40); Mitchell v. Shinseki, 25 Vet. App. 32, 43-44 (2011).

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