Veterans seeking compensation and pension (C&P) exams often face a myriad of challenges. A recent report on Military.com highlights significant issues with the quality of these exams conducted by VA contractors, prompting demands for answers from prominent figures like Senator Elizabeth Warren. Leah Bucholz talks about the concerns surrounding C&P examiners, the experiences of veterans, and the implications of these reports on the veteran community. She also discusses the effective methods for identifying and addressing bad C&P examinations, as well as tips for successfully navigating the exam.
Understanding C&P Exams
C&P exams are often a critical step for veterans filing disability benefit claims. These exams help adjudicators determine whether a disability is service-connected and what percentage of disability a veteran might be entitled to. Depending on the condition, veterans may be seen by various medical professionals, such as psychologists for mental health exams, audiologists for hearing exams, or general practitioners for physical health issues. These exams help determine the extent of the claimed disability.
Unlike a regular medical appointment, the C&P exam is purely evaluative. The examiner, chosen by the VA, gathers evidence to support or deny your claim. All the VA examiner’s findings are compiled into a report that the VA uses to make decisions about your disability claim. If your application involves multiple disabilities, you may need to attend several C&P exams with different specialists.
The claim file is crucial in the C&P exam process as it contains essential records that examiners review to provide informed opinions on a veteran’s service-connected conditions and aid in determining eligibility for benefits.
Despite the importance of these exams, many veterans report dissatisfaction with their experiences. Common complaints include the brevity of the exams, lack of thoroughness, and examiners’ failure to use proper diagnostic tools like goniometry for joint range of motion measurement. These issues can significantly impact the outcomes of disability claims.
The Role of C&P Examiners
C&P examiners can come from various medical backgrounds. For instance, a knee examination might be conducted by any licensed medical professional, including family practice doctors, internal medicine doctors, or even specialists like gynecologists or ER physicians. While the range of motion tests for a knee are within the scope of any medical doctor’s training, the concern arises when examiners lack recent or relevant experience.
The VA C&P examiner reviews your medical history, asks detailed questions about your symptoms, and may conduct physical or psychological tests. They may also require you to complete a Disability Benefits Questionnaire (DBQ), which helps standardize the evaluation process.
Veterans often feel uneasy when examined by practitioners whose specialties seem unrelated to their conditions however it is important to note that these types of exams are within the scope of these licensed healthcare professionals. This apprehension is compounded when exams are conducted quickly or without thorough questioning, leading veterans to doubt the accuracy and fairness of their evaluations.
Why Veteran C&P Examinations Can Be Unfavorable
Since 2017, the VA has increasingly relied on contractors, now handling nearly 90% of disability exams. While this shift reduced backlogs, veterans reported poor-quality exams, long waits, and inadequate facilities.
There are several common mistakes that can occur during C&P examinations. Examiners may disregard lay statements that can provide valuable insight into your condition. They can base VA decisions on insufficient rationale or nonmedical facts, which can undermine the validity of the C&P exam.
Moreover, although VA examiners are supposed to use the “50/50 probability” standard while evaluating your disability, applying a higher threshold can lead to an unfair denial of your claim. Knowing how to identify and address these VA examiner mistakes can make a significant difference in your VA claim.
Identifying Signs of a Bad C&P Examination
The C&P examination should be treated as a legal proceeding rather than a routine medical appointment. Its purpose is to ensure that your VA claim is evaluated within the framework of VA regulations and laws. Here are key factors to watch for during the examination:
Examiner’s Attitude and Professionalism
Pay close attention to how the examiner interacts with you from the moment you meet. An examiner who appears rushed, disinterested, or dismissive may not be giving your case the attention it deserves. While it’s important to maintain professionalism and respect, a negative attitude from the examiner can be a sign that the examination may not be conducted thoroughly.
Adherence to the Schedule for Ratings
Familiarize yourself with the specific criteria for your condition according to the VA’s Schedule for Rating Disabilities. This knowledge allows you to gauge whether the examiner is conducting the appropriate tests and assessments. For example, if you’re being examined for a spinal issue, ensure that the correct region is being evaluated. Skipping necessary medical tests or performing inadequate assessments can lead to an incomplete or inaccurate evaluation.
Use of Proper Equipment and Procedures
The correct tools and procedures must be used during your examination to ensure accurate results. For instance, the range of motion should be measured with a goniometer, and certain conditions may require imaging tests like X-rays or MRIs. If the proper equipment isn’t used, or if standard procedures are not followed, this can significantly impact the outcome of your examination.
Duration of the Examination
The length of your C&P exam can be an indicator of its adequacy. While some examinations may justifiably be brief, such as those for straightforward conditions, others, like psychiatric evaluations, should take more time. If your exam feels rushed or is significantly shorter than expected, this might be a red flag that it wasn’t conducted thoroughly.
Examiner’s Background Knowledge
The examiner’s expertise should match the medical condition they are evaluating. For example, a specialist in audiology should conduct an exam for hearing loss, not a general practitioner. If the examiner lacks the necessary background knowledge, this could compromise the accuracy and fairness of the examination.
Conclusion of the Examination
How the examination ends can also reveal its adequacy. The examiner should offer you the opportunity to ask questions before you leave. If they rush through the conclusion or avoid addressing your concerns, this could indicate that they didn’t fully engage with your case.
Veteran Complaints and Legislative Action
Senator Elizabeth Warren has received numerous complaints from veterans about their experiences with privatized C&P examiners. Veterans are seeking fair VA compensation through these exams. These complaints range from examiners not reviewing service treatment records to conducting exams in inappropriate locations such as co-working spaces, broom closets, or hotel rooms. Such practices raise questions about the professionalism and reliability of the contractors hired by the VA.
Warren has demanded answers from VA Secretary Dennis McDonough by May 14, 2024, regarding contractor vetting, training, and exam quality. She seeks clarification on eligibility requirements, quality control measures, average wait times, and the comparison of appeals between contractor-conducted and VA-conducted exams.
Reports Highlighting Systemic Issues
Several reports have highlighted systemic issues with the VA’s handling of C&P exams, which can significantly affect the outcome of a VA disability claim. A 2019 VA Inspector General report identified limitations within the Veterans Benefits Administration’s electronic exam management system, inadequate staffing, and unreliable data as significant barriers to overseeing exam contractors effectively. Another report in 2022 noted that deficiencies in contractors’ performance could lead to incorrect claims decisions, putting veterans at risk.
A 2021 Government Accountability Office report further identified problems with exams related to traumatic brain injury (TBI), military sexual trauma, and Gulf War illness. These conditions had higher rates of returned exam reports for correction or clarification, indicating substantial quality issues with the initial evaluations.
The Impact on Veterans
The ramifications of inadequate C&P exams can be profound. Veterans who undergo poor-quality exams may face denials or delays in their benefit claims, leading to financial hardship and emotional stress. Senator Warren’s letter to the VA underscores the frustration and pain experienced by veterans who endure long wait times, multiple exam locations, and ultimately, appeals due to inadequate initial exams.
The VA medical center plays a crucial role in ensuring that veterans receive proper examinations, which can help mitigate these issues.
The concern extends beyond individual cases. For every veteran who perseveres through the appeals process, many more may give up, feeling overwhelmed and disillusioned by the system. This outcome is particularly troubling given that veterans rely on these benefits for their well-being and livelihood.
Steps to Take After a Bad C&P Examination
If you feel that your C&P examination was inadequate, there are several steps you can take to address issues with your VA disability claim:
- Write a detailed Memorandum for Record (MFR) outlining specific issues with the exam.
- Report concerns immediately to the C&P exam supervisor, or VA patient advocate, or by calling 1-800-827-1000.
- Request a second opinion from a non-VA provider if you suspect examiner bias or lack of expertise.
- Obtain and review your C&P exam report for errors or omissions.
- Submit additional evidence, like a buddy statement or an independent medical opinion.
- File for a higher-level review so that a more experienced VA examiner can reevaluate your disability claim.
- Consult a VA disability attorney if your claim is denied or if you need guidance.
Moving Forward
Securing VA disability benefits is crucial for veterans’ well-being. While the issues with C&P exams may be significant, it is essential to recognize that not all C&P examiners are subpar. Many dedicated professionals strive to provide fair and thorough evaluations.
Veterans are encouraged to seek help from accredited legal professionals if they encounter problems with their C&P exams. Organizations like the Veterans Service Organizations (VSOs), accredited claims agents, and attorneys can provide valuable assistance in navigating the claims process and appealing unfavorable decisions.
7 Tips for a Successful C&P Exam
Proper preparation can greatly influence the outcome of your C&P exam and the VA benefits you will receive. Proper preparation is crucial for securing VA compensation, as it ensures that your condition is accurately assessed and linked to your military service. To make the most of your examination, follow these essential tips:
- Document Your Symptoms: Record how they impact your daily life and work, and be prepared to discuss your worst days.
- Review Your Medical History: Know your medical records and be ready to discuss relevant details.
- Provide Clear and Accurate Responses: Stick to the facts without exaggeration or unnecessary details.
- Be Punctual: Arrive on time to avoid any last-minute stress.
- Stay Courteous: Maintain politeness throughout the examination.
- Bring a Support Person: Consider having a close family member like a spouse, child, or friend for additional support and insights.
- Request Exam Results: Obtain a copy for your records and any potential future use.
Conclusion
The reports of bad C&P examiners highlight a critical area needing reform within the VA’s disability benefits system. Senator Elizabeth Warren’s advocacy underscores the urgency of addressing these issues to ensure that veterans receive the benefits they rightfully deserve. As the VA works to respond to these concerns, the veteran community remains vigilant, advocating for a just disability compensation system that honors their military service with the fairness and respect they deserve.Also read: What to Expect in a C&P Exam for Depression
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
Our purpose is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
Understanding the unique challenges veterans face, our commitment lies in delivering exceptional service and support.
Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
Prestige Veteran Medical Consulting is not a law firm, accredited claims agent, or affiliated with the Veterans Administration or Veterans Services Organizations. However, we are happy to discuss your case with your accredited VA legal professional.