What to Expect at a C&P Exam

The examiner has a form to complete and a limited amount of time. Everything below is aimed at one goal: making sure the document that leaves that room is a true and complete description of your condition. Not a flattering one. Not a dramatic one. A true one — which, for most veterans, is considerably worse than what they end up saying out loud.

Before the appointment

Keep a symptom log

Start one as soon as the appointment letter arrives, and go back further from memory if you can. Two or three months of entries is enough. For each entry, record the date, what happened, how long it lasted, and — this is the part that matters for rating — what it stopped you doing.

"Bad back day" is worth almost nothing. "14 March: back locked up putting on socks, couldn't stand from a chair without pushing off, lay down for three hours, missed my shift" is evidence. The rating schedule is written in terms of functional loss, so write in terms of function.

Write down the things you will forget

People forget these under pressure, every single time:

• Every medication, dose, and the side effects you actually experience
• Treatments that failed, and treatments you stopped because of side effects
• Emergency room visits, hospitalisations, injections, procedures
• Assistive devices you use — brace, cane, CPAP, hearing aids, shower chair, grab bars
• Accommodations at work or at home: reduced hours, changed duties, help from a spouse
• Things you have simply stopped doing. The hobby you gave up is functional loss.

Know which condition is being examined

Read the appointment letter. It names the condition or conditions. If you have five service-connected issues and the exam is for your knee, the examiner will not usually address the other four, and pressing them to do so wastes the time you have for the knee. Look up the governing DBQ and diagnostic code in advance on our conditions index so you know roughly what will be asked.

What to bring

• Photo ID and the appointment letter
• Your symptom log — printed, and short enough that it will actually be read
• A one-page medication and treatment list
• Any private medical records or opinions VA may not have, if you have not already submitted them (submit them to VA as well — handing paper to a contract examiner is not the same as filing evidence)
• The assistive devices you genuinely use. If you use a cane on bad days, bring the cane; if you do not use one, do not borrow one.
• Someone who can drive you home if the examination is likely to leave you in pain or distress

The most common self-inflicted error

The examiner asks how you are doing. You are having a reasonable morning, you have spent thirty years answering that question politely, and you say "not too bad today." That sentence, or its equivalent, has cost more veterans more compensation than almost anything else in this process.

The exam is not asking about today. It is asking about your condition. So answer in three parts, every time:

1. Your average day — what a typical week looks like, how often the symptom is present, what it limits.
2. Your worst days — how bad it gets, how often that happens, how long it lasts, what you cannot do at all.
3. Today, honestly — including when today is better than usual. Saying "today is one of my better days, but I get three or four days a month where I can't get out of bed" is both completely truthful and far more accurate than either half alone.

The same discipline works in reverse. If today is unusually bad, say so, and give the ordinary picture too. You are describing a condition over time, not performing a snapshot.

Flare-ups: frequency, duration, functional loss

Most C&P exams do not happen during a flare, and examiners are specifically asked about flare-ups on the DBQ. Give them the three things they need:

• How often — "roughly six times a month," not "sometimes"
• How long — hours, days, a week
• What it costs you — the additional loss of motion, strength, endurance or coordination during the flare, in concrete terms

This matters legally. 38 CFR §4.40 and §4.45 require VA to consider functional loss due to pain, weakness, fatigability and incoordination, including on repeated use over time — DeLuca v. Brown, 8 Vet. App. 202 (1995). And under Sharp v. Shulkin, 29 Vet. App. 26 (2017), an examiner who did not see you during a flare is still expected to estimate the functional loss during flares based on all the available information, including your own description — they cannot simply write "cannot estimate without resorting to speculation" and leave it there without explaining why. Your description is the raw material for that estimate. If you do not give it, there is nothing for the examiner to work from.

Range-of-motion testing

For musculoskeletal claims the examiner will measure joint movement with a goniometer. Two rules:

• Move as far as you genuinely can — do not stop early to look worse, and do not push through severe pain to look tough. The second is much more common among veterans and it produces measurements that understate the disability.
• Say clearly when pain begins, and keep saying it. "That's where it starts hurting" at 30 degrees, then "that's as far as I can go" at 45. Under 38 CFR §4.59, painful motion is itself entitled to consideration, and the point where pain begins is a recorded finding.

The examiner should also test more than one way. Correia v. McDonald, 28 Vet. App. 158 (2016) holds that §4.59 requires joint testing, wherever possible, for pain on active motion, passive motion, in weight-bearing and in non-weight-bearing, and — where the other joint is undamaged — testing of the opposite joint for comparison. Many exam reports still omit this. You do not need to argue law in the room; just note afterwards whether it happened, because a missing Correia set is one of the clearest grounds for challenging an inadequate examination.

Expect repetitive-use testing — usually three repetitions — and say honestly what the repetitions do to you. If the third one hurts more than the first, that is a finding.

What to say about work

The DBQ asks about the impact of the condition on your ability to work. Answer functionally, not with a job title:

• Tasks you can no longer perform, or perform more slowly
• Days missed in the last twelve months, as a number if you can
• Accommodations you receive, formal or informal
• Jobs you left, or duties that were reduced, because of the condition
• Whether you are working reduced hours, and why

"I still work" is not the same as "I work, but my supervisor lets me sit down every twenty minutes and I used up all my leave on bad days." If unemployability is in play at all, read our guide to TDIU before the appointment — the vocabulary in that guide is the vocabulary the record needs.

Mental health examinations

For a psychiatric examination the process is an interview rather than a physical exam, and the same principles apply with one addition: describe behaviour and function, not diagnoses. How many hours do you actually sleep. How often do you leave the house. When did you last see a friend. What happened the last time you lost your temper. Who does the shopping, and why. Panic attacks, memory lapses, missed appointments, arguments, isolation — these are the observable facts the criteria in 38 CFR §4.130 turn on.

If you have thoughts of harming yourself, say so plainly. It is a rating factor and, far more importantly, it is something you should be telling a clinician. The Veterans Crisis Line is available at any hour on 988, then press 1.

Immediately afterwards

Do this in the car park, before the details blur. It takes five minutes and it is the single most useful thing most veterans never do.

1. Date, time, location, and the examiner's name and credentials (MD, DO, NP, PA, PhD, AuD) and the vendor if it was a contract exam.
2. How long it lasted — from when you were called in to when you left.
3. What was tested and what was not. Did they measure range of motion? With an instrument or by eye? Weight-bearing as well as seated? Did they examine the joint at all? For hearing, was there a sound booth? For a heart claim, was there any exercise or METs discussion? For skin, did anyone measure or estimate the affected body-surface area?
4. What you were asked and what you were not. Were you asked about flare-ups? About work? About your worst days?
5. Anything said that seemed inconsistent with your record — quote it as closely as you can remember.

Keep that note. If the resulting exam report turns out to be thin, your contemporaneous account of what did and did not happen is genuinely useful evidence in a later challenge.

Then read the report

Do not wait for the decision to find out what the examiner wrote. Request your claims file — VA Form 20-10206 — read the DBQ, and compare it to the criteria for your diagnostic code. Our guide to reading your DBQ walks through how, and the inadequate-exam page sets out what to do when the report is defective. If the decision has already come back wrong, start at your claim was denied.