Loyal Healthcare Veteran Comp & Pen Exams

No, not everyone is required to attend a VA exam. After you have applied for disability compensation and/or pension, you may receive a phone call or a letter from VA or a VA partner asking you to come to a claim exam, also known as a C&P exam. If you have claimed benefits based upon several disabilities, you may be asked to report for one or more exams, so each disability can be reviewed by an appropriate examiner. This is a routine request. You may be asked to go to a VA medical center or a VA partner to complete the claim exams. Not every application.

A VA medical center or a VA partner is responsible for contacting you about scheduling a claim exam. VA may either mail you a letter with the date and time of your appointment(s) and/or call you to find a time that fits with your schedule. If you are receiving treatment at a VA medical center, make sure VA has your current address, phone number and email information. The wrong information could cause your appointment letter to be delayed and not reach you in time. It is a good idea to call and confirm the exam time(s) and locations to make sure you and VA or the VA partner have the correct appointment information. Use the phone number on your appointment letter or if you were called, use the phone number left by VA or the VA partner. If you don’t show up to your exam, you may have a longer wait to get your exam rescheduled; it could delay your claim; and/or your claim could be rated “as-is” (using only the information in your

file).

If your scheduled exam date or time does not work with some other life event, immediately call the number provided and try to reschedule. Unless it is an emergency situation, try not to reschedule the exam the day before or on the day of the exam. Not responding to a phone or letter request for scheduling an exam or missing the exam could cause VA to delay its decision on your claim. Not showing up to your exam takes up an appointment time another Veteran could have used, and also could cause your claim to be rated “as-is” based only on the information in your application. Most facilities try to meet your requests (if possible) if you have a good reason for rescheduling your time and you give enough notice.

It is helpful to be at least 15 minutes early to your scheduled exam time, leaving enough time to arrive at the facility location where your exam will take place. Once you check in with the exam staff, they will be able to answer questions on how long you will have to wait. Many examiners will not perform your exam if you are late, as they will not have enough time to complete the required history and exam review and take care of other Veterans on their schedule.

Unlike a typical medical exam or other healthcare appointment you may have with VA, the claim exam will not give you any treatment or prescribe any medicine. The examiner’s job is to review your medical records related to your disability claim, including the claim file, also known as your c-file/e-file. The c-file typically includes medical treatment records from Department of Defense (DoD), your DoD personnel records, treatment records from your health care providers and any other documents submitted. The amount of time the examiner spends with you during your exam depends on what conditions you claimed and if VA needs more information to make a decision. Following your exam, the examiner completes a report that includes an analysis of clinical test results, if any were performed. You have the right to request and receive copies of your test results by contacting your VA regional office.

Each exam is different depending on the information and needs of each Veteran. Exams can range anywhere from 15 minutes to an hour or more. The examiner may ask you questions, observe you, perform a limited physical exam or simply review your file with you. The time an examiner spends with you during your exam may appear brief, but remember, even if your visit is short, he or she is still carefully reviewing your claim. Examiners often spend an hour or more before or after your appointment reviewing your claim.

VA schedules the claim exam at the end of the “Information Gathering” stage, which is about 60% of the way through the claim decision process. After your exam, the examiner will complete a report that includes a review of the exam and any clinical test results. The examiner submits the report back to the VA regional office, so it can be included within your c-file/e-file and they can continue processing your claim. VA will then perform a final review of your whole claim package and make a decision on your claim.

No, the examiner is only involved in performing the exam and providing the results to the claims processor. They are not part of the rating process and do not make the rating decisions. They will never know the outcome of your pending claim. Only a VA regional office can answer questions regarding rating decisions. To get a claim status update, please go to eBenefits.va.gov or, if you are working with an accredited Veterans Service Organization (VSO) representative, contact them for a status update. You may also contact VA at 1-800-827-1000, and a contact representative will be pleased to answer your questions.

If you have any new non-VA medical records (like records from a recent surgery or illness), please be sure to submit them before your appointment. The health care provider cannot review new information during the exam. All new 3 information should be uploaded through eBenefits.va.gov, submitted to your accredited VSO representative or mailed to VA using the appropriate address found here - https://www.benefits.va.gov/compensation/mailingaddresses.asp.

Based on the approval of the examiner, a caregiver may be allowed to join you during the examination but may not participate in the examination process. Service animals are also permitted.

If you missed your scheduled examination, you will have to request a new exam appointment by calling the contract vendor that scheduled your appointment. If you are unsure who the VA partner was that scheduled your appointment, please contact your nearest Regional Office or contact the VA Hotline at 1-800-827-1000 for assistance.

My claim exam is scheduled far away from where I live; can I get help with paying for my travel?

Yes, Veterans scheduled for a claim exam or C&P exam will receive mileage reimbursement from the contract vendor that conducts your examination. You should expect to receive reimbursement within 14 days of the completed appointment.

Think of the claim exam, or C&P exam, as a medical review. Unlike a typical medical exam or other healthcare appointment you may have with VA, an examiner will not provide you any treatment, make any referrals to other medical providers or prescribe any medicine. Based on the information in your claim file, such as medical documents from current providers, and completed Disability Benefit Questionnaires (DBQs), the examiner will determine what additional questions and information are needed to confirm your health status and complete the exam. In some instances, your file may be so complete that only a few follow up questions may be needed. Know that your case is being carefully reviewed, and VA’s decision will not depend on the length of your exam visit.

The in-person part of your claim exam is only one part of what examiners do as part of their evaluation. They also typically spend more than an hour before or after appointments reviewing claims files to ensure they are providing the most complete and accurate reviews possible. All of the supporting documents that you provide to support your claim play an important part in the examiner’s report.

If you have a question about what is happening during your claim exam, ask the examiner about what he or she is doing and what you can expect during your visit. Keep in mind they are medical experts who are following up on the medical information you provided in your claim application. Neither VA examiners nor VA partner examiners are involved in rating your claim. They are not always familiar with the full claim process and cannot tell you when a decision will be made. All claims-related questions should be directed to the VA regional office nearest you.

If you attend your claim exam and have a negative experience with a VA examiner or a VA partner examiner, VA encourages you to share feedback immediately. You may go to the C&P exam supervisor within a VA medical center or the supervisor within the VA partner facility, reach out to the VA patient advocate at your closest VA medical facility, or call the number on your original appointment letter.

It is helpful to write out a statement of concern that can be submitted as part of your claim file. Share concerns immediately. Do not wait until your claim decision has been made. This will help ensure any issues are handled as quickly as possible.

VA awards disability compensation when the claim file shows three things:

1. Current diagnosis of a disability
2. Record of an event that happened during military service that could have resulted in the disability
3. An opinion that the disability is related to military service, also called a “nexus opinion”

If the first two items are clearly shown in your claim application, that’s when the C&P exam process comes in. If you did not submit enough information with your claim application to show that you have a current diagnosis of a disability or that an event occurred in military service that may have caused the disability, there is no need for VA to schedule a claim exam to get a nexus opinion to tie the two events together. Make sure you submit all relevant military and treatment records as part of your claim application.

VA may use contractors or VA partners who are medical experts with experience working with Veterans to speed up the claim process. They support the timelier scheduling of claim exams and evidence gathering in support of your claim. You may get scheduled for a claim exam with a VA partner. They follow the same HIPAA policies as VA, so you are guaranteed that your privacy is protected.

The exam is performed at the expense of VA and, just as if the exam was done at a VA medical center, the exam is used in the claim decision process for disability compensation or pension benefits. The medical facilities that work with VA are bound by the same rules and privacy laws as VA, so you can be sure your exam can be trusted and all of your information is secure and will be shared directly with VA.

VA recommends you work with an accredited representative, such as a VSO, to help guide you through the entire claims process. These representatives can help you gather evidence in support of your claim, help file your claim and address issues as you move through the claim decision process. You can search for a representative on eBenefits,

https://www.ebenefits.va.gov/ebenefits/vso-search.