What Can I Expect In My VA C&P Exam?

What Can I Expect In My VA C&P Exam?

As part of your disability application & evaluation process, you will experience a VA C&P Exam.

 The C&P Exam is short for, Compensation and Pension exam, and it is typically performed by a VA doctor or contracted health care professional.

Here’s what can you expect from your VA C&P Exam.

Before Your VA C&P Exam, Know The Purpose of the Exam

Before your exam, you will want to be prepared to recount the entire medical history of your conditions.  This is something that the doctor(s) will ask you during your exam.  Regarding your medical concerns, when did it begin, how have you treated it, what is the severity now.  Recall, this all points to a nexus, you need to understand how service nexus plays into your disability claim, it will matter to how you answer these questions.  After the exam, the doctor will be writing up an opinion on the current condition, when it began, and whether or not it is related to your military experience.

During Your VA C&P Exam

The VA C&P exam is simply a doctor’s appointment that evaluates your physical or psychological conditions that you are claiming to be service connected. If you have more than one condition, the doctor will evaluate each one, and you may be sent to a specialist for certain conditions.  For instance, the doctor will probably be a general practitioner, so anything special, such as Vision, Hearing, Dental, Psychiatric, and other conditions, will be referred out.

When you arrive for your C&P exam, you will be given an opportunity to file a travel claim for mileage re-reimbursement.

During your exam, the doctor may do any or all of these things:

  • Review your claim file with you
  • Ask you questions based on the medical records in your claim file. These may include questions from the Disability Benefits Questionnaire for each service-connected condition you’re claiming.
  • Take a look at the Disability Benefits Questionnaires (DBQs).
  • Perform a basic physical exam
  • Ask you to get other tests—like X-rays or blood work—if needed

*Source* 

If you have a psychological condition or disorder the doctor will ask you questions and have you describe the symptoms you have experienced.  Be sure also to tell the doctor how the stress has affected you.  You may be asked to complete some standard psychological tests.

If you have a physical condition, illness, or injury, the doctor will ask you questions, order lab work, and conduct standard medical tests specific to your condition.  Remember to be completely honest with all questions you are asked.  For example, if the doctor asks how you are, do not say fine.  Be truthful and tell him or her that you are depressed or in pain if that is how you feel.  Make sure you don’t leave things unsaid.  If it’s unsaid, it cannot be claimed.

After Your VA C&P Exam

After your exam, the doctor will send the results to a VA claims processor.  The claims processor will then decide to approve or deny your claim based on the exam results along with other medical and military records. It can take  3-4 months for a decision to be made.

If your claim is not approved, you can file an appeal.  You have the right to good representation in your VA compensation case and more often than they should, the VA makes a mistake in its initial determination.  A good VA claims advocate attorney or service officer will look at your claim & the VA decision and be able to figure out what went wrong and help you fix it.  It’s ok to ask for help.

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How to Understand VA Schedular Ratings Vs TDIU

How to Understand VA Schedular Ratings Vs TDIU

Understanding the difference between VA schedular ratings and TDIU can be confusing.

In this article, we explain each of them and how you can determine which best fits you.

VA Schedular Ratings Explained

When dealing with VA disability claims there are two distinct ways of viewing ratings or awards.   By far the most common system is the schedular system.  This is the percentage based rating schedule.  The rating schedule is broken up into 10% increments from 0%-100% service connection.  Other special ratings, such as TDIU, are based upon the ratings schedule but have criteria that are separate and follow other policy directives.

The VA Ratings Schedule breaks down disabilities into categories based on which part of the body is impacted.  Within those categories is a list of diagnoses and each of the diagnoses has a diagnostic code.  Each code specifies the symptoms required for different ratings of disabilities.  Typically, more severe disabilities receive a higher rating, and then, obviously, less severe disability should receive a lower rating.

An example, Under the Digestive System Category in the Ratings Schedule there are four groups

  1. Ulcers
  2. Postgastrectomy syndromes
  3. Weight loss
  4. Coexisting abdominal conditions

There are three diagnoses under ulcers, one being “ulcer, duodenal.”  This diagnosis has a diagnostic code of 7305, and under this code, there are four different ratings.

  1. Severe, 60%
  2. Moderately severe, 40%
  3. Moderate, 20%
  4. Mild, 10%

Each of these schedular ratings lists symptoms you must have.  For a severe rating for an ulcer, you must have periodic vomiting and only partial relief from ulcer therapy.

There are literally thousands of different rating combinations.  But each follows this pattern.  Category, group, diagnosis, rating.  You can get an idea of where you are on the schedule and where you should be.  In fact, if you are bookish, you can get a great idea of how to approach your initial claim or appeal, based on doctors records and your current conditions as they relate to the ratings laid out for your disability.

How Does the VA Assign my Rating

The VA looks at what body system category is affected.  They will then locate your diagnosis and find the diagnostic code that correlates with your symptoms.  They will carefully look at your medical information to make sure the evidence matches the rating they are assigning.

To find out how much the VA currently pays for each rating you can see current VA compensations rate tables.

 

Total Disability based on Individual Unemployment (TDIU)

If you can not do a substantial amount of work and can prove that you are unable to do a substantially gainful occupation, you may be eligible for Total Disability for Individual Unemployment (TDIU) even if you are not rated at 100% disabled under the schedular ratings (above).  Being able to do a substantially gainful occupation means being able to have an occupation that has an annual income above the poverty rate.  The benefit of pursuing TDIU is that you could be compensated at 100% even though by the schedule you are not at 100%.

This seems counter-intuitive at first, however, the purpose of a 100% rating is to reflect total unemployability (or total disability which is assumed to be unemployable) due to an injury.  The problem is that by schedule, and through the multiple disabilities calculator linked above, it is quite difficult to come up with a combination of ratings that are individually less than 100% and have them come together to form a collective 100%.  Without going too deep into the math.  Assuming you have 50% for PTSD, 50% for Bi-Lateral Hearing Loss, & 50% for Back Injuries – your overall rating would be, 90% (not 150%).  So, even though you got a lot of challenges, even with (3) serious ratings decisions, you still are not rated at 100%!  VA Math…  But, that’s the gap that TDIU fills.

The basic criteria for TDIU: An inability to work needs to be linked to a service-connected disability rated at 60% or higher.  If you have more than one disability, then at least one of the disabilities needs to be rated at 40%, and the combined rating needs to be 70% or more.

How to Tell Which Fits You Best

If you have a service-connected disability, you want to apply for VA disability benefits as soon as possible.  Once you receive your rating, if you believe you are eligible for TDIU, then you need to apply for TDIU. To apply you use the VA Application for Increased Compensation Based on Unemployment.

Both the schedular ratings and TDIU will get you the same end result; being paid for your disability. They use a different process to decide a rating but can give you an income where you may not have one otherwise.

Often clients will reach out to us seeking Social Security while receiving VA Disability.  In that conversation, it is discovered that they should have, or already have, qualified for TDIU and it either was not pursued, was turned down, or was never considered by the VA.  This is wrong and we can help.

Contact Us About TDIU Claims!

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How PTSD and Disability are Related for VA Service Connection

How PTSD and Disability are Related for VA Service Connection

Post-traumatic stress disorder (PTSD) is the most common mental health problem experienced by Veterans who have encountered combat or combat training.

This data is according to the US Department of Veteran Affairs (VA).  How PTSD and Disability are related is one of the most common questions we receive from Veterans seeking treatment and compensation for their service-connected injuries. 

PTSD and Disability, Broken Down

Before we cover how PTSD and Disability are related for VA purposes, we should cover PTSD can occur when someone is put in a situation that elicits fear of or actual death, serious injury, witnessing an event of death, or learning of the death or serious injury of a family member or friend.

For you to receive disability benefits for PTSD, you must Establish a direct service connection if the PTSD is combat related. To establish a direct service connection, you no longer need to prove the traumatic event that caused PTSD occurred. This applies to both combat veterans and any veterans that experienced hostile or terrorist activity.

PTSD Disability Requirements for Service Connection

The requirements to establish a direct service connection to PTSD And Disability:

  • Current diagnosis of PTSD
    • This diagnosis must be done by a psychiatrist, psychologist, licensed social worker or another behavioral health practitioner.
    • The PTSD diagnosis must meet specific criteria and the doctor must provide a report on why it is believed you have PTSD and how your symptoms fit the specific criteria.
    • You may file for service connection for PTSD or a related behavioral health condition, but you will need a diagnosis before your service connected decision is granted.
  • In-service stressor
    • You must show that an event or series of events caused (or made worse) your PTSD during your service. You do not need to have been in combat, but there is a different requirement for combat vs non-combat events.
    • Records that may prove combat experience include your DD214, medals and/or awards received, and unit records showing the dates and locations of unit assignments.
    • For non-combat events, you may be able to include statements from fellow veterans that served with you and statements from friends and family that knew you before and after your service and can attest to your changes.
  • Any proof you may have of the stressor event or conditions occurring. This clear event stressor is not strictly required but makes for a less challenging fight with the VA.
  • A Department of Veterans Affairs or VA contracted psychologist/psychiatrist’s opinion the stressor was sufficient to cause PTSD. If you are near a Vet Center they can help with this. They have licensed social workers that can document the connection between your diagnosis and the stressor.
  • Veterans who have experienced rape or sexual harassment that caused PTSD are also eligible for disability benefits, but they do have to prove that the sexual trauma occurred.
  • Other events can happen that can cause PTSD in veterans before they even join the military. In that case, to receive service-connected PTSD and Disability benefits, they must prove that their service has made the disorder worse.

After Meeting the Criteria: PTSD and Disability Compensation

Once you apply for disability benefits and it is established you have PTSD, and that there is a service connection, the VA will assign a disability rating. The rating is based on a percentage of disability, how severe your symptoms are, how often they occur, the length of remissions or improvement, and how much you can work and socially function.

Service Connected Disability benefits are measured in severity increments of 10%; from 10% to 100%. For example, a veteran who has mild PTSD or if the symptoms are infrequent and are controlled well with medication, the disability rating might be 10%. The VA uses the disability rating to determine what benefits you are eligible for and how much compensation you may receive. Benefits can include health care, compensation, and treatment for your PTSD.


If you are considering or fighting a VA disability claim for PTSD, you might want to look at this article about PTSD and Social Security as well!


VA Disability Claims: How to Approach Hard to Prove Hearing Loss Claims

VA Disability Claims: How to Approach Hard to Prove Hearing Loss Claims

 

It’s a straightforward conclusion that if someone loses a leg in combat, their loss of a limb is related to military experience.  That is a simple and clear A+B=C situation.  However, in many cases, such as hearing loss claims, the direct link between the current condition and an incident in service is far less clear.

 

Many Claims are Clear Cut, and Much More are Not

We used the example of someone having an enemy assisted amputation above, but what if instead of a combat-related trauma the leg was lost due to an infected cut from a dirty stair rail at the barracks?  Well, it happened during service, so it is still presumably service connected.  Take our example a little further, an infection started the day after separation, from an unknown source, and it resulted in the loss of a limb, is it then still service connected? What about if the infection began 2 months after service?

The truth is, while many claims are clear cut, there are lots of VA claims for service connection that are reasonable, but the ties that connect them to service incidents are harder to prove.  This issue is why we spent so much time talking about overcoming a service nexus denial in this article.

 

Service Nexus Denials

Service nexus denials are one of the top reasons Veterans end up seeking the support of an experienced VA claims attorney in the first place.  They are hard to prove, and to overcome the denial means getting much deeper into the details of a given Veterans’ service records than most initial claims for compensation delve.

The first step in overcoming the nexus denial barrier is to figure out if there is, in fact, no way to directly tie an injury (mental or physical) to a service incident.  It is ok if there is no clear link, but eliminating all the easiest paths first is usually the best course of action.

If there is no clear and direct connection between the current injury or ailment and a service incident, then the particulars of the Veteran’s military service become the next thing to take an in-depth look into, regarding the pursued claims?  Moreover, it helps to figure out how the claim(s) fit into the broader picture of the Veterans history – before during and after service?

 

 


Check this Out:
25 Things to Know About Service Connected Disability

 

 

 

An Example Of A Hearing Loss Claim Denial Will Help

A Marine has discharged from service ten years ago and is claiming bi-lateral hearing loss & tinnitus.  There’s no direct service connection, no med-call records of ear pain, trauma, or anything related to ears, hearing, or head injuries.  The claim is denied because there’s no direct connection to the injury from the Marine Corps Veteran’s military experience.  The service nexus is unclear.  This claim is a Hard to Prove VA Disability.

Fortunately, “hard to prove” can be overcome with the VA, especially if we remember that the burden of proof is as likely as not, rather than absolute proof beyond all other doubt.    In this example, the way to approach a solution is to look at some of the following lines of conjecture.

 

What Was the Veteran’s Vocation After Service?  

This line of questioning is necessary to either establish that alternative explanations are less likely than their military service to have caused the hearing loss or to recognize the alternative hypothesis the VA through a Decision Review Officer or the VA Board of Appeals may raise.

If for instance the Marine Veteran worked an office job for the last ten years and their exposure to loud noises was minimal, it is a much more reasonable argument that combat and training for combat are the likely cause of hearing damage.  Whereas, if the Veteran worked in a construction environment the last ten years, after leaving service, the alternative explanation for hearing loss is much more likely to be something that needs to be addressed and overcome.  In this particular example, a strong approach is to lean hard on the idea that a 50/50 chance of one proposed nexus vs. another means the VA should side with the Veterans claims when pressed to do so.

 

What Was the Veteran’s Vocation While in Service?  

Again, taking a more wide angle approach means looking at potential alternative genesis, like we just looked at, and it means seeking to look at a lifetime of possible experiences vs. any particular incident.  For instance, a Marine Veteran is likely to have spent extensive time firing weapons and operating in loud environments.  In this case, making the claim that Marines will be exposed to conditions that harm hearing is about as straight forward as it gets.

Still, obvious for one person is obtuse for the next.  So, breaking down the conditions that may harm a service member’s hearing is helpful in making sure there’s no doubt the Veterans experiences were at least as probable as any other alternative explanation.  To make this, list out the circumstances, the numbers, the details, as best you can determine.  Here’s how you might go about it in a letter to the VA on a Veteran’s behalf.

“Mr. Smith, while serving in the Marine Corps as an admin clerk was exposed to loud noises and severe conditions on a regular basis.  Hearing protection was not always readily available nor practical for using due to operational needs.  Starting in boot camp, Mr. Smith fired weapons from his right-hand side, was exposed to extreme noise (repeated loud yelling) in close-proximity, on both sides.  

In Marine Combat Training (MCT), and required to go through basic training, Marine combat Mr. Smith fired larger weapons and practiced using them in operational environments where hearing protection was not always available.  As an admin clerk, Mr. Smith was exposed to loud vehicle noises on a regular basis as he was required to work in close collaboration with armored vehicle sections and was also required to participate in regular weapons qualification and training.

Since separating from military service, Mr. Smith has completed college and worked in software development.  Both environments are much less likely than a typical military environment, and especially a Marine Corps armor, weapons, and training environment.  Mr. Smith also has no family history of hearing loss and cannot propose an alternative explanation for his condition.  

Without an alternative proposal that is more likely than Mr. Smith’s Marine Corps experiences, the VA should acknowledge the Nexus between his current condition and his experiences in the military, and award Mr. Smith the compensation appropriate per his hearing impairment levels.”

 

This Process Works Well for Other VA Claims Too

We are leaning heavily on the loss of hearing as an example, but this process works well for other impairments too.  The basic premise is sound for PTSD, back injuries, knee pain, TBI, and other conditions or incidents that can be hard to prove at first.

We are scratching the surface on this. Please reach out to us and share your thoughts and experiences.   There is a lot more to talk about in regards to nexus denials.

 


Talk to a VA Disability Claims Attorney Today!


 

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Gulf War Illness and Unfair VA Claims Denial Practices

Gulf War Illness and Unfair VA Practices

In our article, How the VA is Failing Gulf War Vets, we described how systematic problems at the VA seem to be resulting in neglect of legitimate service connected claims for Gulf War Illness.  Since we published that article, Anthony Hardie, a Gulf War Veteran and Director for the Veterans for Common Sense published written testimony of his before a Congressional Hearing on Gulf War Veterans & Gulf War Illness service connected detail rates.

It is especially noteworthy to recognize the historical denial rates for service connection are between 30% & 40%.  Some estimate that 60% of those denials are later found to be erroneous. We are going to look into how that compares to other injuries and eras of Veterans.

 

Recent History of Gulf War Illness Claims

Since 2011, denial rates for service-connected claims related to Gulf War Illness climbed from 76% to near 82%.  Remember, historical denial rates for all applications hovers between 30% ~ 40%!  Denials of claims for exposure to the Middle East is 2x the average of all other claims.  And depending on the year, denials for these claims can be almost three times the average rejection rate.

We can take this one step further if you’re saying…

“But I saw Gulf War Illness on the X-Files once, so maybe it’s not so cut and dry as the VA is goofing this up at the expense of Veterans who don’t have data and a clear understanding of the process on their side.”

First of all, we just happen to have a control population of 2 million Veterans that had exposure to the same region and hazards.  That control population we can contrast is the Global War on Terror generation of Veterans (GWOT).  Over 1 million unique service-connected compensation claims were filed by this generation of Veterans, so far.  The denial rate is for these claims is 2%!

 

 

 

 

Gulf War Veterans vs. GWOT Veterans

2% is such an extreme that it deserves another closer look.  We should probably look further into this number at some point in the future.   So, let’s look at this average, taking away the 98% approval rate.  And for the sake of argument, let’s also take away the 81% denial rate on the Gulf War Illness issue. If we normalize this data, it shows us that Gulf War Veterans’ claims are denied 25% more often than the average VA claim!

In conclusion, what’s the recourse?  Education and discussion.  Keep this discussion alive and relevant.  Share this information with friends and Veterans. And educate them on their options.

And please remember, get your claim take care of if you have experienced any of the issues associated with service in the Middle East and Afghanistan.

 

Lilac City Law advocates on behalf Veterans in appeals for Service Connected Disability Benefits

 

 

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