What is a compensation and pension (C&P) examination?
When you file a claim for compensation or pension or for an increased disability rating related to PTSD or other mental disorders, the VA Regional Office may ask for an evaluation to help with the process of making a decision about your claim or rating. The purpose of the exam is to gather information about your mental health that is needed to make that decision. The exam focuses on issues related to your mental health symptoms and their impact on your life, although you’ll likely be asked some questions about your physical health conditions as they relate to your mental health. The exam is not part of or related to any mental health treatment that you may be receiving.
Who does the examination?
Compensation and pension exams for PTSD and other mental disorders are done by board-certified psychiatrists, licensed clinical psychologists, and in some cases, trainees who are working under the direct supervision of board-certified psychiatrists or licensed clinical psychologists. Some examiners work for the Veterans Health Administration and are located in VA facilities. Others work for private companies that have contracts with the Veterans Benefits Administration, and are located outside of VA facilities. All exams, whether done by a VA examiner or a contract examiner, are covered by the same regulations and must meet the same requirements.
What does the examination involve?
You’ll meet with an examiner for a one-on-one interview. The examiner will ask questions about your mental health issues and how they affect your life. A thorough interview will include questions about your life experiences before, during, and after your military service. The examiner will also review any records needed to respond to the request from the Regional Office. These will include your medical records, your military records, your claims file, and any relevant documents that you bring to the interview. You’re welcome to bring family members or close friends to your appointment. However, they may or may not be asked to participate in the interview, since it usually involves questions that many people may not feel comfortable answering in front of others.
How long does the examination take?
A thorough interview usually lasts at least an hour. Yours may take more or less time than that, depending on whether this is your first exam or a follow-up, what specific questions the Regional Office has asked the examiner to address, what your mental health issues are, and other factors. The amount of time that the examiner spends reviewing your records will also vary depending on how many documents there are to be reviewed. The exam may or may not involve psychological testing, which may take up to several hours depending on the specific kind of testing. Exams are at times fairly brief, most often when the examiner has been asked to address only a narrowly focused issue, such as your ability to work or to manage your own finances, or your need for help with self-care tasks or other activities of daily living. You should be told how much time to allow for the exam at the time your appointment is scheduled.
How do I prepare for the examination?
You may want to submit a written statement about your mental health issues as part of filing your claim. If you do so, it’s best to submit your statement to the Regional Office before your exam so that the examiner has time to review it before your appointment. When you file a claim for PTSD, the Regional Office asks that you submit a written statement about the specific stressful experiences that you feel have caused your mental health condition. While for many people it’s very difficult to write such a statement, it usually makes the examination process much easier in some ways. There’s a special form for you to use in submitting a PTSD stressor statement, which should be provided to you by the Regional Office. In your statement, it’s important to provide as much of the requested information as possible, and to be as specific and detailed as you can in describing your experiences.
If you have received or are receiving mental health or substance abuse treatment from providers at VA facilities, you don’t need to submit copies of those treatment records or any letters of support from your VA providers. During the claims review process, the Regional Office asks for your written permission to obtain your VA medical records so that they’ll be available for your examiner to review, which in most cases they’re able to do electronically. If you have received or are receiving mental health or substance abuse treatment from providers outside of VA facilities (including providers at Vet Centers) you do need to submit copies of those treatment records to the Regional Office, or to provide the Regional Office with written permission and the information needed to obtain them. You may submit letters of support from these providers, but such letters usually don’t contain the kind of information needed to fully support your claim.
You don’t need to ask your treatment providers to complete any Disability Benefits Questionnaires (DBQs) to support your claim. Any information that the examiner needs about your providers’ clinical impressions or about your treatment will be contained in your treatment records, and VA mental health care providers have been advised not to complete DBQs for their patients due to conflicts of interest. You don’t need to seek an independent psychological or psychiatric evaluation, particularly if you’re doing so only to support your disability claim and not for any treatment-related reasons, and especially if you’re paying for it out of pocket. Such evaluations may take a significant amount of time and money. They also often aren’t very useful for their intended purpose since independent evaluators aren’t always familiar with the specific requirements of a compensation and pension exam and usually don’t have access to all of the relevant information. For similar reasons, DBQs completed by your treatment providers generally aren’t very useful. If the Regional Office decides that an exam is needed, you must be seen for an exam by either a VA examiner or a contract examiner, even if you’ve had an independent evaluation.
You’re welcome to bring personal notes and records that you think may help you to answer the examiner’s questions or to remember information that you’d like to provide during the interview. The examiner may ask for a copy of them (or for your permission to copy them), so that they can review them after the interview if needed.
What happens after the examination?
The examiner completes a report addressing the questions that the Regional Office has asked. These questions usually include whether you have any mental disorders, and if so, how they affect your day-to-day life and whether they’re related to your military service. They also include whether you’re able to manage your VA benefits without help from anyone else. The answers to these questions are based on the information that you share with the examiner and on information from your records. It’s important for you to know that the standards for deciding whether you have PTSD or any other mental disorder and whether it’s related to your military service are different for a disability evaluation than for an evaluation for treatment purposes, and are much more dependent on what’s documented in your records. It’s also important for you to know that the questions answered by the examiner don’t include whether you should be awarded compensation or pension or whether you should receive a higher disability rating. The amount of time it that takes for the report to be completed varies depending on whether all the relevant records are available on the day of your interview and whether any testing is needed. The completed report will be entered into your VA claims file. If you are evaluated by a VA C&P examiner, the report will also be entered into your VA medical record, and anyone who is authorized to access your record (including you) will be able to read it.
When will a decision be made and how will I be notified?
The exam is only one source of information that the Regional Office uses in the process of making its decision about your claim or rating. The amount of time it that takes for a decision to be made after the exam report is complete varies depending on the specifics of your case and on whether any other information is needed. Once the decision is made, the Regional Office will notify you directly, so it is important to make sure that they have the correct contact information for you on file. It’s important for you to know that your C&P examiner does not make the decision about your claim or rating. They only provide professional opinions about your mental health issues and how they affect your life, and whether any specific conditions you have were caused (or made worse) by your military service.
What else do I need to know?
Veterans seeking advice on how to prepare for a compensation and pension exam are often told that they should see a treatment provider in order to get a diagnosis “on record” to help with their claims. Such advice is somewhat misguided, since you don’t have to be receiving treatment in order to file a claim for compensation or pension or to be awarded service connection, and since your C&P examiner will do an evaluation to determine whether you have PTSD or any other mental disorders. More importantly, treatment services are meant for people who are interested in getting help in managing their mental health conditions. Any time that providers spend evaluating people for the purpose of disability claims is time that they can’t spend helping people who want treatment. It’s best not to try to give the impression that you’re interested in treatment if that’s not the case. It may be that you want treatment, but for financial reasons can’t get it unless you’re awarded service connection for your mental health conditions. If so, it’s best to be honest about that with the provider from whom you’re seeking an evaluation.
Veterans seeking advice on how to prepare for an exam are also often told that they shouldn’t share with their examiners certain kinds of information that many believe may not be helpful to their claims for service connection. Examples of such information include their family history of behavioral health problems, their personal history of substance abuse problems, emotional or behavioral problems that they had as a child or teenager, and traumatic experiences that they had before or after their military service. It’s important for you to know that in many cases, service connection can be awarded even for mental health conditions that existed prior to military service. More importantly, it’s not helpful to a claim for service connection when the examiner becomes aware that relevant information has been withheld by the Veteran, and/or that information provided during the interview varies in significant ways from what’s documented in the Veteran’s records. This makes it hard for the examiner to provide a valid opinion, and may delay the decision making process. It’s important to be as direct and focused as you can in answering the examiner’s questions, and to be as open and honest as you can in order to make it as easy as possible for the examiner to reach a conclusion and to provide the requested opinion to the Regional Office.