If your application for disability benefits has been denied, it’s possible that your Compensation & Pension (C&P) medical exam results are inaccurate. Your attorney can help you file an appeal to challenge the examiner’s opinion.
Purpose of a C&P Exam
A C&P exam is a type of medical exam that will be required as part of your application for VA Disability benefits. Even though you’ve already been diagnosed with a disability and are seeking treatment for your condition, you must attend this exam performed by a VA general physician, VA contractor, or VA partner. In some cases, you may also be asked to submit to a second exam by a VA medical specialist.
The examiner has two jobs: determine the severity of your disability and determine whether it is service-connected. They will prepare a report of their findings that is sent to the Regional Benefits Office (RO) for use in making a rating decision.
You can request a copy of your C&P examination results using the Freedom of Information Act or make an in-person request at the Regional Benefits Office. If the exam was performed at a VA facility, there should be an option to download the report on the VA’s MyHealthEVet website approximately one week after your exam.
Reasons to Challenge a C&P Exam
There are three primary errors that can be used to successfully challenge a C&P exam:
- The examiner overlooked important evidence in your file. For a C&P exam to be valid, the examiner is required to read all of the relevant information in your file. If evidence is overlooked, you have the right to ask for a new exam. For example, if your doctor attributes your knee problem to the demands of your factory job and ignores the record of your in-service injury, you can argue that vital evidence was overlooked.
- The examiner drew an unsubstantiated conclusion. The examiner is required to explain how they arrived at the opinion that resulted in the denial of your benefits. If your C&P exam results don’t describe the details of your condition, fully address your concerns about your injuries, and state why the evidence provided is relevant to the conclusion, this can be grounds to request a new exam.
- The examiner made biased assumptions. C&P examiners see hundreds of Veterans each year, but they are not allowed to make assumptions about your condition based on Veterans with similar injuries. It is unfair to assume that your injuries shouldn’t be causing severe pain or limiting your ability to work simply because another Veteran has a different experience.
It is also possible to object to a C&P exam based on the belief that the examiner is not qualified to provide an opinion about your eligibility for benefits. The person performing your exam should have experience evaluating Veterans with your specific type of disability. For example, a urologist wouldn’t be qualified to give an opinion on a patient suffering from liver disease, and an anesthesiologist would be qualified to give an opinion about a patient’s diabetes. Under Gambill v. Shinseki, 576 F.3d 1306 (Fed. Cir. 2009), Veterans have a right to request information about their examiner’s background, experience, and professional qualifications.
Submitting Evidence That Counters Your C&P Exam Results
In addition to directly challenging the C&P exam, you are also allowed to submit evidence that counters the examiner’s findings. This may include:
- Providing an outside medical opinion from a private physician or healthcare provider with extensive experience treating your specific disability
- Submitting buddy statements from friends, family, and coworkers who can support your claims regarding the onset, progression, and severity of your condition
- Writing a personal letter to the VA to explain why you believe the examination provided was inadequate
Let Us Help You Prepare Your Appeal
If you have been denied VA disability benefits, don’t give up hope. The appeals process has several stages, and our attorneys are here to help. Contact the office of Sean Kendall, Attorney-at-Law, or fill out the contact form on this page to request a free, no-obligation initial consultation.