After a veteran files a VA disability claim for a mental health condition, VA may order a Compensation and Pension (C&P) examination. A C&P exam for mental health allows a medical professional to deliver an opinion about whether the condition is connected to the veteran’s military service or how severe the condition is.
This article will provide CCK insights into the VA mental health C&P exam, likely questions and criteria, and appeal options for VA behavioral health claims like PTSD, anxiety, and depression.
Who We Are: Chisholm Chisholm & Kilpatrick LTD is the nation’s leading veterans law firm. Over the course of 24,000+ appeals, our attorneys and VA-accredited claims advocates have recovered more than $1 billion for veterans. Call us today at (800) 544-9144 for a free case evaluation.
Play
Compensation and Pension, or C&P, exams are medical exams ordered by VA to evaluate the conditions that a veteran is claiming for disability compensation.
These exams are meant to assess the cause and severity of a veteran’s condition and are part of VA’s duty to assist veterans in obtaining evidence to support their disability claims.
VA does not always request C&P exams for mental health claims. As you prepare for your mental health C&P exam, it can be useful to keep in mind why VA requested a C&P exam in your case. For example:
VA behavioral health exams may be conducted by a VA examiner or by a VA-contracted third-party medical professional. The veteran cannot pick the examiner.
Prior to the exam, the examiner will review the veteran’s C-file so they have some familiarity with the veteran’s claim. However, the examiner will likely not be as fully informed as the veteran’s own physicians or mental health professionals. The veteran should be prepared to explain their mental health condition in detail again.
VA C&P exams for mental health are highly significant in the VA claims process. VA will often give more weight to the opinion of the C&P examiner than that of the veteran’s treating doctor.
CCK strongly advises veterans to attend their mental health C&P examination. Failure to attend without providing a good cause can result in VA denying the veteran’s claim.
The C&P exam for mental health has a number of similarities to regular C&P exams.
The medical examiner will typically ask the veteran questions about how their mental health affects them daily. The questions the examiner asks will vary based on the veteran’s claim (service connection vs. increased rating).
The examiner or a treating physician may also complete a Disability Benefits Questionnaire (DBQ). The form allows the user to use checkboxes and standardized language to evaluate the veteran’s disability quickly and correctly. Specifically, healthcare providers will “check a box” next to a description that most accurately depicts the disability in question.
The DBQ also addresses the veteran’s level of social and occupational impairment. For example, the level of impairment due to depression ranges from no diagnosis to total occupational and social impairment, with various levels in between. Assuming a veteran meets all the criteria from the DSM-5 necessary for a diagnosis of their specific condition, the symptoms section of the DBQ will then help determine the appropriate disability rating.
In some instances, the examiner may physically examine the veteran. With behavioral health conditions, a physical examination may occur if the veteran’s mental health condition is linked to another condition. For example, if the veteran suffers from debilitating back pain which has caused them to experience depression, they may file a claim for depression secondary to back pain. At the C&P exam, the examiner could physically examine the veteran’s back and ask questions regarding the connection between the back condition and the veteran’s depression.
Veterans must be honest and upfront with the C&P examiner about their symptoms and the way the condition impacts their lives.
VA uses criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to evaluate whether there is a valid diagnosis of a mental health condition during the C&P exam.
Common conditions that a mental health C&P exam may consider include:
VA adjudicators will use the veteran’s C-file with the results of the mental health C&P exam to assign a numerical rating that will be used as the basis for the veteran’s monthly compensation and other disability benefits.
Except for eating disorders, VA rates all mental health conditions using the same diagnostic criteria. Specifically, VA rates mental health conditions under 38 CFR § 4.130.
Ratings range from 0, 10, 30, 50, 70, and 100% based on:
However, the symptoms listed are not exhaustive. They are meant to serve as a guide for the level of impairment at each rating.
No, veterans do not need to exhibit every single symptom listed in the rating criteria. Since mental health conditions can manifest differently per individual, VA’s rating formula for mental health conditions is simply a set of guidelines.
Symptoms listed in each level of the rating formula are simply examples meant to demonstrate the types and levels of impairment commonly found at that assigned percentage rating.
For example, a veteran may be so anxious that they pick at their skin, causing physical harm to themselves. In this case, skin picking can be considered as both self-injurious behavior and an obsessive ritual that interferes with routine functioning, thereby warranting a 70 percent disability rating. It should be noted that even though skin picking is not a symptom that is listed in the rating criteria, it is similar to other symptoms that are listed.
It is not uncommon for a C&P exam for a mental health claim to identify a different or even multiple mental health disorders. Psychiatric disorders can sometimes be difficult to tell apart as many disorders have overlapping symptoms. Similarly, many mental health conditions are connected.
For example, it is common for veterans to develop depression or anxiety as a result of their PTSD. However, VA does not rate each condition separately under its General Rating Formula. Instead, veterans with multiple mental health conditions will likely be assigned one combined rating.
VA exams will typically address this directly, as the DBQ form requires the veteran to specify if they have more than one mental health condition.
Veterans can only be rated for a symptom’s functional limitations once.
An example would be a veteran who suffers from PTSD but who might also have a diagnosis of major depressive disorder. If VA has conceded that both of those conditions are attributed to the veteran’s service, the veteran is not going to receive a 50 percent rating for PTSD and a separate 30 percent rating for major depressive disorder. Rather, the veteran may receive a combined 70 percent rating under the diagnostic code for one condition.
To have the same symptom considered under more than one diagnostic code is called pyramiding, which VA regulations strictly prohibit. Veterans may not receive an overlapping rating for the same condition or the same symptoms.
Play
Veterans may disagree with the results of their mental health C&P exam. Whether you receive an outright denial or an unfavorable rating, it is important to remember that VA frequently makes mistakes and that there are multiple ways to combat an unfavorable C&P exam result.
Veterans can counter C&P exam results with additional evidence like independent medical exams and lay evidence like buddy statements.
Veterans are also entitled to go to outside mental health professionals and doctors (i.e., private physicians) to obtain opinions that will be weighed against VA examinations. Private treatment notes and medical records may provide more favorable evidence.
VA should not simply treat the VA examination as more probative (i.e., give it more weight) than private medical opinions. Instead, VA must consider what both sets of opinions contain and what evidence the examiners considered to reach a decision.
Likewise, VA must provide adequate rationale for deciding that one of these medical opinions has more probative value. If VA does not do so, then the veteran can rebut VA’s determinations.
If you have received an unfavorable result from VA after a mental health C&P exam, then CCK may be able to help.
Since 1999, our accredited attorneys and advocates have been developing the processes, tools, and relationships necessary to maximize benefits while making appeals as efficient as possible. We fight VA so veterans can focus on their health and responsibilities while getting the benefits that they need and deserve.
Call CCK today at (800) 544-9144 for a free case evaluation with a member of our team to see if we can assist.
Note that delays in contacting CCK might impact your options for appeal.
Kaitlyn joined CCK in September of 2017 as an Associate Attorney. Her practice focuses on representing disabled veterans before the United States Court of Appeals for Veterans Claims.
