What to know about Disability Exams (a.k.a. Compensation and Pension or Consultative Exams)
By Douglas I. Friedman of Friedman Law Firm, P.C.
Thursday, September 24, 2020
Both the VA and SSA like to send people for exams before deciding claims. The VA calls them Compensation and Pension (C and P) exams and the SSA calls them Consultative Exams (CE).
The importance of a C and P exam/CE
When you make a claim for a disability benefit, the VA/SSA will usually send you out for a medical examination. They choose the doctor. For VA exams, the exam may be at the VA or it may be performed by an outside medical examiner. For SSA exams, the exam will be conducted by a private examiner. The examiner may be a physician, psychologist or another medical professional, such as a nurse.
Decisions made by the VA and SSA are based heavily on these. At the VA, the decision-maker may actually input your exam finding into a computer program to determine a rating. While you may think that a person is deciding your rating, it may well be that a computer does most -- if not all --; of the work.
What happens at the examination?
A lot of questions and answers hopefully. But, we often hear from clients that their exam was only a few minutes, and they did not get to tell the examiner about all their medical problems. You may want to note how long the examiner spends with you, as it may be important later if your claim is denied. You may also want to note whether a non-professional, such as an assistant, interviews you first and records your answers for the examiner.
The qualifications of these examiners vary widely. And there is no assurance that they will have expertise in the condition for which you are being examined. In other words, if you have a knee injury, you would expect to be examined by an orthopedic doctor, but that is not always the case.
You may want to try to find out the name of the examiner in advance, and then research their qualifications. This may help you interact more effectively with the examiner
Should I bring my medical records to the exam?
This may be helpful, particularly if you have private treatment records that have not yet been submitted. But you should think about how many records to give the examiner. Remember that the examiner may not have time to read through all of your private records. So, this is probably a situation where “less is more.” Giving the examiner only a few pages with the best descriptions and summaries may have the best results.
What if I miss my exam?
This can cause your case to be denied. Even if you call the VA/SSA and tell them that you can’t attend the appointment, sometimes your message does not make it into your file. Not showing up for the exam is grounds for a denial. If you can’t make it to the exam, send the VA/SSA a written note if you can, and call several times to be sure they know you can’t be there. Try to reschedule if you can.
The bottom line
Think about your symptoms in advance and be prepared to inform the examiner. Even if the examiner does not ask you about what’s really ailing you, look for an opportunity to tell the examiner. Be truthful -- don’t exaggerate --; and don’t take the John Wayne stiff upper lip approach either. This is your chance to tell the VA/SSA about your condition, and the importance cannot be over-emphasized.
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Some of the Differences Between Social Security and VA Disability.