Understanding Why VA C&P Exams Might be Inadequate and Your Options

 Posted on June 03, 2024 in Uncategorized

Veterans seeking disability benefits from the Department of Veterans Affairs (VA) rely heavily on Compensation and Pension (C&P) exams. These exams play an integral role in determining the outcome of a veteran's claim for disability benefits. However, there are instances when a C&P exam may be deemed inadequate, potentially jeopardizing the claim's success. It's essential for veterans to understand why an exam might be found inadequate and what steps they can take to address it.

Watch the video:

Reasons for Inadequate C&P Exams:

1. Examiner Qualifications: The validity of a C&P exam hinges on the qualifications of the examiner. It's crucial to ensure that the examiner possesses the appropriate medical credentials and specialization. For example, a mental health condition should ideally be assessed by a psychologist or psychiatrist.
2. Consideration of Lay Statements: Veterans often submit statements from friends, family, and fellow service members to support their claims. If an examiner fails to consider these lay statements, particularly those offering credible observations of symptoms or events, the exam is deemed inadequate.
3. Lack of Rationale: An examiner must provide a detailed explanation for their conclusions. Simply stating a condition is unrelated to service without a proper rationale renders the exam insufficient.
4. Deciding Non-Medical Facts: It is not the duty of the medical examiner to make determinations on non-medical facts, like whether a stressor event in a PTSD claim occurred. Such decisions are the purview of VA adjudicators.
5. Inaccurate Factual Premises: A medical opinion based on incorrect information can invalidate an exam. For example, if the examiner mistakenly believes there are fewer documented instances of in-service injury than actually occurred, their conclusions may be flawed.
6. Incorrect Evidentiary Standard: The standard of proof in VA claims generally adheres to a "benefit of the doubt" approach, meaning a 50-50 probability is enough to decide in favor of the veteran. If an examiner uses a higher standard like "medical certainty," the exam is inadequate.
7. Speculation Without Explanation: Examiners cannot simply claim they can't form an opinion due to speculation unless they explain why and if additional tests or evidence might clarify the issue.

What to Do if You Face an Inadequate Exam:

If your exam is found inadequate for any of these reasons, and if it’s been less than a year since your adverse VA decision, you have options. Consider filing a higher-level review, utilizing VA Form 20-0996 to request a formal review of the decision. If more than a year has passed, submitting a supplemental claim with new evidence might be necessary.

Should efforts at the regional office level prove fruitless, veterans have the option to appeal to the Board of Veterans Appeals, where there's often a better understanding of the legalities involved in exam assessments.

Inadequate C&P exams need not be the end of the road for your VA disability claim. Understanding these common inadequacies and knowing how to effectively address them can significantly bolster your case. Veterans are encouraged to seek assistance from experienced VA-accredited attorneys or representatives who can navigate these complexities.** Schedule a free consultation with our team - https://calendly.com/vetlawoffice