When veterans apply for VA compensation, VA will almost always send them to one of its own examiners. These examinations are called Compensation and Pension examinations, or C&P exams, and they are critical to determining whether the veteran will be awarded VA disability benefits. Because of the VA’s backlog, a lot of these examinations are now handled by private contractors, such as QTC or LHI, instead of being conducted by VA.
One of the primary reasons that claims are denied is because the C&P examiner determined that the veteran’s condition was not related to military service, or that the condition wasn’t severe enough to meet a higher disability rating. When I look through claims files, I always look very, very closely at what the examiner wrote in the opinion. If the only evidence in the file is a C&P exam that is unfavorable the veteran’s claim, it is extremely unlikely that the VA will grant the claim.
Some VA Compensation and Pension examiners, especially contract examiners, act as gatekeepers protecting the VA disability process. Some of them do everything they can and find any reason to deny a claim.
C&P exams are just opinions, and they are not infallible. If the VA relies on an opinion that contains some kind of error or oversight, the veteran may be able to convince VA to either provide a new C&P examination or to rely on some other medical evidence in the file instead. VA regulations prohibit adjudicators from relying on an “inadequate” medical examination to deny a claim.You can’t trust that VA will, on its own accord, determine that the examination is inadequate. Look the exam over and see if you can spot any factual errors.
So how do you know if the examination that the VA relied on in your case is inadequate? First off, you need to obtain a copy of the examination and look it over. You can’t trust that VA will, on its own accord, determine that the examination is inadequate. Look the exam over and see if you can spot any factual errors.
I always take a close look through the claims file and make sure the doctor got all of the facts right. If the facts that the doctor relied on are incorrect, the examination is probably inadequate. Other times, the examiner missed something important in the file, which also would render the examination inadequate. Perhaps the examiner was providing an examination that was out of his field of expertise.
The examiner is also under a legal obligation to provide some sort of rationale for the opinion. A bare-bones conclusion is not good enough. If the examiner simply gives a conclusion without describing his thought process, the examination is likely inadequate.
It isn’t always easy to tell if an examination is inadequate, but it is important that VA is using only adequate examinations to rate cases. A flawed examination can ruin an otherwise good case.
Take Action: What Veterans Can Do And Who Veterans can Contact About Bad C&P Exams and Examiners
Here are the excellent steps one Reddit.com veteran user recently took action following a bad C&P exam:
-I called the VA VBA regional office to file a complaint and request a new exam.
-I called QTC to file a complaint against the doctor
-I called the General Inspector and the White House VA to file complaints against her
-I am drafting a letter to send to Congress to file another complaint.
-I am compiling statements from various doctors and coworkers who disagree with her examination.
The Reddit veterans benefits forum also suggests the following as soon as possible after a bad examination/examiner:
Get the name of your examiner.
Find out your examiner’s experience/specialization(google is often good for this).
Write out a Memorandum for Record (MFR) and detail why the examiner was bad.
Call the VA at 1-800-827-1000.
Read them your MFR and tell them you are requesting another C&P exam.
Upload your MFR to your claim.
Leave a google review of the doctor to help other veterans.
The MFR is a letter in which you detail what went wrong during the exam. Your letter should stick to the facts and be specific. There is no place for “FEEL or FELT in this letter! It should also NOT be a rambling rant, full of expletives!
Your letter should be done on a VA Form 21-4138.
Here are several examples in which you can/should request another examination:
Examiner treated you poorly.
Examiner did not pay attention to your answers.
Examiner had a personal agenda against the military or Veterans.
Examiner was not qualified or specialized enough to conduct the exam.
Did you have a Nurse Practitioner (NP) or a foot doctor conduct your mental health exam?
Examiner did NOT use a goniometer to measure your range of motion (ROM)
Examiner rushed through everything.
Not giving you a chance to explain how your disability affects you.
Examiner was clueless/confused about what they were doing.
The Memorandum for Record Example, Template and Sample Letter for Veterans Complaint In VA Disability Claims
I am requesting another Compensation and Pension Examination.
On MM/DD/YYYY, I had a Compensation and Pension Examination at location. The examination was done by examiner’s name.
From walking into the examiner’s room to me walking out the door. The exam took less than 10 minutes. During which, I was not asked or allowed to tell the examiner how my conditions affect me. Further, when the examiner manipulated my joints to determine my range of motion, they did not use a goniometer.
Due to the shortness of the examination, not being given the opportunity to explain how my conditions affect me, and the failure to use a goniometer to get accurate measurements, I am requesting another Compensation and Pension Examination so that the VA will be provided a more accurate and complete report of my conditions.
Here’s another actual successfully used Veterans Example, Sample, & Template Letter To Use To Dispute A Bad VA C&P Exam or Examiner from a hadit.com user:
My C&P examiner has a lot of bad ratings online what should I do?
You can call the contractor/VAMC that is conducting the exam to reschedule your exam in the hopes of getting a different examiner.
Do know, just because someone has poor online reviews. It does not mean they are a bad examiner. People can attribute their denial to an examiner who by all rights isn’t bad, but the Veteran themselves didn’t have evidence to support service connection. Plus, who is more likely to go online a write a review: Someone who had a fantastic experience or someone who felt slighted?
Find the contact for the leadership of the particular contractor or VA Medical Facility leadership team online and email them(keep it in writing). You can usually figure out an email address with a name. All VA email addresses follow the firstname.lastname@example.org format unless the name is very common like John Smith. VES also uses the email address feedback@VES for feedback on C&P exams.
My examiner wasn’t bad but I didn’t feel like I properly explained my symptoms or their severity. Is there anything thing I can do?
Yes, you can call the 1-800 number and request another exam. Ask that you be given the new exam before a decision is made. Just know again, that the VA is not obligated to provide you with another exam and getting another exam may delay the decision process.
Should I get a Nexus Letter/Independent Medical Opinion or DBQ too?
It depends on what was written but I believe that most times you should trust your instincts on this subject. If the VA c&p exam didn’t go well then it just didn’t go well.
Additional Useful VA/VBA and Outside contacts + tips for Veterans to officially dispute, formally complain, challenge and report bad c&p exams or examiners. Always request a new exam before a decision is made in all of your communicaitons.
The White House VA Hotline (1-855-948-2311) provides a direct, dedicated contact line that allows Veterans, their family members, caregivers and survivors to interact with highly trained, live customer service representatives to answer their needs and concerns 24 hours a day, 365 days a year. The hotline is a non-clinical, non-emergency, around-the-clock hotline for complaints, compliments, and recommendations, and can also provide a warm hand-off to the Veterans Crisis Line for Veterans who may be in crisis.
Email The VA’s Veterans Experience Office email@example.com : The mission of the Veterans Experience Office is to leverage customer experience data, tools, technology, and engagement to enable the Department of Veterans Affairs (VA) to be the leading Customer Experience (CX) organization in government, so Service members, Veterans, their families, caregivers and survivors choose VA. Use them!
For very serious and urgent complaints contact the actual VA secretary’s office for most serious and urgent complaints by email using either firstname.lastname@example.org or email@example.com. All VA email addresses follow the firstname.lastname@example.org format unless the name is very common like John Smith so you can contact any of the higher-ups with their name by getting their name off of the leadership page of the VA’s website va.gov.
Use VA’s Official Exam Feedback Survey To Get A Call Back From A Human At the VA. Here’s the link to the survey: research.net/r/VBAMDESURVEY.
Contact Your Congressman or Senators Office. Submit a copy of the complaint with your VA claim/appeal. Keep things in writing to leave a paper trail.
Contact your state’s medical/nursing board and file a formal complaint/grievance about the bad c&p examiner. Be specific. Turn a copy of the complaint in with your claim or appeal.
Contact a member of your VA regional office leadership team in writing to keep a paper trail. All VA email addresses follow the email@example.com format unless the name is very common like John Smith so you can contact any of the higher-ups with their name by getting their name off of the leadership team page of the VA’s regional office websites va.gov. Be specific. Turn a copy of the complaint in with your claim or appeal.
Contact VA Officials On Linkden about terrible exams. Keep it in writing. Submit copy of you complaints with your claim or appeal.
Make a petition against the examiner or contractor(VES, QTC or LHI) on change.org.
I hope this helps you take action against a bad c&p exam, examiner or contractor. Leave us a comment about your experience with these suggestions or your c&p exam experience. If you have a new suggestion that would help other veterans or useful va contact information leave a comment as well.